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Amoxicillin directions: Amoxicillin: MedlinePlus Drug Information


Amoxicillin (Oral Route) Proper Use

Proper Use

Drug information provided by: IBM Micromedex

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

You may take this medicine with or without food.

For patients using the oral liquid:

  • Shake the bottle well before each use. Measure the dose with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.

  • You may mix the oral liquid with a baby formula, milk, fruit juice, water, ginger ale, or another cold drink. Be sure the child drinks all of the mixture immediately.

Keep using this medicine for the full treatment time, even if you feel better after the first few doses. Your infection may not clear up if you stop using the medicine too soon.


The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage forms (capsules, powder for suspension, and tablets):

    • For bacterial infections:

      • Adults, teenagers, and children weighing 40 kilograms (kg) or more—250 to 500 milligrams (mg) every 8 hours, or 500 to 875 mg every 12 hours.

      • Children and infants older than 3 months of age weighing less than 40 kg—Dose is based on body weight and must be determined by your doctor. The usual dose is 20 to 40 milligrams (mg) per kilogram (kg) of body weight per day, divided and given every 8 hours, or 25 to 45 mg per kg of body weight per day, divided and given every 12 hours.

      • Infants 3 months of age and younger—Dose is based on body weight and must be determined by your doctor. The usual dose is 30 mg per kg of body weight per day, divided and given every 12 hours.

    • For treatment of gonorrhea:

      • Adults, teenagers, and children weighing 40 kilograms (kg) or more—3-grams (g) taken as a single dose.

      • Children 2 years of age and older weighing less than 40 kg—Dose is based on body weight and must be determined by your doctor. The usual dose is 50 milligrams (mg) per kilogram (kg) of body weight per day, combined with 25 mg per kg of probenecid, taken as a single dose.

      • Children younger than 2 years of age—Use is not recommended.

    • For treatment of H. pylori infection:

      • Adults—

        • Dual therapy: 1000 milligrams (mg) of amoxicillin and 30 mg of lansoprazole, each given three times a day (every 8 hours) for 14 days.

        • Triple therapy: 1000 mg of amoxicillin, 500 mg of clarithromycin, and 30 mg of lansoprazole, all given two times a day (every 12 hours) for 14 days.

      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.


Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

You may store the oral liquid in the refrigerator. Throw away any unused medicine after 14 days. Do not freeze.


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Portions of this document last updated: Feb. 01, 2021

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Amoxicillin: antibiotic to treat bacterial infections


The usual dose of amoxicillin capsules is 250mg to 500mg, taken 3 times a day. The dose may be lower for children.

Amoxicillin liquid is available in 125mg and 250mg doses.

How to take it

Try to space the doses evenly throughout the day. If you take it 3 times a day, this could be first thing in the morning, mid-afternoon and at bedtime.

You can take amoxicillin before or after food.

Swallow amoxicillin capsules whole with a drink of water. Do not chew or break them.

Amoxicillin is available as a liquid for children and people who find it difficult to swallow capsules.

If you or your child are taking liquid amoxicillin, it will usually be made up for you by your pharmacist. The medicine will come with a plastic syringe or spoon to help you measure out the right dose. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

If you forget to take it

If you forget to take a dose, take it as soon as you remember, unless it’s nearly time for your next dose. In this case, just leave out the missed dose and take your next dose at the usual time.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember your medicines.

If you take too much

Taking an extra dose of amoxicillin is unlikely to harm you or your child, but speak to your pharmacist or doctor if you’re worried.

Amoxil (amoxicillin) dosing, indications, interactions, adverse effects, and more




USES: Amoxicillin is used to treat a wide variety of bacterial infections. This medication is a penicillin-type antibiotic. It works by stopping the growth of bacteria.This antibiotic treats only bacterial infections. It will not work for viral infections (such as common cold, flu). Using any antibiotic when it is not needed can cause it to not work for future infections.Amoxicillin is also used with other medications to treat stomach/intestinal ulcers caused by the bacteria H. pylori and to prevent the ulcers from returning.

HOW TO USE: Chew the tablets thoroughly and swallow, followed by a full glass of water (8 ounces or 240 milliliters). Take this medication with or without food as directed by your doctor, usually every 8 or 12 hours. The dosage is based on your medical condition and response to treatment.Drink plenty of fluids while using this medication unless your doctor tells you otherwise.For the best effect, take this antibiotic at evenly spaced times. To help you remember, take this medication at the same time(s) every day.Continue to take this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow, which may result in a return of the infection.Tell your doctor if your condition persists or worsens.

SIDE EFFECTS: Nausea, vomiting, or diarrhea may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.This medicine may cause temporary staining of the teeth. Proper brushing will usually remove any stains and may prevent them from occurring.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Use of this medication for prolonged or repeated periods may result in oral thrush or a new vaginal yeast infection (oral or vaginal fungal infection). Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge or other new symptoms.Tell your doctor right away if any of these rare but serious side effects occur: dark urine, persistent nausea or vomiting, stomach/abdominal pain, yellowing eyes or skin, easy bruising or bleeding, persistent sore throat or fever.This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn’t stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse. A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.Amoxicillin can commonly cause a mild rash that is usually not serious. However, you may not be able to tell it apart from a rare rash that could be a sign of a severe allergic reaction. Get medical help right away if you develop any rash.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: Before taking amoxicillin, tell your doctor or pharmacist if you are allergic to it; or to penicillin or cephalosporin antibiotics; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, a certain type of viral infection (infectious mononucleosis).This medication may contain aspartame. If you have phenylketonuria (PKU) or any other condition that requires you to limit/avoid aspartame (or phenylalanine) in your diet, ask your doctor or pharmacist about using this medication safely.Amoxicillin may cause live bacterial vaccines (such as typhoid vaccine) to not work well. Tell your health care professional that you are using amoxicillin before having any immunizations/vaccinations.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor. Amoxicillin passes into breast milk. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring.To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor’s approval.A product that may interact with this drug is: methotrexate.Amoxicillin may cause false positive results with certain diabetic urine testing products (cupric sulfate-type). This drug may also affect the results of certain lab tests. Make sure laboratory personnel and your doctors know you use this drug.This document does not contain all possible drug interactions. Keep a list of all the products you use. Share this list with your doctor and pharmacist to lessen your risk for serious medication problems.

OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe vomiting, persistent diarrhea, a severe decrease in the amount of urine, or seizures.

NOTES: Do not share this medication with others.This medication has been prescribed for your current condition only. Do not use it later for another infection unless your doctor tells you to.With prolonged treatment, laboratory and/or medical tests (such as kidney and liver function, complete blood counts) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

STORAGE: Store at room temperature according to the product labeling, away from light and moisture. Different brands of this medication have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

Information last revised October 2021. Copyright(c) 2021 First Databank, Inc.

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

Amoxicillin | 1800PetMeds

What is Amoxicillin?

Amoxicillin is a broad-spectrum penicillin antibiotic used to treat various infections caused by susceptible strains of bacteria. Amoxicillin is sold per capsule or per tablet and requires a prescription from your veterinarian.

NOTE: Amoxicillin is also available in a suspension as Amoxicillin Drops.


Cats and Dogs


  • Broad-spectrum antibiotic that treats a wide array of bacterial infections
  • Treats ear infections, urinary tract infections, and skin infections (infected bite wounds)
  • Also effective against upper respiratory, bladder, and dental infections
  • Sold per capsule or per tablet

How does amoxicillin work?

Amoxicillin works by inhibiting the formation of bacterial cell walls.


Tell your veterinarian if your pet is being given another antibiotic. Also tell your veterinarian if your pet has allergies, or kidney, stomach or intestinal disease. While symptoms may subside early, use all of the prescribed medicine.

Brand Name:

Amoxil (GlaxoSmithKline), Biomox (Delmarva), Robamox-BV (Fort Dodge), Trimox (Apothecon)

Generic Name:


What is the most important thing I should know about Amoxicillin?

Amoxicillin is a prescription medication available as 100 mg and 400 mg tablets, 250 mg and 500 mg capsules. Amoxicillin Drops suspension is also available in a 15 ml bottle. The usual dose of amoxicillin in dogs and cats is 5-10 mg/lb every 12-24 hours. Contact your veterinarian immediately if your pet develops severe or bloody diarrhea. Give all of the amoxicillin that is prescribed for your pet, since symptoms may begin to improve before the infection is completely treated.

What should I discuss with my veterinarian before giving amoxicillin to my pet?

Tell your veterinarian if your pet has ever had an allergic reaction to another penicillin or to a cephalosporin. Tell your veterinarian if your pet has kidney disease or stomach or intestinal disease.

How should amoxicillin be given?

Give this medication exactly as directed by your veterinarian. Amoxicillin can be given with or without food. Give all of the amoxicillin even if your pet appears to be better. Symptoms may improve before the infection is completely treated.

What are the potential side effects of amoxicillin?

Contact your veterinarian immediately if the pet experiences severe or bloody diarrhea during treatment. Stop giving amoxicillin and seek emergency veterinary medical care in the event of an allergic reaction (shortness of breath; hives; swelling of the lips, tongue, or face; rash; or fainting), seizures, unusual bleeding, or bruising. Other less serious side effects such as mild nausea, vomiting, diarrhea or abdominal pain, or yeast or fungal infection may be more likely to occur. Continue to give amoxicillin and notify your veterinarian if these symptoms occur. Talk to your veterinarian about any side effect that seems unusual or bothersome to your pet.

What happens if I miss giving a dose of amoxicillin?

Give the missed dose as soon as you remember unless it is almost time for the next regularly scheduled dose. Do not give a double dose unless otherwise directed by your veterinarian.

What happens if I overdose my pet on amoxicillin?

Seek emergency veterinary medical treatment if an overdose is suspected. Symptoms of overdose may include muscle spasms or weakness, pain or twitching, seizures, confusion, coma, or agitation.

What should I avoid while giving amoxicillin to my pet?

There are no restrictions on food or activity during treatment with amoxicillin unless otherwise directed by your veterinarian.

What other drugs will affect amoxicillin?

Before giving amoxicillin, tell your veterinarian if your pet is being given another antibiotic (for the same or a different infection), allopurinol, or probenecid. You may not be able to give amoxicillin or you may need to have the dosage adjusted. Drugs other than those listed here may also interact with amoxicillin. Talk to your veterinarian or pharmacist before giving any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.

Auro-Amoxicillin – Uses, Side Effects, Interactions

How does this medication work? What will it do for me?

Amoxicillin belongs to the group of medications known as antibiotics, specifically to the family of antibiotics known as penicillins. It is used to treat infections caused by certain types of bacteria. It kills some types of bacteria that can cause infections of the ear, sinus, chest or lung, bone, bladder, and throat.

It may also be used to kill some types of bacteria that can cause infection in the stomach or small intestine, chlamydia (in pregnant and breast-feeding women), lyme disease, or typhoid fever (in children). Amoxicillin may also be used for prevention of infections that can be caused by certain dental or medical procedures.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

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What form(s) does this medication come in?

250 mg
Each maroon/yellow size “1” hard gelatin capsule, filled with white-to-off-white granular powder and imprinted with “A” on maroon cap and “85” on yellow body with black ink contains 286 mg of amoxicillin trihydrate equivalent to 250 mg amoxicillin. Nonmedicinal ingredients: cellulose, microcrystalline, magnesium stearate; capsule shell: Brilliant Blue (E 133), Allura Red (E 129), erythrosine (E 127), iron oxide yellow (E172), titanium dioxide (E171), gelatin, and sodium lauryl sulfate.

500 mg
Each maroon/yellow size “0EL” hard gelatin capsule, filled with white-to-off-white granular powder and imprinted with “A” on maroon cap and “86” on yellow body with black ink, contains 573.394 mg of amoxicillin trihydrate equivalent to 500 mg of amoxicillin. Nonmedicinal ingredients: cellulose, microcrystalline, magnesium stearate; capsule shell: Brilliant Blue (E 133), Allura Red (E 129), erythrosine (E 127), iron oxide yellow (E172), titanium dioxide (E171), gelatin, and sodium lauryl sulfate.

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How should I use this medication?

The recommended adult dose of amoxicillin varies widely depending on the age group and the condition being treated, but the medication is usually taken 3 times daily, once every 8 hours. Amoxicillin can be taken with or without meals.

Finish all this medication, even if you have started to feel better. This will reduce the chance of the infection returning and being harder to treat.

For the liquid form of amoxicillin, use an oral syringe to measure each dose of the liquid, as it gives a more accurate measurement than household teaspoons.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store the capsule and tablet forms of this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children. The liquid form of amoxicillin may be stored for 7 days at room temperature or 14 days in the refrigerator. Safely discard any unused medication after this time.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take this medication if you:

  • are allergic to amoxicillin or any ingredients of the medication
  • are allergic to the class of antibiotics called cephalosporins
  • have or may have infectious mononucleosis

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • abdominal pain (mild)
  • diarrhea (mild)
  • dizziness or lightheadedness
  • nausea
  • swollen tongue or black “hairy” tongue
  • tooth discoloration (in children)
  • trouble sleeping
  • vomiting

Although most of these side effects listed below don’t happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • anxiety
  • signs of kidney problems (e.g., increased urination at night, decreased urine production, blood in the urine)
  • skin rash, hives, or itching
  • symptoms of liver damage (e.g., yellow skin or eyes, abdominal pain, dark urine, clay-coloured stools, loss of appetite)

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • convulsions (seizures)
  • diarrhea (watery and severe), which may also be bloody
  • symptoms of a serious allergic reaction (e.g., swelling of the face or throat, difficulty breathing, wheezing, or itchy skin rash)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Allergy: Amoxicillin is a penicillin and should not be used by anyone with a penicillin allergy or an allergy to the class of medications called cephalosporins. People who have allergies in general should watch carefully for any reaction to amoxicillin when starting a new prescription. In rare cases, some people may develop a serious allergic reaction to this medication. Signs of an allergic reaction include a severe rash, hives, swollen face or throat, or difficulty breathing. If these occur, seek immediate medical attention.

Bacterial resistance: Misuse of an antibiotic such as amoxicillin may lead to the growth of resistant bacteria that will not be killed by the antibiotic. If this happens, the antibiotic may not work for you in the future. Although you may begin to feel better early in your course of treatment with amoxicillin, you need to take the full course exactly as directed to finish ridding your body of the infection and to prevent resistant bacteria from taking hold. Do not take amoxicillin or other antibiotics to treat a viral infection such as the common cold; antibiotics do not kill viruses, and using them to treat viral infections can lead to the growth of resistant bacteria.

Birth control: Penicillins may decrease the effectiveness of birth control pills. Some doctors recommend adding another method of birth control for the rest of the cycle when penicillin is taken.

Diarrhea: This medication is associated a serious infection called Clostridium difficile-associated diarrhea, caused by the bacteria C. difficile. This can occur even after your last dose of this medication. If you have severe diarrhea (with or without fever or blood) after taking amoxicillin, get medical attention as soon as possible.

Kidney disease: Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Medical conditions: When amoxicillin is used by a person who has mononucleosis, acute lymphocytic leukemia (a type of cancer that affects white blood cells), or cytomegalovirus infection (a viral infection), a widespread rash may occur. Talk to your doctor if you have any concerns.

Overgrowth of organisms: Treatment with any penicillin may allow normal fungus or types of bacteria not killed by the antibiotic to overgrow, causing unwanted infections such as yeast infections, which may cause vaginal itching and irritation. Talk to your doctor if you have any concerns.

Pregnancy: This medication is generally considered safe in pregnancy. If you are pregnant, discuss with your doctor this risks and benefits of taking this medication. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking amoxicillin, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

What other drugs could interact with this medication?

There may be an interaction between amoxicillin and any of the following:

  • allopurinol
  • BCG vaccine
  • cholera vaccine
  • birth control pills
  • methotrexate
  • mycophenolate
  • sodium picosulfate
  • tetracyclines (e.g., minocycline, doxycycline)
  • typhoid vaccine
  • warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Auro-Amoxicillin

Amoxicillin dosage and administration – wikidoc

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamed Moubarak, M.D. [2]

Dosage and Administration

Amoxicillin capsules, chewable tablets, and oral suspensions may be given without regard to meals. The 400 mg suspension, 400 mg chewable tablet and the 875 mg tablet have been studied only when administered at the start of a light meal. However, food effect studies have not been performed with the 200 mg and 500 mg formulations.

Amoxicillin tablets, chewable should be chewed before swallowing

Neonates and Infants aged ≤ 12 weeks (≤ 3 months): Due to incompletely developed renal function affecting elimination of amoxicillin in this age group, the recommended upper dose of amoxicillin is 30 mg/kg/day divided q12h.

Adults and Pediatric Patients > 3 months

‡ Dosing for infections caused by less susceptible organisms should follow the recommendations for severe infections.

§ The children’s dosage is intended for individuals whose weight is less than 40 kg. Children weighing 40 kg or more should be dosed according to the adult recommendations.

π Each strength of the suspension of amoxicillin is available as a chewable tablet for use by older children.

After reconstitution, the required amount of suspension should be placed directly on the child’s tongue for swallowing. Alternate means of administration are to add the required amount of suspension to formula, milk, fruit juice, water, ginger ale, or cold drinks. These preparations should then be taken immediately. To be certain the child is receiving full dosage, such preparations should be consumed in entirety.

All patients with gonorrhea should be evaluated for syphilis. (See PRECAUTIONS – Laboratory Tests.)

Larger doses may be required for stubborn or severe infections.

It should be recognized that in the treatment of chronic urinary tract infections, frequent bacteriological and clinical appraisals are necessary. Smaller doses than those recommended above should not be used. Even higher doses may be needed at times. In stubborn infections, therapy may be required for several weeks. It may be necessary to continue clinical and/or bacteriological follow-up for several months after cessation of therapy. Except for gonorrhea, treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic or evidence of bacterial eradication has been obtained. It is recommended that there be at least 10 days’ treatment for any infection caused by Streptococcus pyogenes to prevent the occurrence of acute rheumatic fever.

H. pylori Eradication to Reduce the Risk of Duodenal Ulcer Recurrence:
Triple Therapy: Amoxicillin/clarithromycin/ lansoprazole

The recommended adult oral dose is 1 gram amoxicillin, 500 mg clarithromycin, and 30 mg lansoprazole, all given twice daily (q12h) for 14 days. (See INDICATIONS AND USAGE.)

Dual Therapy:

The recommended adult oral dose is 1 gram amoxicillin and 30 mg lansoprazole, each given three times daily (q8h) for 14 days. (See INDICATIONS AND USAGE.)

Please refer to clarithromycin and lansoprazole full prescribing information for CONTRAINDICATIONS and WARNINGS, and for information regarding dosing in elderly and renally impaired patients.

Dosing Recommendations for Adults with Impaired Renal Function:
Patients with impaired renal function do not generally require a reduction in dose unless the impairment is severe. Severely impaired patients with a glomerular filtration rate of < 30 mL/minute should not receive the 875 mg tablet. Patients with a glomerular filtration rate of 10 to 30 mL/minute should receive 500 mg or 250 mg every 12 hours, depending on the severity of the infection. Patients with a less than 10 mL/minute glomerular filtration rate should receive 500 mg or 250 mg every 24 hours, depending on severity of the infection.

Hemodialysis patients should receive 500 mg or 250 mg every 24 hours, depending on severity of the infection. They should receive an additional dose both during and at the end of dialysis.

There are currently no dosing recommendations for pediatric patients with impaired renal function.

Directions for Mixing Oral Suspension:
Prepare suspension at time of dispensing as follows: Tap bottle until all powder flows freely. Add approximately 1/3 of the total amount of water for reconstitution (see table below) and shake vigorously to wet powder. Add remainder of the water and again shake vigorously.

200 mg/5 mL

Each teaspoonful (5 mL) will contain 400 mg amoxicillin.[1]


Adapted from the FDA Package Insert.

Clavamox Antibiotic for Bacterial Infections

Call 1-877-357-9661

By Evan Ware, DVM


Therapeutic Class

Potentiated Aminopenicillin


Dogs, Cats

May Be Prescribed by Vets for:

Urinary tract, skin, and soft tissue infections

Search for Available Dosage Forms

Basic Information

In veterinary medicine, one of the most commonly prescribed antibiotics is a combination drug consisting of Amoxicillin and Clavulanate. These two drugs work together to treat a wide range of bacterial infections in both cats and dogs.

This is an effective compounded combination because it is like Penicillin, except that it has a much broader spectrum of antibacterial action, while the Clavulanate effectively inhibits the beta-lactamase enzyme produced by bacteria that would otherwise make the Amoxicillin inactive.

When combined into one administration, the drugs work synergistically to treat a variety of bacterial infections, many of which may have otherwise been resistant to Amoxicillin alone.

Veterinary Medicine Uses for Amoxicillin/Clavulanate

Amoxicillin/Clavulanate can have several uses in veterinary medicine. Some of its most-common uses include infections caused by susceptible bacteria, as well as bacterial infections such as:

  • Wound Infections
  • Skin Infections
  • Bone Infections
  • Infections in the Mouth
  • Bladder Infections
  • Pneumonia

Amoxicillin/Clavulanate can be a highly effective treatment choice for bacterial infections; however, the patient can develop a resistance to the drug with prolonged use. In such cases, the bacteria can prove unresponsive to the medicine and other antibiotics may need to be considered. Because Amoxicillin/Clavulanate is an antibacterial agent, it is not effective against viral or parasitic infections.

Potential Side-Effects of Amoxicillin/Clavulanate

One of the things that makes Amoxicillin/Clavulanate a popular drug combination is that the medication is appropriate when administered according to a veterinarian’s prescribed directions. However, precautions still need to be considered. For instance, Amoxicillin/Clavulanate should not be prescribed to a patient that has a known allergy to either Amoxicillin or Clavulanate.

The most-common side effects of Amoxicillin/Clavulanate include vomiting and/or diarrhea. To help prevent vomiting, the patient should be fed prior to the dose administration. In cases where the patient experiences diarrhea, it is typically the result of the intestinal bacteria being affected by the Amoxicillin. If the vomiting or diarrhea persist, then the pet should be seen by the veterinarian as quickly as possible.

Drug Interactions with Amoxicillin/Clavulanate

Amoxicillin/Clavulanate can interact with other medications. Two common drugs known to interact with this combo are tetracycline and chloramphenicol. Any time a patient is taking other medications, the veterinarian should be made aware so potential drug interactions can be avoided.

Precautions for Using Amoxicillin/Clavulanate

Amoxicillin/Clavulanate generally is appropriate for use in cats and dogs, but it should never be administered to small animals like ferrets, rabbits, guinea pigs, chinchillas, or hamsters because the antibiotic nature of the medicine affects the normal bacteria in a small animal’s gastrointestinal tract, as this can cause potentially fatal diarrhea.

The appropriateness of this drug for use in pregnant or breeding patients has not been determined, so in most cases, the veterinarian will prescribe it based on a risk vs. reward basis.

Dosage and Administration of Amoxicillin/Clavulanate

Amoxicillin/Clavulanate is available in tablets, capsules, and liquid formulations. The dosage, frequency of administration, and duration of treatment are based on a wide variety of factors, including the breed and size of the pet, and the type and severity of the infection being treated.

It is extremely important to administer the medication exactly as prescribed by the veterinarian. Missing doses can result in the bacterial infection developing a resistance to the antibiotic, so the prescription needs to be followed as thoroughly as possible.

About the Author

Dr. Evan Ware is a veterinary practitioner in Phoenix, Arizona. He received both his undergraduate degree in microbiology and his Doctorate of Veterinary Medicine from The Ohio State University.

Dr. Ware is currently the Medical Director of University Animal Hospital (VCA) and is also the owner of two other hospitals, including Laveen Veterinary Center and Phoenix Veterinary Center. His areas of interest include orthopedic medicine and surgery, veterinary oncology and chemotherapy, and general and advanced soft-tissue surgery.

Amoxicillin 20% – inv.

Amoxicillin 200

Davati, Georgia

Oral antibiotic


Content in 1 g of powder:

Amoxicillin trihydrate…………………………………………… …………………………………………. 200 mg.


Amoxicillin is a semisynthetic broad-spectrum penicillin with bactericidal activity against gram-positive and gram-negative bacteria. The bactericidal effect is due to the inhibition of the synthesis of the bacterial cell wall.Amoxicillin is excreted mainly in the urine. A significant part can also be excreted in the bile.


Infectious diseases of the gastrointestinal tract, respiratory and urinary tract caused by microorganisms sensitive to amoxicillin such as E. coli, Campylobacter, Clostridium, Corynebacterium, Erysipelothrix, Haemophilus, Pasteurella and Salmonella spp.as well as non-penicillinase-producing Staphylococcus and Streptococcus spp. in calves, goats, poultry, sheep and pigs.


Calves, goats, sheep: ………………………….. 5 g per 100 kg of body weight 2 times a day within 3-5 days.

Poultry, pigs: ……………………………………… 1 kg per 1000-2000 liters of drinking water for 3-5 days.

Note: ………………………………………….. for calves, lambs and kids only in the pre-ruminant period.

Against Order:

Hypersensitivity to amoxicillin. Severe renal impairment. Concomitant use of tetracyclines, chloramphenicol, macrolides and lincosamides.

Elimination time:

Calves, goats, sheep, pigs: 8 days.
Bird: 3 days.


In bags of 50 g and 500 g.

Storage conditions :

The drug should be stored in a dry, dark place at a temperature from 0 ° to 25 ° C.


Medicinal product Active ingredient More info
Avamis spray Fluticasone furoate
Avodart capsules Dutasteride
Atarax tablets Hydroxyzine hydrochloride
Augmentin oral suspension 156 mg Amoxicillin / clavulanic acid
Augmentin oral suspension 228 mg Amoxicillin / clavulanic acid
Augmentin oral suspension 312 mg Amoxicillin / clavulanic acid
Augmentin tablets 375 mg Amoxicillin / clavulanic acid
Augmentin BD tablets 625 mg Amoxicillin / clavulanic acid
Augmentin BD tablets 875 mg Amoxicillin / clavulanic acid
Valtrex tablets Valacyclovir
Dermovate cream Clobetasone propionate
Dermovate ointment Clobetasone propionate
Duodart capsules Dutasteride / tamsulosin
Zentel oral suspension Albendazole
Zentel Tablets Albendazole
Zinacef Powder for Injection Cefuroxime
Zyrtec oral drops Cetirizine dihydrochloride
Zyrtec tablets Cetirizine dihydrochloride
Integrilin solution for infusion 0.75 mg / ml Eptifibatid
Integrilin solution for infusion 2 mg / ml Eptifibatid
Infanrix Hexa suspension for injection + powder for injection Vaccine for the prevention of diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B and infections caused by Haemophilus Influenzae type B
INFANRIX suspension for injection Vaccine for the prevention of diphtheria, tetanus and pertussis
Calgel dental gel Lidocaine / Cetylpyridinium
Kivexa tablets Abacavir / Lamivudine
Clotrimazole cream Clotrimazole
Clotrimazole vaginal tablets Clotrimazole
Ksizal tablets Levocetirizine dihydrochloride
Lamictal 2 mg tablets Lamotrigine
Lamictal tablets 5 mg Lamotrigine
Lamictal tablets 100 mg Lamotrigine
Priorix powder for solution for injection Vaccine for the prevention of measles, ep.mumps, rubella 90 130

Relenza powder for inhalation Zanamivir
Rotarix oral suspension Vaccine for the prevention of rotavirus gastroenteritis
Salbutamol inhalation aerosol Salbutamol
Seretide Akkuhaler / Discus powder for inhalation 100 μg 90 130

Salmeterol Xinafoate / Fluticasone Propionate
Seretide Akkuhaler / Discus powder for inhalation 250 μg 90 130

Salmeterol Xinafoate / Fluticasone Propionate
Seretide Akkuhaler / Discus powder for inhalation 500 μg 90 130

Salmeterol Xinafoate / Fluticasone Propionate
Seretide Evohaler aerosol Salmeterol / Fluticasone Propionate
Tivikey Tablets Dutegravir
Triumek tablets Dutegravir / Abacavir / Lamivudine
Fliksonase spray Fluticasone propionate
Flixotide Evohaler Fluticasone propionate
Fortum powder for injection Ceftazidime
Havrix B suspension for injection Vaccine for the prevention of hepatitis A 90 130

The Sandoz company presents a novelty in the children’s line – Amoxiclav® Kviktab 312 mg

Moscow, April 9, 2018 – The Sandoz company, one of the leading manufacturers of generic drugs in the world, announces the expansion of the Amoxiclav ® product line in Russia and presents the long-awaited novelty – Amoxiclav ® Kviktab 312 mg. This form of the drug – dispersible tablets No. 20, a combination of amoxicillin 250 mg + clavulanic acid 62.5 mg – was developed specifically for the age segment 3-12 years old, which occupies the largest share in the appointment of all antibiotics for respiratory diseases 1 .

Acute respiratory diseases are associated not only with the majority of outpatient care visits, but also missed school hours and parental workdays, and significant drug costs 2 . In acute respiratory infections of a bacterial nature, it is important to choose the right rational antibiotic therapy in order to avoid possible relapses, complications and not contribute to the development of bacterial resistance.

Amoxiclav ® Kviktab contains amoxicillin, which performs the main antibacterial activity, and clavulanic acid, which helps protect amoxicillin from the action of special enzymes – beta-lactamases.Beta-lactamases are produced by a number of bacteria and destroy the antibiotic, preventing it from reaching its target and destroying the bacteria. In addition, clavulanic acid in Amoxiclav ® has its own antibacterial activity and stimulates antimicrobial immunity, phagocytosis and chemotaxis. The result of this symbiosis is the active development of antimicrobial immunity and, ultimately, the complete destruction of the infectious agent 3 .

When it comes to a drug for children, in addition to the effectiveness of the drug, factors such as speed of action, ease of use and pleasant taste play an important role.The active substance “Amoxiclav ® Kviktab” is completely absorbed and quickly reaches the site of action 4 . Thanks to the new form of the drug, the child can dissolve a tablet with a sweet orange flavor, which is especially convenient when the throat hurts and it is unpleasant to swallow the tablet, or take it in the form of an aqueous solution.

“One of the main goals of Sandoz is patient care. Like all our products, Amoxiclav ® Kviktab undergoes multi-stage quality control and has a high safety profile, which is especially important for children.The new form of product release will be an excellent solution in terms of efficiency and ease of use, ”comments Alexandra Lukashova, head of the recipe department at Sandoz.

The age of the child is one of the most important factors in determining the choice of an antibiotic. Most children under the age of 5 suffer an average of 3-6 episodes of infections accompanied by a high fever during the year. Determining the need for an antibiotic prescription, choosing the right drug and fulfilling the doctor’s prescriptions are the main measures to maintain the effectiveness of antibiotic therapy.

“The rational combination of drugs, the choice of the right drug in the correct dose, the correct criteria for evaluating the effectiveness of treatment and its duration are the key points to which you need to pay attention to antibiotic therapy. That is why the Sandoz company focuses on the quality of the antibiotics produced, is constantly looking for innovative ways to interact with the medical community and actively supports the fight against antibiotic resistance around the world, including in Russia, “said Alexander Alekseev, Director of Corporate Communications of the Sandoz company in Russia.

About Sandoz

Sandoz, a division of the Novartis group of companies, is a world leader in the development and production of generic drugs and biosimilars. The company is constantly striving to improve the availability of high-quality medical care for patients around the world. The Sandoz product portfolio consists of more than 1,100 chemical compounds. Sales of Sandoz in 2017 amounted to $ 10.1 billion. The company is headquartered in St.Holzkirchen, Germany.

* This material is for reference and can be used as an additional source of information.

# # #

Contact information:

Alexander Alekseev
Director of Corporate Relations, Sandoz
Tel: +7 495 660 7509
Mob. tel: +7 916 580 3111
[email protected]

Amoxicillin 150 suspension for injection 100 ml

Release form, composition and packaging

Suspension for injection from white to light yellow, oily; during storage, stratification of the suspension is allowed, which disappears when shaken.

1 ml
amoxicillin trihydrate 150 mg

Excipients: butylhydroxytoluene – 2 mg, benzyl alcohol – 10 mg, aluminum monostearate – 15 mg, vegetable oil – up to 1 ml.

Packaged in 50, 100 and 250 ml glass bottles of appropriate capacity, hermetically sealed with rubber stoppers and reinforced aluminum caps. Each packing unit is supplied with instructions for use.

Pharmacological (biological) properties and effects

Antibacterial drug of the group of semi-synthetic penicillins. Has a wide spectrum of antibacterial action, is active against most gram-positive and gram-negative microorganisms, incl. Actinomyces spp., Bacillus anthracis, Clostridium spp., Corynebacterium spp., Erysipelothrix rhusiopathiae, Listeria monocytogenes, Staphylococcus spp., Escherichia coli, Haemophilus spp., Pasteurella spp., Salmonella spp., Streptococcus spp., Actinobacillus spp., Proteus mirabiIis, Leptospira spp.

The mechanism of action of amoxicillin consists in disrupting the synthesis of mucopeptide, which is part of the cell wall of microorganisms, by inhibiting the enzymes transpeptidase and carboxypeptidase, which leads to disruption of the osmotic balance and destruction of the bacterial cell.

After parenteral administration of the drug, the maximum concentration of amoxicillin trihydrate in the blood serum is achieved after 1-2 hours and is maintained at a therapeutic level for 48 hours.It is excreted from the body with urine and feces, mainly unchanged.

Amoxicillin 150 according to the degree of impact on the body refers to moderately hazardous substances (hazard class 3 according to GOST 12.1.007).

Indications for the use of AMOXICILLIN 150

Primary and secondary infections of bacterial etiology, pathogens of which are sensitive to amoxicillin, in cattle, small ruminants, pigs, dogs and cats including:

– gastrointestinal infections;

– respiratory tract infections;

– infections of the genitourinary system;

– joint infections;

– infections of soft tissues and skin;

– necrobacteriosis;

– umbilical infections;

– atrophic rhinitis;

– metritis-mastitis-agalactia syndrome.

Application procedure

The drug is administered i / m or s / c to large and small ruminants, pigs, dogs at a dose of 1 ml per 10 kg of animal weight, cats – s / c at a dose of 1 ml per 10 kg of animal weight. If necessary, it is possible to re-administer the drug after 48 hours.

Before use, the suspension should be shaken thoroughly.

The maximum volume of suspension injection in the same place should not exceed 20 ml for cattle, 10 ml for pigs, and 5 ml for sheep, goats, calves and dogs.

No peculiarities of the action of the drug during the first use and withdrawal were revealed.

Avoid skipping the next dose of the drug, because this can lead to a decrease in efficiency. If one or more doses are missed, the use of the drug is resumed in the same dose and according to the same scheme.

Side effects

When using the drug Amoxicillin 150 in recommended doses, side effects and complications, as a rule, are not observed.In rare cases, some animals may develop edema at the injection site, which resolves within 1-2 days.

Symptoms of an overdose in animals can be manifested by depression, dysfunction of the gastrointestinal tract, swelling at the injection site.

Contraindications to the use of AMOXICILLIN 150

– increased individual sensitivity of the animal to antibiotics of the penicillin group.

Special instructions and personal prevention measures

In case of increased individual sensitivity of the animal to amoxicillin and the development of allergic reactions, the use of the drug is discontinued and, if necessary, antihistamines are prescribed.

Amoxicillin 150 should not be mixed in the same syringe with other drugs.

Slaughter of animals for meat is allowed no earlier than 28 days after the last use of the drug Amoxicillin 150. The meat of animals that were forcedly killed before the expiration of the specified period can be used as feed for fur animals.

Milk of dairy animals may be used for food purposes no earlier than 96 hours after the last administration of the drug. Milk obtained during the treatment period and within 4 days after the last injection of the drug can be used after boiling in animal feed.

Personal prevention measures

All work with Amoxicillin 150 should be carried out in compliance with the rules of personal hygiene and safety measures provided for when working with medicinal products for animals. During work, it is forbidden to drink, smoke, and eat. After finishing work, wash your hands with warm water and soap.

People with hypersensitivity to the drug components should avoid direct contact with Amoxicillin 150.In case of accidental contact of the drug with the skin or mucous membranes of the eyes, they should be rinsed with plenty of water. In the event of allergic reactions or accidental ingestion of the drug into the human body, you should immediately contact a medical institution (you should have instructions for use of the drug or a label with you).

It is forbidden to use empty containers of the preparation for household purposes, they must be disposed of with household waste.

Storage conditions Amoxicillin 150

The drug should be stored in the manufacturer’s sealed packaging, separately from food and feed, in a dry, dark place, out of the reach of children, at a temperature of 5 ° to 25 ° C.

The unused product is disposed of in accordance with legal requirements.

Shelf life Amoxicillin 150

Shelf life, subject to storage conditions – 3 years from the date of production. It is forbidden to use the drug after the expiration date.

Amoxicillin: portrait against the background of community-acquired pneumonia

Most patients with community-acquired pneumonia (CAP) can be treated on an outpatient basis, the main advantages of which are convenience and comfort for the patient, the possibility of oral administration of antibiotics, as well as the lower cost of treatment for the health care system as a whole (according to foreign studies, the treatment of patients with CAP in hospitals costs 20–25 times more than at home) [1, 2].An important condition for outpatient therapy is the minimum risk of an unfavorable outcome (delayed recovery, complications and / or death). Accordingly, patients with mild CAP will be the main candidates for home treatment.

Oral antibiotics are usually used for outpatient treatment of patients with mild CAP. Taking into account the etiological significance in the occurrence of CAP, both typical ( S. pneumoniae , H. influenzae ) and atypical microorganisms ( M.pneumoniae , C. pneumoniae ) one would expect that the optimal antibiotics for the treatment of CAP would be drugs covering the entire spectrum of putative pathogens. In general, macrolides, tetracyclines (doxycycline) and respiratory fluoroquinolones meet this criterion. It is these antibiotics that are recommended for home monotherapy of patients with CAP by experts from IDSA and ATS [3], with the first two classes of drugs being considered as first-line agents, and respiratory fluoroquinolones as alternatives.American experts place particular emphasis on the activity of the listed classes of antibiotics against atypical pathogens. On the other hand, in agreement documents published in many European countries (including Great Britain, France, Russia, Ukraine) [4–7], β-lactams are the drugs of choice for the treatment of patients with non-severe CAP without concomitant diseases and modifying factors. (amoxicillin) and macrolides. Moreover, amoxicillin is superior to macrolides in activity against S.pneumoniae but has no effect on atypical bacteria. This disadvantage, according to experts, is leveled by the fact that CAP caused by atypical microorganisms are prone to spontaneous resolution, and the main threat of unfavorable outcomes is associated with pneumococcal pneumonia.

Thus, there are 2 different approaches to the treatment of the same categories of patients with the same disease. The first, relatively speaking, “American”, offers antibiotics active against atypical microorganisms as drugs of choice – macrolides, respiratory fluoroquinolones, doxycycline.Another, “European” (accepted in our country), proceeds from the fact that β-lactams have not exhausted their capabilities in outpatient therapy for patients with CAP [8].

1. Should the antibiotic of choice for the treatment of non-severe CAP be active against atypical pathogens?

The efficacy of β-lactams and antibiotics active against intracellular pathogens (fluoroquinolones, macrolides) in the treatment of mild CAP was analyzed in a recent meta-analysis [9]. It included patients with radiologically verified CAP aged ≥ 18 years who received treatment with oral antibiotics on an outpatient basis.The final analysis included 13 double-blind randomized clinical trials (RCTs) (a total of 3402 people, of which 53% were men, the average age of patients was 49 years). The cure and improvement rates in the analyzed RCTs averaged 90%, and the mortality rate was 0.7%.

The clinical efficacy of antibiotics active against atypical pathogens did not differ from that of β-lactams: relative risk (RR) 0.98; 95% confidence interval (CI) 0.93–1.04 (Fig. 1). There were no differences in mortality when using the compared groups of antibiotics.

The authors of the meta-analysis proposed several possible explanations for the lack of differences between the comparison groups. First, it is the insufficient power of the analyzed RCTs. Assuming 90% clinical efficacy in the control group,> 3200 patients would have to be enrolled in each group to find a 2% difference between the control and the intervention group (92% efficacy), and more than 13000 patients would have to be included to find a 1% difference. … Based on a mortality rate of 0.7%, to detect a 2-fold reduction in risk (in absolute terms – by 0.35%),> 6700 patients would have to be included in each of the groups.These calculations are based on the method of two proportions [10].

Another possible explanation may be the fact that in a significant part of patients with mild CAP, the disease is caused by viruses and is prone to self-healing [11]. It cannot be ruled out that atypical bacteria can be copathogens, while β-lactams destroy CAP pathogens [12]. It is also possible that antibiotics active against atypical pathogens accelerate the recovery of patients with CAP caused by atypical bacteria; however, the recovery time is difficult to analyze due to the limited available data [9].

The disadvantages of this meta-analysis include the ability to take into account only the initial ABT. In the absence of improvement and in cases of deterioration, the choice of antibiotic should be reconsidered.

The conclusion reached by the authors of the study is that the outcomes of mild CAP treated on an outpatient basis are generally good, regardless of whether the antibiotic is active against atypical pathogens, but provided that it is active against S. pneumoniae . Therefore, the choice of antibiotic in such cases should, apparently, be based on the profile of adverse drug events (ADP), cost, preferences of the doctor and patient, taking into account the risk of resistance induction [9].

2. Penicillins: historical background

Penicillin is considered to be the first antibiotic that has found wide clinical use. It has established itself as a highly effective treatment for infections caused by many gram-positive and anaerobic microorganisms. At the same time, the vast majority of gram-negative microorganisms had natural (natural) resistance to penicillin. Moreover, a number of gram-negative and gram-positive bacteria, initially sensitive to penicillin, became resistant to it over time.

Another disadvantage of penicillin was the lack of an oral dosage form. The introduction into clinical practice of phenoxymethylpenicillin, which did not break down in the acidic environment of the stomach and was administered orally, was undoubtedly a step forward. Unfortunately, this drug was noticeably inferior to penicillin in absolute antimicrobial activity, and the spectrum of its antibacterial action did not cover microorganisms with natural and / or acquired resistance (resistance) to penicillin.

The mechanisms of acquired resistance of bacteria to antibiotics include:
– synthesis of enzymes that destroy antibiotics;
— Structural or spatial modification of targets for antibiotic action;
– violation of the permeability of cell walls and membranes of bacteria for antibiotics;
– synthesis of enzymes that modify antibiotics;
– active removal (pumping out) of antibiotics from the cell using membrane pumps;
– Creation of new metabolic pathways.

For penicillins, in particular, the first three mechanisms are of greatest importance. Moreover, the last of them – a violation of the permeability of cell walls and membranes of bacteria for antibiotics – determines in penicillins not so much acquired as natural resistance. Structural or spatial modification of the targets for the action of antibiotics leads to the fact that the drug loses its ability to bind to certain components of the microbial cell and thus becomes ineffective.Figuratively, this situation can be described as follows: a doctor, prescribing an antibiotic, tries to open the door lock of bacteria with it, like a key. But the lock is already new, and the key is old, and it no longer fits the new lock. Therefore, a different antibiotic key is needed. (There are, however, exceptions: for example, an old antibiotic is not so much a “key” as a universal “master key”; or to open the door lock of the bacteria, the doctor made additional efforts (say, “pressed the door”, i.e. increased the dose of the drug ) or used “adjuvants” – added another antibiotic that has the ability to enhance the effect of the first, etc.etc.).

Nevertheless, natural penicillins (benzylpenicillin and phenoxymethylpenicillin) suffered the greatest damage from bacteria that acquired the ability to synthesize penicillinases. The latter are enzymes that destroy (and therefore inactivate) antibiotics. One of the first to synthesize penicillinases “learned” staphylococci.

Thus, at the end of the 40s of the XX century. medicine faced two problems. First, it was necessary to develop new penicillins that would be resistant to the action of bacterial (primarily staphylococcal) penicillinases.Secondly, new penicillins were needed, effective not only against gram-positive, but also gram-negative microbes. It was not possible to create an antibiotic that would satisfy both of these requirements. However, each of the tasks was solved separately.

The first antibiotic resistant to the action of bacterial penicillinases was methicillin. Unfortunately, neither he himself, nor the subsequent drugs of the group of penicillinase-resistant penicillins (oxacillin, cloxacillin, dicloxacillin, etc.)) were not active against gram-negative microorganisms. Streptococci and pneumococci were found to be more sensitive to natural than to penicillinase-resistant penicillins. Therefore, the field of application of the new group of antibiotics was actually limited to the treatment of infections caused by methicillin-sensitive staphylococci.

The discovery of broad-spectrum semi-synthetic penicillins turned out to be one of the remarkable achievements of mankind in the fight against infections. The main representatives of this group of antibiotics (the modern name of which is aminopenicillins) are ampicillin and amoxicillin.They were destroyed by bacterial penicillinases, did not act on Pseudomonas aeruginosa, were inferior to benzylpenicillin in antimicrobial activity against streptococci, pneumococci and staphylococci sensitive to the latter. However, the spectrum of their action turned out to be so wide that it became possible to effectively treat most infections caused by clinically significant gram-negative bacteria.

Further evolution of penicillins proceeded in two directions. On the one hand, antipseudomonal penicillins (carbenicillin, ticarcillin, piperacillin, etc.) were created and introduced into clinical practice.etc.). On the other hand, attempts to protect some known antibiotics from the destruction of bacteria by enzymes have been crowned with success. This is how protected penicillins appeared, which are combinations of antibiotics with inhibitors of bacterial β-lactamases: ampicillin + sulbactam, amoxicillin + clavulanic acid, ticarcillin + clavulanic acid, etc.

3. Which β-lactam should be preferred in the treatment of non-severe CAP?

In clinical practice, the most commonly used oral β-lactams for the treatment of patients with mild CAP are aminopenicillins (amoxicillin and amoxicillin / clavulanate).Cephalosporins of II – III generations can also be used, however, the activity of amoxicillin against S. pneumoniae , the key causative agent of CAP, is more predictable [13].

Of the two oral aminopenicillins registered in Ukraine (ampicillin and amoxicillin), only the latter retains its clinical significance in CAP therapy. Comparative characteristics of both antibiotics are presented in table. 1.

The advantages and disadvantages of aminopenicillins as drugs of choice for the treatment of patients with CAP on an outpatient basis are summarized in Table.2 [13, as amended].

In recent years, there has been a tendency in domestic practice to prescribe amoxicillin / clavulanate on an outpatient basis to all patients with mild CAP. This approach is not objectionable when it comes to patients who have certain concomitant diseases (chronic obstructive pulmonary disease, chronic heart or renal failure, etc.) or modifying factors (age over 65, structural lung diseases (bronchiectasis, cystic fibrosis), exhaustion, etc.etc.). But in patients with mild CAP without concomitant diseases and modifying factors, preference should be given to amoxicillin. There are several arguments in its favor.

1. Amoxicillin is highly active against pneumococci, the frequency of excretion of which in patients with CAP reaches 14–36% [14–16], and the true role in the onset of the disease, apparently, is even greater. The use of a combination of amoxicillin with clavulanic acid in this case is not rational, since pneumococci do not produce penicillinase.

2. Amoxicillin is effective in the treatment of diseases caused by Haemophilus influenzae (0.5–10% of all cases of CAP). Unfortunately, some of these microorganisms produce penicillinase. However, the prevalence of such strains in the environment is likely to be low. In particular, in Russia, currently insensitivity (moderate resistance + resistance) H. influenzae to ampicillin (and amoxicillin) is 5.2%, amoxicillin / clavulanate – 0%, while to co-trimoxazole it reaches 29 , 8% (Fig.2) [17]. The results of experimental and clinical studies indicate that with a low level of resistance (<20%), the effectiveness of antibiotic therapy does not decrease.

3. Tolerance of amoxicillin is significantly better than the combination of amoxicillin with clavulanate. In particular, NLE on the part of the digestive tract are recorded statistically significantly less frequently when prescribing amoxicillin than its combination with clavulanate. Consequently, more patients will adhere to the prescribed therapy regimen, which is important for both the patient (early recovery) and society as a whole (preventing the emergence and spread of resistant strains of microorganisms).The introduction of new technologies (the creation of Flemoxin Solutab) ensures the maximum bioavailability of amoxicillin and the comfort of its use. An increase in bioavailability means that the maximum amount of antibiotic is absorbed and reaches the focus of infection, and does not remain in the intestine and does not disturb the balance of its microbial flora with the appearance of NFA. Comfort (the ability to take Flemoxin Solutab inside in the form of tablets, dissolve and take in the form of a syrup with a pleasant smell) is no less important. Conventional tablets containing at least 1 g of amoxicillin are difficult to swallow, and the choice of a convenient method of use is allowed only for the solutab dosage form and is not provided for others, including microcrystalline ones.

4. The use of amoxicillin (or macrolides) in patients with CAP without concomitant diseases and modifying factors is prescribed by the current in our country “Protocol for the provision of medical care to patients with community-acquired pneumonia” (put into effect by order of the Ministry of Health of Ukraine No. 128 dated 03.19.2007 .). Therefore, the appointment in such cases of a combination of amoxicillin with clavulanate is not only unreasonable, but also a violation of the documents regulating medical activity.


In recent decades, evidence-based medicine has increasingly invaded clinical practice and largely determines it. All the more attention deserves the statements of people who have done a lot for the development of evidence-based medicine. At the end of the article, I would like to quote the words of the now deceased J.D. Williams, former president of the European Association of Chemotherapists and editor of Antibiotic Chemotherapy. At the turn of the century, in the September 1999 issue.of the mentioned bulletin, he wrote:

“… There are no perfect clinical studies or perfect recommendations [for treatment] …

In our age of penicillin-resistant pneumococci, Chlamydia pneumoniae and many other microorganisms that cause pneumonia, I have a request to our doctors: if I get into your hands with pneumonia, please treat me first with amoxicillin (in a large dose, please, and more often than twice a day) ”[18].


1.Lave J.R., Lin C.J., Fine M.J., Hughes-Cromwick P. The cost of treating patients with community-acquired pneumonia // Seminars in Respiratory and Critical Care Medicine. – 1999. – 20. – 189-97.

2. Niederman M.S., McCombs J.S., Unger A.N., Kumar A., ​​Popovian R. The cost of treating community-acquired pneumonia // Clin. Ther. – 1998. – 20. – 820-37.

3. Mandell L. A., Wunderink R. G., Anzueto A., Bartlett J. G., Campbell G. D., Dean N. C. et al. Infectious Diseases Society of America / American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults // Clin.Infect. Dis. 2007. 44 (Suppl. 2). – S27-S72.

4. Macfarlane J.T., Boldy D. 2004 update of BTS pneumonia guidelines: what’s new? // Thorax. – 2004 .– 59 .– 364-366.

5. Agence française de sécurité sanitaire des produits de santé. Systemic antibiotic treatment in upper and lower respiratory tract infections: official French guidelines // Clin. Microbiol. Infect. – 2003 .– 9. – 1162-78.

6. Chuchalin A.G., Sinopalnikov A.I., Yakovlev S.V., Strachunsky L.S., Kozlov R.S., Rachina S.A. Community-acquired pneumonia in adults: practical recommendations for diagnosis, treatment and prevention: A guide for doctors. – Smolensk, 2003.

7. Protocol for providing medical assistance We have a problem with non-hospital and nosocomial (hospital) pneumonia in adults: etiology, pathogenesis, classification, diagnostics, antibacterial therapy. Approved by the order of the Ministry of Health of Ukraine dated 19.03.2007 r. No. 128.

8.Bereznyakov I.G. Community-acquired pneumonia. – Donetsk: Publisher Zaslavsky A.Yu., 2009.

9. Maimon N., Nopmaneejumruslers C., Marras T.K. Antibacterial class is not obviously important in outpatient pneumonia: a meta-analysis // Eur. Respir. J. – 2008. – 31. – 1068-1076.

10. Browner W.S., Newman T.B., Cummings S.R., Hulley S.B. Estimating sample size and power: the nitty gritty // Hulley S.B., Cummings S.R., Browner W.S., Grady D., Hearst N., Newman T.B., eds. Designing Clinical Research. Philadelphia: Lippincott Williams & Wilkins 2001. P. 65-91.

11. Riley P.D., Aronsky D., Dean N.C. Validation of the 2001 American Thoracic Society criteria for severe community-acquired pneumonia // Crit. Care Med. – 2004 .– 32 .– 2398-402.

12. Creer D.D., Dilworth J.P., Gillespie S.H. et al. Aetiological role of viral and bacterial infections in acute adult lower respiratory infection (LRTI) in primary care // Thorax.- 2006 .– 61 .– 75-9.

13. Mandell L.A., Bartlett J.G., Dowell S.F., File T.M. Jr., Musher D.M., Whitney C. Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults // Clin. Inf. Dis. – 2003 .– 37 .– 1405-33.

14. Jokinen C., Heiskanen L., Juvonen H. et al. Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland // Am. J. Epidemiol. – 1993 .– 137 .– 977-88.

15. Woodhead M.A., Macfarlane J.T., McCracken J.S. et al. Prospective study of the aetiology and outcome of pneumonia in the community // Lancet. – 1987. – 1. – 671-4.

16. Almirall J., Bolibar I., Vidal J. et al. Epidemiology of community-acquired pneumonia in adults: a population-based study // Eur. Respir. J. – 2000. – 15. – 757-63.

17. Reshedko G.K., Kozlov R.S. The state of resistance to anti-infectious chemotherapy drugs in Russia // Practical guide to anti-infectious chemotherapy / Ed.L.S. Strachunsky, Yu.B. Belousova, S.N. Kozlova. – Smolensk: MAKMAKH, 2007. – S. 32-46.

18. Williams J.D. Opinion: a rash rush of guidelines // Antibiotic Chemotherapy. 1999. 3 (3). – 12.

How to prevent a pandemic due to addiction to antibiotics

Photo: Moscow City News Agency

Russians, like citizens of many other countries, are accustomed to self-medication.Many do not even see anything shameful in prescribing an antibiotic drug for themselves, just in case, for a runny nose or slight malaise. As a result, when a really dangerous infection occurs, its pathogen successfully resists the drugs. To raise awareness of the issue, the World Health Organization (WHO) organizes Antibiotic Awareness Week each year during the height of the cold season. Within its framework, the ways out of the “antibiotic” crisis were discussed at a round table in the Federation Council.

Scarecrow about invulnerable germs becomes reality

A long period of uncontrolled use of antimicrobial drugs has led to the spread of forms of microorganisms that are resistant to antimicrobial drugs. Bacteria are increasingly developing the ability to survive under the influence of drugs designed to fight them. In Europe alone, the resistance of pathogens to clarithromycin, which is used to treat stomach diseases, has doubled in 20 years.This is evidenced by the results of a study that was recently presented at the Gastroenterology Congress in Barcelona.

Desensitization to antibiotics could return humanity to a pre-antibiotic era, when common infections could easily kill people. More than 700 thousand people die from drug resistance in the world every year, of which 22 thousand cases are in European countries, said Igor Kagramanyan, First Deputy Chairman of the Federation Council Committee on Social Policy , opening the round table.

“According to international experts, if coordinated measures are not taken at the state level under the auspices of the World Health Organization, then by 2050 this figure may increase to 10 million people,” the senator continued.

Over time, there may simply be no working antibiotics left, and infectious diseases will acquire the scale of pandemics. “The situation is particularly complicated by the fact that the pace of development and market entry of new antibiotics has slowed sharply in recent decades.And the likelihood that new antibiotics will appear in the near future, which will be used instead of drugs that are ineffective due to drug resistance, is rather small, ”added Kagramanyan.

Russian microbiologists and clinical pharmacologists are working together to develop measures to be taken in the near future, assured Assistant Minister of Health Lyalya Gabbasova . In September 2017, the Government approved the Strategy for preventing the spread of antimicrobial resistance.

“The problem of antimicrobial resistance over the past 20 years has acquired particular relevance in countries with developed health systems and intensive agriculture. They began to assess it as a factor of a global biological threat, to create government commissions and state programs. In Russia, this topic is indicated as one of the priority areas in the “Fundamentals of State Policy in the Field of Chemical and Biological Safety of the Russian Federation for the Period until 2025,” Gabbasova recalled.

The problem of antimicrobial resistance over the past 20 years has acquired particular relevance in countries with developed health systems and intensive agriculture.

One of the components of the strategy is an educational program on the use of medicines among citizens. The motto of the information campaign is “Antibiotic is a reliable weapon if the target is a bacterial infection”. Anyone can go to antibiotic-save.ru to find out about these drugs.

Antibiotics will be told “stop” in animal husbandry

A separate problem is the widespread use of antibiotics by agricultural producers.The drugs are given to animals for prophylaxis, and they often remain in the meat that ends up in stores and markets.

“Unfortunately, we quite often find drug residues in animal products. This also applies to poultry farming, pig farming, and animal husbandry in general, ”admitted Leonid Kish , Director of the All-Russian State Center for the Quality and Standardization of Medicines for Animals and Feed.

Thus, the center tested the popular drug amoxicillin.According to the instructions, it is excreted from the pig’s body after two weeks, but this did not happen after four. The indicators came to the level of the norm only after two months.

Determination of the sensitivity of the culture to antibiotics. Photo: wikimedia.org

In addition, the manufacturer is most interested in the safety of the livestock, and this leads to the uncontrolled use of pharmacological substances.“Antibiotics cannot be used for prophylaxis, our task is to make it profitable to dispense them only by prescription and only for medicinal purposes,” Kish emphasized.

The Ministry of Agriculture, together with Rosselzoznadzor, have already prepared a draft law, which is dedicated to the use of drugs in veterinary medicine. “On the one hand, our task is to preserve the livestock, and on the other, we must not allow anything left in the products of animal origin, which in the future can negatively affect human health,” explained Polina, Deputy Director of the Veterinary Department of the Ministry of Agriculture Smyshlyaeva .

WHO recommendation

  • Never buy antibiotics without a doctor’s prescription.
  • Do not expect your doctor to prescribe antibiotics for every infectious disease. Many respiratory infections, including colds and flu, are caused by viruses. Antibiotics can only cure bacterial infections; if they are not effective for your disease, you do not need these drugs, and their use may make you more vulnerable in the future.
  • If you are prescribed antibiotics, take them exactly as directed by your doctor or pharmacist. Always finish the prescribed course of treatment, even if you feel much better. If you don’t, the infection may return.
  • Never take medicines that have been prescribed for another person or for another medical condition.
  • Try to prevent infections. Wash your hands regularly and encourage your family and colleagues to do the same.
  • Vaccination is an important step in preventing certain bacterial infections. Farmers should only give antibiotics to their animals as directed by a veterinarian and not as growth stimulants that contribute to the spread of resistance.

Treatment of adenoids in children – ENT clinic No. 1

Effective treatments for adenoids in children

In ENT clinic No. 1, adenoids are treated in children

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Methods for the treatment of adenoids in children

Until recently, the main method of treatment of adenoids in children was adenotomy and adenectomy – incomplete or complete removal of adenoid vegetations from the nasopharynx. The operation can be performed under local or general anesthesia using routine or endoscopic technology. However, adenotomy does not always lead to the elimination of the pathological condition, since postoperative relapses of hypertrophy and inflammation of the pharyngeal tonsil often occur.Adenotomy was so widely used in the 1950s that about 50% of the child population in the United States and Great Britain was devoid of tonsils. Subsequently, it was found that it was this contingent that most often suffered from poliomyelitis, especially its bulbar form. Often, children underwent repeated operations due to recurrent adenoids (their repeated increase). Symptoms of adenoiditis returned, i.e. the operations were ineffective.

Considering the high role of the lymphoid tissue of the pharynx in the formation of the body’s immunological defense, indications for surgical treatment of adenoid vegetations are significantly narrowed today.In this regard, the development of conservative methods for the treatment of chronic adenoiditis, especially in children with allergic respiratory diseases, becomes urgent.

Treatment of adenoiditis, as the treatment of any disease, should be comprehensive, taking into account the causes and nature of the course of the inflammatory process. Treatment is selected individually, based on examination data, the results of laboratory research methods, and the child’s medical history.

To date, according to the main effect of the therapeutic action, the following directions in the drug treatment of adenoiditis can be distinguished:

  • rinsing the nasal cavity – irrigation therapy;
  • anti-inflammatory therapy;
  • antimicrobial therapy;
  • immunocorrective therapy;
  • physiotherapy (ultraviolet irradiation, laser therapy, electrophoresis).

Let’s take a closer look at each point.

The role of irrigation therapy is to mechanically remove mucus, which in conditions of inflammation contains microorganisms, products of inflammation, etc. By removing pathological secretions from the nasal cavity, the surface of the nasal mucosa and nasal breathing are cleared, which facilitates the penetration of drugs (if necessary). The choice of preparations for washing with moistening of the nasal and pharyngeal mucosa is quite wide.By their composition, the preparations are saline solutions of different concentrations. It should be borne in mind that nasal lavage sometimes leads to complications in the form of tubo-otitis and acute otitis media. there may be a solution to the auditory tube. Frequent, excessive rinsing of the nose contributes to the formation of subatrophic rhinitis, rhinopharyngitis.

When pathogenic microflora is detected, antibacterial drugs are used according to indications, as a rule, during an exacerbation of adenoiditis.According to the child’s condition and the severity of symptoms, local and systemic drugs are prescribed. Aminopenicillins (amoxicillin), cephalosporins (cefuroxime axetil, cefixime, ceftibuten, etc.), macrolides (azithromycin, clindamycin, etc.) are prescribed. In children’s practice, soluble forms of solutabs, suspensions are preferred. The use of systemic antibiotics entails a lot of undesirable effects: the mucous membranes of the gastrointestinal tract are irritated, there may be vomiting, diarrhea, dysbiosis, candidiasis of the oral cavity.

Antiviral drugs may be used in frequently ill children.They are usually prescribed in the acute period of the disease or in case of relapse. Outside of exacerbation, viruses are inaccessible to drugs. The use of drugs-inducers of interferonogens is shown. In particular, there is a positive experience with the use of immunomodulators of systemic action – Imunorix, bronchomunal, ribomunil, cycloferon, etc.

If a child belongs to the group of “frequently ill children”, it is necessary to observe him by an immunologist. In childhood, both congenital and transient and acquired disorders of the immune system are possible.This requires the determination of the state of the immune system (immune status), and its correction according to indications.

Anti-inflammatory therapy

The most effective anti-inflammatory drugs are topical intranasal glucocorticosteroids (THCS). Their mechanism of action is to reduce the reaction of inflammation: to reduce the formation of secretions (mucus) in the focus of inflammation, to reduce the swelling and volume of the adenoids.

In the treatment of adenoids, adenoiditis, physiotherapy has a good effect.

The apparatus “Cavitar” is effectively used in otorhinolaryngology.

The technique is simple, painless and comfortable even for a small patient.

The device irrigates mucous membranes with solutions with low doses of drugs activated by low-frequency ultrasound in combination with photochromotherapy (by the action of LED light sources with a narrow spectrum of radiation, with several wavelengths in the visible range. For irrigation of the nasal cavity, nasopharynx and oropharynx, antiseptic solutions are used ( miramistin, octenisept, chlorhexidine, etc. according to indications), antibiotics (ceftriaxone, fluimucil antibiotic, etc. according to indications) once a day for 3-5 minutes.The micromassage effect of the jet helps to wash out mucopurulent secretions from the nasal cavity, nasopharynx, and sanitize the tonsils. The solution, activated by ultrasound, has a more pronounced antibacterial and antimycotic effect directly in the focus of inflammation. Immediately after irrigation, endonasal photochromotherapy is carried out for 4–6 minutes.

Photochromotherapy has a different effect depending on the wavelength, topical radiation. Blue LED radiation has antibacterial, anti-edematous, analgesic effects, without additional heating of tissues; has a pronounced anti-inflammatory effect, stimulates local immunity, when exposed directly to the mucous membranes, it has a fast, persistent and long-term therapeutic effect in rhinosinusitis, otitis media, tonsillitis and pharyngitis.The antimicrobial effect of blue LED radiation on Staphylococcus aureus was revealed.

It has been established that red light has a stimulating effect on the immune activity of the tonsils, both immediately after treatment and in the long-term period (1-1.5 years), as well as a positive effect of this wavelength on the stage of proliferation in acute rhinitis; has a pronounced antiviral, antiexudative, immunostimulating effect. Photochromotherapy serves as an additional combined physical factor that consolidates the positive effects in the treatment of ENT pathology after ultrasonic irrigation of tissues.

Of the physiotherapy procedures, ultraviolet irradiation, through the nose, is often used. It has bactericidal properties. UHF on the nasal area has an anti-inflammatory effect. Magnetotherapy accelerates cell regeneration. With the help of electrophoresis, antiseptics, anti-allergic, anti-inflammatory drugs can be administered.

Laser radiation may be directly applied to the surface of the adenoids. But in order for the laser radiation to work, two conditions must be met: The laser must be brought directly to the adenoids using a special fiber-optic tube; before laser therapy, it is necessary to remove pus and mucus from the adenoids by rinsing the nose and nasopharynx with saline solutions.

Physiotherapy procedures are auxiliary methods of treatment. Under the influence of physiotherapeutic procedures, the body’s defenses, metabolic processes are activated, blood circulation, lymph outflow improve, and inflammation decreases.