Amoxy clavulanic

Randomized, double-blind clinical studies performed in the United States in patients with H.

pylori and duodenal ulcer disease (defined as an active ulcer or history of an ulcer within 1 year) evaluated the efficacy of lansoprazole in combination with amoxicillin capsules and clarithromycin tablets as triple 14-day therapy, or in combination with amoxicillin capsules as dual 14-day therapy, for the eradication of H. Based on the results of these studies, the safety and efficacy of 2 different eradication regimens were established: Triple therapy: Amoxicillin 1 gram twice daily/clarithromycin 500 mg twice

daily/lansoprazole

pylori eradication was defined as 2 negative tests (culture and histology) at 4 to 6 weeks following the end of treatment. Triple therapy was shown to be more effective than all possible dual therapy combinations. Dual therapy was shown to be more effective than both monotherapies.

pylori has been shown to reduce the risk of duodenal ulcer recurrence.

pylori Eradication Rates When Amoxicillin is Administered as Part of a Triple Therapy Regimen Study Triple Therapy Triple Therapy Evaluable Analysis a [95% Confidence Interval] (number of patients) Intent-to-Treat Analysis b [95% Confidence Interval] (number of patients) Study 1 92 86 [80.0 - 97.7] [73.3 -93.5] (n = 48) (n = 55) Study 2 86 83 [75.7 - 93.6] [72.0 - 90.8] (n = 66) (n = 70) a This analysis was based on evaluable patients with confirmed duodenal ulcer (active or within 1 year) and H.

pylori infection at

baseline

Patients were included in the analysis if they completed the study.

Additionally, if patients

dropped

pylori infection at baseline as defined above and had a confirmed duodenal ulcer (active or within 1 year).

pylori Eradication Rates When Amoxicillin is Administered as Part of a Dual Therapy Regimen Study Dual Therapy Dual Therapy Evaluable Analysis a [95% Confidence Interval] (number of patients) Intent-to-Treat Analysis b [95% Confidence Interval] (number of patients) Study 1 77 70 [62.5 - 87.2] [56.8 -81.2] (n = 51) (n = 60) Study 2 66 61 [51.9 -77.5] [48.5 -72.9] (n = 58) (n = 67) a This analysis was based on evaluable patients with confirmed duodenal ulcer (active or within 1 year) and H.

pylori infection at baseline defined as at least 2 of 3 positive endoscopic tests from CLOtest®, histology, and/or culture. Patients were included in the analysis if they completed the study. Additionally, if patients dropped out of the study due to an adverse event related to the study drug, they were included in the analysis as failures of therapy. b Patients

were

Clinical and Laboratory Standards Institute (CLSI).

Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically; Approved Standard – Tenth Edition.

CLSI document M07-A10, Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, Pennsylvania 19087, USA, 2015.

Clinical and Laboratory Standards Institute (CLSI).

Performance Standards for Antimicrobial Disk Diffusion Susceptibility Tests; Approved Standard – Twelfth Edition. CLSI document M02-A12, Clinical and

Laboratory

Oral semisynthetic aminopenicillin similar to ampicillin; not stable to beta-lactamases of either gram-positive or gram-negative bacteria; more stable to gastric acid than penicillin; more bioavailable than oral ampicillin; commonly used to treat otitis media, bronchitis, sinusitis; also used in combination regimens for H. Amoxicillin/Amoxicillin Trihydrate/Amoxil Oral Tab Chew: 125mg, 250mg Amoxicillin/Amoxicillin Trihydrate/Amoxil Oral Tab: 500mg, 875mg Amoxicillin/Amoxicillin Trihydrate/Amoxil/Moxilin/Sumox/Trimox Oral Cap: 250mg, 500mg Amoxicillin/Amoxicillin Trihydrate/Amoxil/Moxilin/Sumox/Trimox Oral Pwd F/Recon: 5mL, 125mg, 200mg, 250mg, 400mg Moxatag Oral Tab ER: 775mg. 775 mg PO once daily, given within 1 hour of completing a meal, for 10 days. The American Heart Association (AHA) recommends amoxicillin extended-release as an alternative to penicillin V for rheumatic fever prophylaxis. 1 g PO once daily or 500 mg PO twice daily

for

Alternatively, 50 mg/kg/dose PO once daily (Max: 1 g/dose) for 10 days is recommended by The American Heart Association (AHA) as an alternative to penicillin V.

For ear/nose/throat infections in general, the FDA-approved dosage is 20 mg/kg/day PO in divided doses every 8 hours (Max: 250 mg/dose) or 25 mg/kg/day PO in divided doses every 12 hours (Max: 500 mg/dose) for mild to moderate infections and 40 mg/kg/day PO in divided doses every 8 hours (Max: 500 mg/dose) or 45 mg/kg/day PO in divided doses every 12 hours (Max: 875 mg/dose) for severe infections. 45 mg/kg/day PO in divided doses every 12 hours is the standard dose for children with uncomplicated disease that is mild to moderate in severity who do not attend daycare and who have not been treated with an antimicrobial agent in the previous 4 weeks. 80 to 90 mg/kg/day PO in divided doses every 12 hours (Max: 2 g/dose) is recommended for children in areas with high rates of S.

pneumoniae resistance (more than 10%, including intermediate- and high-level resistance). Children younger than 2 years should be treated with amoxicillin; clavulanic acid, not amoxicillin alone. 500 mg PO every 12 hours or 250 mg PO every 8 hours for mild/moderate infections and 875 mg PO every 12 hours or 500 mg PO every 8 hours for severe infections.

20 mg/kg/day PO in divided doses every 8 hours (Max: 250 mg/dose) or 25 mg/kg/day PO in divided doses every 12 hours (Max: 500 mg/dose) for mild to moderate infections and 40 mg/kg/day PO in divided doses every 8 hours (Max: 500 mg/dose) or 45 mg/kg/day PO in divided doses every 12 hours (Max: 875 mg/dose)

for

30 mg/kg/day PO given in divided doses every 12 hours.

500 mg PO every 12 hours or 250 mg PO every 8 hours for mild/moderate infections and 875 mg PO every 12 hours or 500 mg PO every 8 hours for severe infections.

80 to 90 mg/kg/day PO divided every 12 hours is first-line therapy. Treat all patients younger than 2 years and patients 2 years and older with severe disease for 10 days.

For children 2 to 5 years with mild to moderate disease, a 7-day course is acceptable. For children 6 years and older with mild to moderate disease, a 5- to 7-day course is acceptable.[53345] Although the FDA-approved dosage ranges from 20 to 45 mg/kg/day PO depending on the severity of infection (Max: 500 mg/dose for every 8 hour dosing and 875 mg/dose for every 12 hour dosing), these low doses are not clinically recommended for the treatment of otitis media.[43844] [53345] 80 to 90 mg/kg/day PO divided every 12 hours for 10 days was recommended by experts as first-line therapy in previous guidelines; however, this age group is not addressed in the most current guidelines by the American Academy of Pediatrics (AAP).

Although the FDA-approved dosage ranges from 20 to 45 mg/kg/day depending on the severity of infection, these low doses are not clinically recommended for the treatment of otitis media. 30 mg/kg/day PO divided every 12 hours is the general FDA-approved dosing. Young infants are less capable of responding to infection, and the clinical manifestations of infection can be subtle. Because of the increased risk for complications of an undiagnosed systemic infection, every young infant presenting with a fever should be carefully evaluated. 500 mg PO every 12 hours or 250 mg PO every 8 hours. 20 mg/kg/day PO given in divided doses every 8 hours (Max: 250 mg/dose) or 25 mg/kg/day PO in divided doses given every 12 hours (Max: 500 mg/dose).

30 mg/kg/day PO given in divided doses every 12 hours. 875 mg PO every 12 hours or 500 mg PO every 8 hours.

40 mg/kg/day PO in divided doses every 8 hours (Max: 500 mg/dose) or 45 mg/kg/day PO in divided doses every 12 hours (Max: 875 mg/dose). 30 mg/kg/day PO given in divided doses every 12 hours.

875 mg PO every 12 hours or 500 mg PO every 8 hours.

45 mg/kg/day PO in divided doses every 12 hours or 40 mg/kg/day PO in divided doses every 8 hours (Max: 1,750 mg/day).[43844] 30 mg/kg/day PO in divided doses every 12 hours.[43844] 1 g PO every 8 hours for at least 5 days as monotherapy for outpatients without comorbidities or risk factors for MRSA or P. aeruginosa or as part of combination therapy for HIV-infected outpatients.

Guide treatment duration by clinical stability.[34362] [64669] 90 mg/kg/day PO in divided doses every 8 to 12 hours (Max: 4 g/day) for 5 to 7 days.[34362] [46963] Dividing 90 mg/kg/day into 3 doses/day increases the probability for reaching a clinical and microbiological cure to 90% compared with the same daily dose divided into 2 doses/day (65%) in patients with pneumococcal pneumonia (MIC of 2 mcg/mL).

For less resistant pneumococcal strains (MIC of 0.5 mcg/mL), dividing 90 mg/kg/day into 2 doses will likely achieve a clinical and microbiological cure in more than 99% of children.[51856] Consider the addition of a macrolide for patients 5 years and older who do not have clinical, laboratory, or radiologic evidence to distinguish bacterial CAP from atypical

CAP

Depending on the causative organism, definitive therapy may range from 45 to 100 mg/kg/day PO in divided doses.[46963] In HIV-infected patients, amoxicillin is recommended as part of combination therapy for outpatients.[34362] 90 mg/kg/day PO in divided doses every 8 to 12 hours (Max: 4 g/day).[46963] Dividing 90 mg/kg/day into 3 doses/day increases the probability for reaching a clinical and microbiological cure to

90%

Depending on the causative organism, definitive therapy may range from 45 to 100 mg/kg/day PO in divided doses.[46963] 500 mg PO every 12 hours or 250 mg PO every 8 hours.

The Infectious Diseases Society of America (IDSA) does not recommend amoxicillin for empiric use due to the antimicrobial resistance. 20 mg/kg/day PO given in divided doses every 8 hours (Max: 250 mg/dose) or 25 mg/kg/day PO given in divided doses every 12 hours (Max: 500 mg/dose).

30 mg/kg/day PO given in divided doses every 12 hours.

875 mg PO every 12 hours or 500 mg PO every 8 hours. The Infectious Diseases Society of America (IDSA) does not recommend amoxicillin for empiric use due to the antimicrobial resistance.

40 mg/kg/day PO in divided doses every 8 hours (Max: 500 mg/dose) or 45 mg/kg/day PO in divided doses every 12 hours (Max: 875 mg/dose).

30 mg/kg/day PO given in divided doses every 12 hours. The IDSA recommends 500 mg PO 3 times per day for 14—21 days in the absence of neurological symptoms.

A double-blind, randomized trial compared amoxicillin (without probenecid) with azithromycin in patients with erythema migrans.

Those treated with amoxicillin were significantly more likely than those treated with azithromycin to achieve complete resolution by day 20, the end of the study. Significantly more azithromycin recipients relapsed than amoxicillin recipients. The dose of amoxicillin in this study was 500 mg PO 3 times per day for 20 days. The IDSA recommends 50 mg/kg/day PO in divided doses every 8 hours for 14—21 days. Amoxicillin 250—375 mg PO three times daily with metronidazole (250 mg PO three times daily) for 7—10 days.

2 g PO as a single dose given 30 to 60 minutes before procedure. Prophylaxis is recommended

for

patients

Prophylaxis is recommended for at-risk cardiac patients undergoing dental procedures that involve manipulation of gingival tissue, manipulation of the periapical region of teeth, or perforation of the oral mucosa. Cardiac patients that are considered to be at highest risk include those with prosthetic cardiac valves or prosthetic material used for cardiac valve repair, previous infective endocarditis, select types of congenital heart disease (CHD), and cardiac transplantation with valvulopathy.

For acute infections, 50—100 mg/kg/day PO in 3 to 4 divided doses for 14 days.

For chronic carriers, 100 mg/kg/day PO in 3 to 4 divided doses plus probenecid (1 g/day PO for adults or 23 mg/kg/day PO for children) for 6 weeks. 1,000 mg PO twice daily in combination with clarithromycin (500 mg PO twice daily) and lansoprazole (30 mg PO twice daily) for 10 to 14 days is recommended.