Amoxil over the counter

A type-IV hypersensitivity reaction does not get mediated by histamine release, and is more papular or morbilliform and often not itchy. Professionals suggest that almost all patients that receive amoxicillin inadvertently for infectious mononucleosis develop a maculopapular rash caused by a type IV-mediated hypersensitivity reaction. These types of reactions are not known to lead to anaphylaxis. Any previous anaphylactic reaction or serious skin reaction (for example, Stevens-Johnson syndrome) to amoxicillin or any other beta-lactam is a significant contraindication to amoxicillin.

These reactions may have crossover sensitivity with cephalosporins or carbapenems. It is important to note that newer data has suggested a much lower cross-reactivity with cephalosporins and carbapenems than once suspected. Another important consideration is to determine if the patient’s allergic rash is a type-I or a type-IV hypersensitivity reaction. Occasionally patients will report a childhood allergy to amoxicillin, which is, in fact, a type-IV-mediated hypersensitivity reaction, often in the setting of infectious mononucleosis; this is not a contraindication to giving repeat amoxicillin. A type-1 mediated hypersensitivity reaction is, however, a contraindication given that a repeat exposure puts the patient at risk for anaphylaxis.

Skin testing has been approved to help assist in hypersensitivity to penicillins.

Reports are that the risk of an allergic reaction in a patient with a positive skin test is roughly four percent, whereas a negative skin test has a relatively high sensitivity in ruling out a type-I hypersensitivity reaction.[4] Monitoring.

It is essential to be aware of hypersensitivity reactions, and the patient should understand to notify their physician of any rashes.[4] Mild diarrhea is often toleratable.[5] However, prolonged diarrhea with fever and abdominal pain should prompt evaluation by a clinician. In a

patient

The clinician (MD, DO, NP, PA) will initiate therapy, but a pharmacist should verify the dosing and duration are correct for the infection being treated and verify that there are no drug interactions that could impede treatment. Nursing can counsel on administration, verify compliance, reinforce along with the pharmacist to take the entire course, and not stop when they start to feel better. Any issues the

nurse

These examples of interprofessional team stewardship will improve the likelihood of positive patient outcomes. To access free multiple choice questions on this topic, click here.

Common harms from amoxicillin: a systematic review and meta-analysis of randomized placebo-controlled trials for any indication.

Background: When prescribing antibiotics for common indications, clinicians need information about both harms and benefits, information that is currently available only from observational studies.

We quantified the common harms of the most frequently prescribed antibiotic, amoxicillin, from randomized placebo-controlled trials. Methods: For this systematic review, we searched MEDLINE, Embase and the Cochrane Central Register of Controlled Trials, without language restriction, for any randomized, participant-blinded, placebo-controlled trials of amoxicillin or amoxicillin–clavulanic acid for any indication, in any

setting

Rashes, nausea, itching, vomiting and abnormal results on liver function tests were not significantly increased. The results were not altered by sensitivity analyses, nor did funnel plots suggest publication bias. The number of courses of antibiotics needed to harm was 10 (95% CI 6–17) for diarrhea with amoxicillin–clavulanic acid and 27 (95% CI 24–42) for candidiasis with amoxicillin (with or without clavulanic acid).

Interpretation: Diarrhea was caused by use of amoxicillin–clavulanic acid, and candidiasis was caused by both amoxicillin and amoxicillin–clavulanic acid. Harms were poorly reported in most trials, and their true incidence may have been higher than reported.

Nevertheless, these rates of common harms associated with amoxicillin therapy may inform decisions by helping clinicians to balance harms against benefits. Most antibiotics are prescribed by primary care clinicians for common infections, particularly acute respiratory infections.

1 However, for most acute respiratory infections, antibiotics provide only marginal benefits, and an inevitable consequence of this injudicious use is the prospect of antibiotic resistance. One way to reduce antibiotic prescribing in primary care is to explain to patients how little these drugs help for many common infections and to apply a process of shared decision-making during the consultation.

The practice of shared decision-making requires not just an explanation of the paucity of benefits of antibiotics in most primary care situations, but also an explanation of the potential harms. Serious harms are probably sufficiently rare to be discounted by most clinicians and their patients. 3 Yet when the decision to use or not use antibiotics relates to a self-remitting illness, for which the benefits are likely to be modest at best, the more common, mild harms of antibiotics become important. Unfortunately, common harms from antibiotics are poorly quantified, and clinicians cannot talk to patients with confidence about their likelihood.

Current understanding of the common harms of antibiotics is derived largely from observational studies. However, estimates of common harms from such studies may be biased, principally because it is difficult to distinguish adverse drug reactions from disease-related symptoms.

One approach to addressing this problem is to investigate common harms encountered in randomized

controlled

The most common antibiotic used in primary care is amoxicillin, either alone or in combination with clavulanic acid. “Common harms” can be defined as those frequent enough to be observable in the

patient

We considered all randomized, participant-blinded, placebo-controlled trials, in any language, with any population, in which amoxicillin or amoxicillin–clavulanic acid was used to treat any condition.

We excluded studies that involved coadministration of any drug other than acetaminophen (paracetamol). Outcomes of interest were any reported adverse event, including nausea, vomiting, diarrhea, rash, candidiasis, itch and abnormal results on liver function tests. and A.R.) independently screened the titles and abstracts of retrieved studies to identify those that appeared to meet the inclusion criteria. The full texts of

these

discussion

Discrepancies were resolved by discussion, and the same third author arbitrated if necessary.

We examined the texts of included trials for reported adverse events and checked registration information at trial registers for all included trials. The two reviewers independently undertook risk-of-bias assessment using Cochrane methods. 5 Disagreements were resolved by discussion, and the same third author arbitrated if necessary.

We undertook sensitivity analyses based on patient age (adult or child), drug doses and durations of therapy, and we analyzed funnel plots to determine potential publication bias.

We used Peto odds ratios (ORs) to analyze the data (because of their paucity 5 ) and calculated 95% confidence intervals (CIs). We planned several subgroup analyses (see protocol at www.crd.york.ac.uk/prospero/). The numbers needed to harm (NNH) were estimated as follows: the OR for each harm was multiplied by the risk of harm with placebo (after converting this value to its odds) to derive the

odds

We identified 730 studies (after removal of duplicates), of which 573 were classified as ineligible on the basis of their titles or abstracts.

Of the remaining 157 studies, 45 were included in the qualitative analysis and 25 in the quantitative analysis ( Figure 1 ). Selection of studies for inclusion in a meta-analysis of common harms in randomized placebo-controlled trials of amoxicillin or amoxicillin–clavulanic acid.

The trials were published from 1977 to 2013 ( Figure 2 ).

The setting and reason for use of an antibiotic varied ( Table 1 ): primary care (15 [33%]), dental care (9 [20%]), secondary care (i.e., referral; 20 [44%]), treatment (25 [56%]) or prophylaxis (20 [44%]). The median duration of antibiotic therapy was 7 days (range 1 dose to 1 yr).

Across all included studies, there were 10 519 participants: 4280 received only amoxicillin, 1005 received amoxicillin–clavulanic acid, and 5234 received placebo ( Table 1 ). Among the 25 trials that reported usable harms data, the mean number of types of harms reported was 2.7 (range 0–10). Most study reports gave minimal information about harm ascertainment. For 12 studies (27%) we could determine whether patients had been asked about specific harms; in 8 studies (18%) patients used a diary to record harms. Number of trials, subdivided according to whether or not harms were reported, by year of publication. of participants Daily dose, * mg or mg/kg Period, d Domain of care Age group Indication for antibiotic Patient diary used Patients asked about specific harms Trial registration found † Usable harms data No.

acid Placebo Treatment Harms follow-up Treatment of respiratory or ENT infection Burke et al.

7 114 NA 118 375 7 21 Primary Child Acute otitis media Yes Yes No Yes 3 Gottfarb et al.

8 NA 26 26 20/kg 7 14 Referral Child Persistent cough No ? 9 NA 57 58 40/kg 7 7 Referral Child Prevention of acute otitis media No ?

10 NA 144 147 90/kg 10 10 Referral Child Acute otitis media Yes ? 11 133 NA 137 1500 7 8 Primary Adult Acute exacerbation of chronic bronchitis No No No Yes 5 Kaiser et al.

12 NA 146 142 1125 5 7 Primary Adult Common cold Yes Yes No Yes 1 Leach et al.

13 52 NA 51 50/kg 168 NR Primary Child Prevention of high-risk otitis media No ? 14 1038 NA 1023 3000 7 28 Primary Adult Acute lower respiratory tract infection Yes Yes Yes No 5 Mandel et al. 15 83 NA 81 1000 14 28 Referral Child Otitis media with effusion (glue ear) No No No Yes 1 Mandel et al.

16 57 NA 54 40/kg 14 NR Referral Child Prophylaxis for recurrent otitis media No ? 17 NA 25 25 20/kg 14 28 Referral Child Chronic wet cough Yes No Yes Yes 2 Meltzer et al.

18 251 NA 252 45/kg 14 29 Primary Adult Acute rhinosinusitis No ? 19 67 NA 68 1500 10 14 Primary Adult Acute rhinosinusitis No ?

20 330 NA 330 2000 7 14 Primary Adult Acute bronchitis in a high-prevalence HIV-positive population No Yes No Yes 5 Ruohola et al. 21 NA 39 40 45/kg 7 7 Primary Child Ear discharge from tympanostomy tube for glue ear No ? 22 NA 50 46 40/kg 7 NR Referral Child Prevention of otitis media in otitis-prone children with new acute respiratory infection No ?

23 56 NA 66 375 5 8 Primary Child Presumed viral acute respiratory infection Yes Yes No Yes 4 Wald et al. 24 41 44 48 40/kg 10 10 Primary or referral Child Acute rhinosinusitis No ?

25 60 NA 63 1500 7 42 Primary Adult Acute rhinosinusitis No ? Yes Yes 0 Treatment of other infections Glupczynski et al.

26 22 NA 23 2000 8 NR Referral Adult Campylobacter gastritis No ?

27 NA 51 22 750 5 5 Referral Adult Infected skin wounds (surgical and nonsurgical) No ? 28 15 NA 15 100/kg 5 6 Primary Child Salmonella gastroenteritis Yes No No Yes 5 Sclafani et al.

29 NA 86 81 40/kg 30 30 Referral Child Chronic adenotonsillar hypertrophy No ? No Yes 2 Prevention or prophylaxis against infection Albu et al. 30 NA 50 50 1250 14 NR Referral Adult Postoperative prophylaxis (endoscopic sinus surgery) No ? 31 16 NA 16 1000 5 7 Referral Adult Prophylaxis for obstetric Streptococcus colonization No ?

32 39 NA 35 Not stated 5 NR Referral Child Prophylaxis for kerosene-associated pneumonitis No ? 33 NA 88 97 375–750 5 — ‡ Referral Child, adult Prophylaxis for animal bites No ?

34 54 NA 54 1500 14 14 Referral Adult Bacterial vaginosis in pregnancy Yes No No No 1 Kumana et al. 35 38 NA 12 3000 1 NR Dental Adult Pharmacokinetics (antibiotic levels) in prophylaxis against endocarditis No ? 36 39 NA 34 750 28 NR

Referral

37 205 NA 182 750 10 7 Primary Child, adult Prophylaxis for Lyme disease after tick bite No ? 38 NA 65 65 375 1 NR Referral Adult Prevention of UTI after urodynamic study No ? No No 0 Dental treatment or prophylaxis Arteagoitia et al. 39 NA 16 17 4000 5 NR Dental Adult Prophylaxis for dental extraction No ? 40 15 NA 15 1500 5 NR Dental Adult Prophylaxis for dental extraction No ?

41 165 NA 165 2000 1 7 Dental Adult Prophylaxis for dental implant No ?

42 254 NA 255 2000 1 7 Dental Adult Prophylaxis for dental implant No ? 43 NA 10 11 750 30 NR Dental Adult Periodontal infection No ?

44 96 NA 96 2000 1 NR Dental Adult Preoperative prophylaxis for tooth extraction or toothbrushing No ? 45 16 NA 15 750 7 180 Dental Adult Periodontal disease No ?

46 NA 10 11 1500 10 24 Dental Adult Periodontal disease No No No Yes 1 Obstetric or gynecologic treatment or prophylaxis Almeida et al.

47 50 NA 56 2250 1 NR Referral Adult Prophylaxis for premature rupture of membranes No ?

48 NA 76 73 1500 7 or 14 — ‡ Referral Adult Prophylaxis for preterm

delivery

49 NA 22 22 1500 3–20 20 Referral Adult Foot ulcers in diabetic neuropathy No ? 50 22 NA 78 25/kg 180 NR Primary Child Malabsorption and growth No ?

51 952 NA 959 80–90/kg 5 14 Primary Child Severe acute malnutrition No Yes Yes Yes 6 Total no.