Side effects, dosage, uses, and more

1. Amoxicillin is an antibiotic. It’s used to treat infections caused by certain types of bacteria.
2. Amoxicillin oral tablet comes as immediate-release (IR) or chewable tablets. The chewable tablet and IR tablet are only available as generic drugs.
3. Amoxicillin also comes as a capsule and a suspension. All forms are taken by mouth. (This article focuses on the oral tablet forms only.)

Amoxicillin oral tablet does not cause drowsiness, but it can cause other side effects.

More common side effects

The more common side effects of amoxicillin oral tablet can include:

• nausea
• vomiting
• diarrhea
• rash
• vaginal yeast infection

If these side effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Hypersensitivity reactions. Symptoms can include:
  • flu-like symptoms, such as fever, body aches, or sore throat
  • a painful red or purple rash that spreads
  • blisters that could cause the skin to break down and cause open sores
• Liver damage. This effect is rare. Symptoms can include:
  • increased liver enzymes shown on a blood test
  • pain in the abdomen (stomach area)
  • yellowing of the skin and eyes
  • tiredness
• Serious skin reaction.* This side effect is rare. Symptoms may include:
  • flu-like symptoms, such as fever, body aches, or sore throat
  • a skin rash and discoloration
  • swollen lymph nodes
  • itchiness

* Serious skin reactions were not reported in clinical trials of amoxicillin. However, they have been reported since the drug was approved.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare professional who knows your medical history.

• Finishing therapy: It’s important to finish the entire course of amoxicillin treatment as prescribed by your doctor. Do not stop taking this drug or skip doses if you start to feel better. This could cause your infection to last longer. You could also develop a resistance to the medication. This means that if you get a bacterial infection in the future, you may not be able to treat it with amoxicillin.
• Diarrhea: Amoxicillin may cause diarrhea. Call your doctor if you have bloody or watery diarrhea, with or without stomach cramps and fever.
• Serious skin reaction: Skin reactions can occur during amoxicillin treatment. In rare cases, serious skin reactions such as Steven-Johnson syndrome or toxic epidermal necrolysis may occur. Talk with your doctor if you experience a skin rash or condition that becomes bothersome or doesn’t go away.
• Serious allergic reaction: This drug can cause a serious allergic reaction. This reaction can be fatal (cause death). If you’re allergic to other antibiotics, such as penicillins or cephalosporins, your risk for an allergic reaction may be higher. Call your doctor right away if you have trouble breathing or swelling of your throat or tongue while you’re taking this drug.

Amoxicillin is a prescription antibiotic. It’s used to treat infections caused by a certain type of bacteria. It may be used as part of combination therapy. This means you may need to take it with other medications.

The oral tablet comes as an immediate-release (IR) tablet and chewable tablet. These are only available as generic drugs.

Generic drugs usually cost less. Amoxicillin also comes as a capsule and a suspension. All forms are taken by mouth. This article focuses on the oral tablet forms only.

Why it’s used

Amoxicillin is an antibiotic. It’s used to treat infections caused by a certain type of bacteria.

Amoxicillin may be used as part of combination therapy. This means you may need to take it with other medications.

How it works

Amoxicillin belongs to a class of drugs called penicillins. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Amoxicillin works by killing bacteria and stopping its growth in your body.

How long it lasts

The effects of amoxicillin should last as long as you continue taking the drug. Amoxicillin is typically a short-term treatment.

Amoxicillin typically stays in your system for 8 to 12 hours after your most recent dose. It’s possible to continue experiencing some effects of amoxicillin after you stop taking the drug, especially during this 8-hour to 12-hour period. However, the drug’s effects typically end when your treatment ends or soon afterward.

There have been reports of diarrhea lasting for up to 2 months after people stopped amoxicillin treatment. If you experience diarrhea after stopping amoxicillin, especially along with a fever or abdominal pain, talk with your doctor.

Amoxicillin oral tablets start working right away after taking a dose. It can take up to a couple of days after your first dose for the drug to start reducing symptoms of your infection.

If you have questions about how long amoxicillin treatment or its effects last, you can talk with your doctor.

As with all medications, the cost of amoxicillin can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use. You can refer to this article for details about the cost of amoxicillin treatment.

Financial and insurance assistance

Financial assistance to help you pay for amoxicillin may be available.

Medicine Assistance Tool and NeedyMeds are two websites offering resources that may help decrease the price you pay for amoxicillin. They also offer tools to help you find low cost healthcare, as well as educational resources. To learn more, visit their sites.

You can also refer to the coupons in this article for possible ways to save on amoxicillin oral tablets.

To learn more about saving money on prescriptions, check out this article.

Mail-order pharmacies

Amoxicillin may be available through a mail-order pharmacy. Using this service may help lower the drug’s cost and allow you to get your medication without leaving home.

If you’re interested in this option, check with your doctor, pharmacist, or insurance company. Some Medicare plans may help cover the cost of mail-order medications.

If you don’t have insurance, you can ask your doctor or pharmacist about online pharmacy options.

This dosage information is for amoxicillin oral tablet. All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

• your age
• the condition being treated
• how severe your condition is
• other medical conditions you have
• how you react to the first dose

Forms and strengths

Generic: amoxicillin

• Form: oral tablet
• Strengths: 500 milligrams (mg), 875 mg
• Form: oral chewable tablet
• Strengths: 125 mg, 250 mg

Note: Amoxicillin also comes as a capsule and a suspension, both of which are taken by mouth. This article focuses on the oral tablet forms only.

Dosage for infections of the ears, nose, and throat

IMMEDIATE-RELEASE TABLET AND CHEWABLE TABLET

Adult dosage (ages 18–64 years)

Typical dosage is 500 mg every 12 hours, or 250 mg every 8 hours.

Child dosage (ages 3 months–17 years)

Typical dosage is 25 mg per kilogram per day (mg/kg/day) in divided doses every 12 hours, or 20 mg/kg/day in divided doses every 8 hours.

The children’s dosage listed here is meant for children who weigh less than 88 pounds (40 kg). Children who weigh more than 88 pounds should be dosed according to the adult recommendations.

Child dosage (ages 0–2 months)

Maximum dosage is 30 mg/kg/day. Your child’s doctor can tell you more about dosage.

Dosage for urinary tract infections

Adult dosage (ages 18–64 years)

Typical dosage is 500 mg every 12 hours, or 250 mg every 8 hours.

Child dosage (ages 3 months–17 years)

Typical dosage is 25 mg/kg/day in divided doses every 12 hours, or 20 mg/kg/day in divided doses every 8 hours.

Child dosage (ages 0–2 months)

Maximum dosage is 30 mg/kg/day. Your child’s doctor can tell you more about dosage.

Older adult dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

Your doctor may start you on a lower dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Special considerations

• For children’s dosage: The children’s dosage listed here is meant for children who weigh less than 88 pounds (40 kg). Children who weigh more than 88 pounds should be dosed according to the adult recommendations.

Dosage for skin infections

Adult dosage (ages 18–64 years)

Typical dosage is 500 mg every 12 hours, or 250 mg every 8 hours.

Child dosage (ages 3 months–17 years)

Typical dosage is 25 mg/kg/day in divided doses every 12 hours, or 20 mg/kg/day in divided doses every 8 hours.

The dosage listed here is meant for children who weigh less than 88 pounds (40 kg). Children who weigh more than 88 pounds should be dosed according to the adult recommendations.

Child dosage (ages 0–2 months)

Maximum dosage is 30 mg/kg/day. Your child’s doctor can tell you more about dosage.

Older adult dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

Your doctor may start you on a lower dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Dosage for lower respiratory tract infections

Adult dosage (ages 18–64 years)

Typical dosage is 875 mg every 12 hours, or 500 mg every 8 hours.

Child dosage (ages 3 months–17 years)

Typical dosage is 45 mg/kg/day in divided doses every 12 hours, or 40 mg/kg/day in divided doses every 8 hours.

Child dosage (ages 0–2 months)

Maximum dosage is 30 mg/kg/day. This is meant for children who weigh less than 88 pounds (40 kg). Children who weigh more than 88 pounds should be dosed according to the adult recommendations. Your child’s doctor can tell you more about dosage.

Older adult dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

Your doctor may start you on a lower dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Dosage for gonorrhea

Adult dosage (ages 18–64 years)

Typical dosage is 3 grams (g) as a single dose.

Child dosage (ages 24 months–17 years)

Typical dosage is 50 mg/kg amoxicillin combined with 25 mg/kg probenecid as a single dose. The children’s dosage listed here is meant for children who weigh less than 88 pounds (40 kg).

Children who weigh more than 88 pounds should be dosed according to the adult recommendations.

Child dosage (ages 0–23 months)

This medication should not be used in children younger than 2 years of age for treatment of gonorrhea.

Older adult dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

Your doctor may start you on a lower dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Dosage for stomach and intestinal ulcers

Adult dosage (ages 18–64 years)

• Typical dosage for triple therapy: 1 g amoxicillin with 500 mg clarithromycin and 30 mg of lansoprazole, all given twice per day for 14 days.
• Typical dosage for dual therapy: 1 g amoxicillin and 30 mg of lansoprazole, given three times per day for 14 days.

Child dosage (ages 0–17 years)

This drug has not been studied in children to treat stomach and intestinal ulcers.

Older adult dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

Your doctor may start you on a lower dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Amoxicillin oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking.

To find out how this drug might interact with something else you’re taking, talk with your doctor or pharmacist.

Examples of drugs that can cause interactions with amoxicillin are listed below.

Drugs that increase the risk of side effects from amoxicillin

Taking amoxicillin with certain medications raises your risk of side effects from amoxicillin. This is because the amount of amoxicillin in your body may be increased. Examples of these drugs include:

• Probenecid: Taking probenecid with amoxicillin could lead to increased blood levels of amoxicillin. A doctor may need to decrease the dose of amoxicillin in some patients.
• Allopurinol: If you use allopurinol and amoxicillin together, you may develop a rash.

Interactions that increase the risk of side effects from other drugs

Taking amoxicillin with certain medications raises your risk of side effects from these medications. Amoxicillin increases the amount of these drugs in your body.

Examples of these drugs include drugs to treat blood clots. These are called anticoagulants (or blood thinners) and include warfarin (Jantoven), apixaban (Eliquis), heparin, and others.

If you use these drugs with amoxicillin, you have a higher risk of bleeding. Your doctor may adjust your dose of amoxicillin as a result.

Interactions that can make your drugs less effective

When amoxicillin is less effective: When amoxicillin is used with certain drugs, it may not work as well. In vitro studies have shown potential interactions that can cause the amount of amoxicillin in your body may be decreased.

Because in vitro studies are only conducted in a lab and not on live subjects, it is not clear whether this can significantly impact you if you’re taking amoxicillin with these drugs.

Nevertheless, examples of these drugs include:

• Chloramphenicol
  • If you use these drugs together, your doctor will likely keep your dosage of amoxicillin the same.
• Macrolides, such as erythromycin, clarithromycin, or azithromycin
  • If you use these drugs together, your doctor will likely keep your dosage of amoxicillin the same.
• Sulfonamides, such as sulfamethoxazole
  • If you use these drugs together, your doctor will likely keep your dosage of amoxicillin the same.
• Tetracyclines, such as tetracycline or doxycycline
  • If you use these drugs together, your doctor will likely keep your dosage of amoxicillin the same.

When other drugs are less effective: When certain drugs are used with amoxicillin, they may not work as well. This is because the amount of these drugs in your body may be decreased. Examples of these drugs include:

• Oral contraceptives (birth control)
  • If you need to take amoxicillin, you should consider using a barrier method of birth control while on amoxicillin. Or, your doctor may prescribe a different form of birth control for you.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare professional about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you’re taking.

This drug comes with several warnings.

Allergies

Amoxicillin can cause a severe allergic reaction. Symptoms can include:

• trouble breathing
• swelling of your throat or tongue

If you have an allergic reaction, call your doctor or seek guidance from America’s Poison Centers at 800-222-1222 or through its online tool. If your symptoms are severe, call 911 or go to the nearest emergency room. Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Warnings for people with certain health conditions

For people with mononucleosis (mono or kissing disease): Amoxicillin raises your risk of developing a severe rash.

For people with diabetes: Amoxicillin may cause you to have a false-positive reaction when testing for glucose (sugar) in the urine. Talk with your doctor about how to manage your blood sugar while taking amoxicillin.

For people with kidney disease: If you have severe kidney disease, your kidneys may not clear this drug from your body quickly. As a result, levels of amoxicillin may build up in your body. To help prevent this, your doctor may give you a lower dose of this drug.

Warnings for other groups

For pregnant people: Research in animals has not shown adverse effects on the fetus when pregnant animals were exposed to amoxicillin. There haven’t been enough studies done on humans to be certain if the drug poses a risk to the fetus. However, you may want to still speak with your doctor if you’re pregnant or planning to become pregnant.

For people who are breastfeeding (nursing): Amoxicillin may pass into breast milk and may cause side effects in a child who is breastfed. Talk with your doctor if you are breastfeeding your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

For older adults (ages 65 years and over): The kidneys of older adults may not work as well as those of younger adults. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

Amoxicillin oral tablet is used for short-term treatment. It comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all: Your bacterial infection may not heal or may get worse.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

It’s important to finish the entire course of treatment as prescribed by your doctor. Do not stop taking the drug or skip doses if you start to feel better. This could cause your infection to last longer.

You could also develop a resistance to the medication. This means if you get a bacterial infection in the future, you may not be able to treat it with amoxicillin.

If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose may not be significant at less than 250 mg/kg. In higher-dose cases, it may lead to kidney failure.

If you think you’ve taken too much of this drug, call your doctor or seek guidance from America’s Poison Centers at 800-222-1222 or through its online tool. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working: The symptoms of your infection should ease.

Keep these considerations in mind if your doctor prescribes amoxicillin oral tablet for you.

General

• Take this drug at the time(s) recommended by your doctor.
• You can take the amoxicillin capsule, tablet, or suspension with or without food.
• You can crush, cut, or chew regular or chewable amoxicillin tablets.

Storage

Store amoxicillin at room temperature between 59°F and 86°F (15°C and 30°C). Keep this drug away from light. Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication may be refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it in a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t hurt your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

You and your doctor should monitor certain health issues. This can help make sure you stay safe while you take this drug. These issues include your:

• Kidney function. Blood tests can check how well your kidneys are working. If your kidneys aren’t working well, your doctor may decide to lower your dosage of this drug.
• Liver function. Blood tests can check how well your liver is working. If your liver isn’t working well, your doctor may lower your dosage of this drug.

The cost of these blood tests will depend on your insurance coverage.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk with your doctor about other drug options that may work for you.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

What is the best antibiotic to treat strep throat?

Medically reviewed by Carmen Pope, BPharm. Last updated on Nov 10, 2022.

Penicillin or amoxicillin are considered the best first-line treatments for Strep throat. According to the CDC (Centers for Disease Control and Prevention) “There has never been a report of a clinical isolate of group A strep that is resistant to penicillin”.

For people with a penicillin allergy, treat Strep throat with either a narrow-spectrum cephalosporin (such as cephalexin or cefadroxil), clindamycin, azithromycin, or clarithromycin. Note that resistance to azithromycin and clarithromycin has been reported.

What are the recommended dosages of antibiotics used to treat Strep throat?

Antibiotic dosages can vary depending on age and weight. The CDC recommends the following dosages of antibiotics for Strep throat, for those people without a penicillin allergy. One dosage regimen should be chosen that is appropriate for the person being treated.

Oral Penicillin V

• Children: 250mg twice daily or 250mg three times daily for 10 days
• Adolescents and adults: 250mg four times daily or 500mg twice daily for 10 days

Oral amoxicillin

• Children and adults: 50 mg/kg once daily (maximum 1000mg once daily) for 10 days
• Children and adults: 25 mg/kg twice daily (maximum 500mg twice daily) for 10 days

Intramuscular Benzathine penicillin G

• Children <27 kg: 600 000 units as a single dose
• Children and adults ≥27 kg: 1 200 000 units as a single dose

The CDC recommends the following dosages of antibiotics for Strep throat, for those people with a penicillin allergy. One dosage regimen should be chosen that is appropriate for the person being treated.

• Oral cephalexin 20 mg/kg twice daily (maximum 500 mg twice daily) for 10 days
• Oral cefadroxil 30 mg/kg once daily (maximum 100mg once daily) for 10 days
• Oral clindamycin 7 mg/kg three times daily (maximum 300 mg three times daily) for 10 days
• Oral azithromycin 12 mg/kg once daily for the first day (maximum 500 mg), followed by 6 mg/kg once daily (maximum 250 mg once daily) for the next 4 days
• Oral clarithromycin 7.5 mg/kg twice daily (maximum 250 mg twice daily) for 10 days.

Are antibiotics always necessary to treat a Strep throat?

Although most Strep throats will get better by themselves, there is a risk of acute rheumatic fever and other complications (such as oral abscesses or mastoiditis [a bacterial infection in the mastoid process, which is the prominent bone behind the ear]) occurring. The CDC recommends that all patients, regardless of age, who have a positive rapid antigen detection test (RADT) (also known as the rapid streptococcal test, which detects the presence of GABHS cell wall carbohydrate from swabbed material) or throat culture receive antibiotics.

Antibiotics have been shown to:

• Shorten the duration of Strep throat symptoms
• Reduce the likelihood of transmission to family members, friends, and other close contacts
• Prevent the development of rheumatic fever and other complications.

Viral sore throats should not be treated with antibiotics. Treatment is usually given for ten days and liquid antibiotics can be given to children who are unable to swallow tablets or capsules. Some patients may benefit from a single shot of penicillin intramuscularly.

What are the symptoms of a Strep throat?

Generally, Strep sore throats tend to be very painful and symptoms persist for a lot longer than sore throats due to another cause. Swallowing may be particularly difficult and painful. Symptoms of a Strep throat may include:

• Sudden onset of sore throat
• Very red and swollen-looking tonsils and back of the throat
• Sometimes streaks of pus or red spots may appear on the roof of the mouth
• A headache
• Fever and Chills
• Swollen and tender glands (lymph nodes) in the neck.

Children are more likely to feel sick (develop nausea) and vomit.

People with a Strep throat do NOT typically have a cough, runny nose, hoarseness, mouth ulcers, or conjunctivitis. If these symptoms occur there is more likely to be a viral cause for the sore throat.

Some people (usually children aged 4 to 8years) are susceptible to the toxins (poisons) produced by the S. pyrogenes bacteria and develop a bright red rash that feels like sandpaper to the touch. A rash caused by S. pyrogenes bacteria is known as Scarlet Fever (also called scarlatina). Although it usually follows a sore throat, it may also occur after school sores (impetigo).

How is a Strep throat diagnosed?

A throat swab taken by a doctor and then cultured in a laboratory is the only way to definitively tell if a sore throat is a Strep throat. If the result is positive, your doctor will prescribe antibiotics to prevent any complications, reduce symptoms, and prevent spread to other people.

Are Strep throats contagious?

Yes, Strep throats are contagious, and the bacteria are easily transmitted and spread by coughing or sneezing or after coming into contact with infected droplets, and then touching your mouth, nose, or eyes. Transmission of bacteria can also occur via contact with people with Scarlet fever, or other group A skin infections.

Without treatment, people with Strep throat can pass on the bacteria to others for one to two weeks after symptoms appear. The best way to prevent infection is to wash your hands often and always before eating or after being in contact with an infected person. Do not share utensils, linen, or personal items. People with Strep throat or scarlet fever should stay home for at least 24 hours after starting antibiotics or until they feel well enough to return to school or work.

What is scarlet fever?

Scarlet fever is the name given to a bright red rash that develops following a Strep throat, although it can also develop following school sores (impetigo).

Scarlet fever is less common than it was one hundred years ago because of antibiotic use and it only occurs in those who are susceptible to the toxins produced by the Streptococcal bacteria. It mostly occurs in children aged 4 to 8 years. By 10 years old more than 80% of children have developed lifelong protective antibodies against streptococcal toxins, whilst infants younger than 2 still have antibodies against the toxin that they acquired from their mother. This means that if two children in one family develop Strep throat, only one may develop scarlet fever.

Scarlet fever is a bright red rash that feels like sandpaper to the touch. The rash typically starts on the neck, underarm, or groin as small, flat red blotches that gradually become fine bumps and feel rough to the touch. In the body folds (such as in the armpits, elbows, and groin) the rash may appear a brighter red (called Pastia’s lines). Facial flushing is common although a pale area may remain around the mouth. After seven days, the rash fades and some skin peeling may occur over the next month or longer, particularly around the fingertips, toes, and groin area.

Left untreated, Scarlet fever may progress to:

• Ear, sinus, and skin infections
• Joint inflammation
• Rheumatic fever (an inflammatory disease that can cause permanent heart damage and also affect the brain, joints, and skin)
• Otitis media
• Pneumonia
• Septicemia
• Glomerulonephritis
• Osteomyelitis.

In the pre-antibiotic era, death occurred in 15-20% of people with Scarlet fever. Nowadays, most people fully recover within four to five days with antibiotics.

What is Rheumatic Fever?

Rheumatic fever can develop following a Strep throat infection or scarlet fever. Although rare in the contiguous U.S., the disease is still prevalent in children of Samoan descent living in Hawaii and residents of American Samoa.

Symptoms of rheumatic fever usually show 14 to 28 days after a Strep infection. Because the bacteria trick the body’s immune system into attacking healthy tissues, the disease can affect the heart, joints, skin, and brain.

Symptoms of rheumatic fever include:

• Fever
• Abdominal pain
• Chest pain or shortness of breath
• Joint swelling, pain, redness, or warmth
• Nose bleeds
• A rash on the upper part of the arms or legs (usually ring-shaped or snake-like)
• Skin nodules or lumps
• Unusual crying or laughing or quick jerky movements of the face, hands, or feet.

Rheumatic fever has the potential to cause life-long cardiac problems if not treated promptly or properly. Antibiotics are effective at preventing the disease if administered within nine days of symptoms. Children who develop rheumatic fever may need regular penicillin injections until the age of 21 or for 10 years after diagnosis.

References

• Oakley A. Scarlet fever. DermNet NZ. Updated Sept 2015. https://dermnetnz.org/topics/scarlet-fever/#:~:text=Scarlet%20fever%20occurs%20mostly%20in,and%20females%20are%20affected%20equally.
• Pharyngitis (Strep Throat) Centers for Disease Control and Prevention https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html#:~:text=Penicillin%20or%20amoxicillin%20is%20the,is%20common%20in%20some%20communities.

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Medical Disclaimer

Antibiotics for the treatment of sore throat: for or against?

PUBLICATIONS

During the discussion, the following points were discussed:

It is important to emphasize the difference between sore throat, pharyngitis, and tonsillitis: the latter two refer to the physical detection, while the former refers to the subjective symptom.

A sore throat is often associated with a cold. According to a recent study, more than 80% of students with an acute viral respiratory tract infection had pain at the onset of the disease.

Viruses can be detected in up to two-thirds of children with pharyngitis using polymerase chain reaction analysis. Scientists believe that antibiotics should be given to 30-40% of patients with confirmed GAS (Group A streptococcus) infection. The potential role of Fusobacterium necrophorum has been reconsidered, but there is no evidence of benefit from antibiotic treatment in cases of this infection.

It has been suggested that instead of focusing on the sore throat, the question of whether antibiotics should be used to treat GAS infection should be discussed. The question of confirming the diagnosis remained open. The use of diagnostic tools such as Centor, McIsaac and FeverPAIN has been recommended: the higher the score, the more likely the patient is suffering from a GAS infection.

Symptom scores are often inaccurate, especially in young children. An example was given of a report that examined the use of the Centor instrument in 441 children attending a pediatric emergency department. The authors concluded that the Centor criteria were ineffective in predicting a positive GAS culture in throat swabs from symptomatic patients.

It is widely accepted that antibiotics should be avoided in viral infections. A clinical case was discussed of a patient with a 2-day history of sore throat, fever, enlarged tonsils and cervical lymph nodes, but no cough or rhinitis; the patient had a FeverPAIN score of 4–5 and 4 points, in accordance with European recommendations, it is an indication for antibiotic treatment. However, swabs were positive for adenovirus.

Also cited was a similar case where a 5-year-old boy had a FeverPAIN score of 4-5 and a Centor score of 3. The culture from his throat swab was GAS positive, illustrating the problem of distinguishing between bacterial and viral infections.

If cultures from the pharynx are GAS-positive, is this a direct indication for antibiotic therapy? On the one hand, it prevents serious complications such as rheumatic fever. At the same time, there is a low level of acute rheumatic fever in developed countries (in Hungary there has not been a single case in the last 30 years).

At the moment, there is no statistically significant evidence that antibiotics prevent the development of angina. The delay in seeking care means that the window for treatment is often missed. However, if symptoms appear early, there is no statistical evidence that antibiotics can prevent the development of angina. In addition, such prevention means excessive use of antibiotics.

A Cochrane review indicates a reduction in the duration of sore throat and fever with antibiotic therapy. In addition, compared with placebo, antibiotics reduce the incidence of purulent complications such as acute otitis media and sinusitis after sore throat. Other studies have also pointed to the potential benefit of reducing transmission within families where one of the relatives with pharyngitis was GAS positive.

Source:

medscape.com/viewarticle/942876#vp_1

whether they help with influenza and SARS, what and when to take

During the epidemic of colds, everyone is in a hurry to stock up on antibiotics. However, if used incorrectly, they can be harmful to health. In the article, we understand whether antibiotics are needed for colds, why they are prescribed for ARVI and other viral infections, and why self-medication is dangerous.

How antibiotics work

Antibiotics are antibacterial drugs. They affect the metabolic processes of bacteria and disrupt protein synthesis. This prevents reproduction and stops the growth of the colony (bacteriostatic effect) or leads to the death of the pathogenic microbe (bactericidal effect).

Does an antibiotic help with a cold

In medicine, the common cold most often means SARS – respiratory diseases that are caused by viruses. Pathogenic viruses are fundamentally different from bacteria, fungi and other microorganisms. This is a cell-free entity that is not able to carry out metabolism and reproduce on its own.

The virus is an absolute parasite: it uses host cells for all life processes. Outside a living organism, it is a collection of crystals consisting of protein molecules, which does not show signs of vital activity. And when the viral part (virion) is introduced into a living cell, it begins to replicate, that is, to reproduce many of its own copies.

Since the virus does not synthesize protein on its own, the antibiotic has no effect on it. Therefore, it is useless to use antibacterial drugs for an uncomplicated viral infection. In such cases, antiviral agents are effective – their active substances prevent the penetration of the virus into the cell and replication.

When to take antibiotics for a cold

If antibiotics do not help against viruses, why do doctors prescribe them? Such an appointment is justified if:

● A cold has a bacterial nature, for example, a patient has streptococcal tonsillitis ¹ .

● Both viruses and bacteria are involved in the infection at the same time – this is called a mixed infection.

● A bacterial infection joins the disease caused by a virus. This process is called superinfection. The protective barrier of the affected tissues is weakened, and they become vulnerable even to opportunistic microbes that are safe for a healthy person. This is a common complication of the common cold – it develops in the range of 4-66% ² cases.

To accurately determine the pathogen, it is necessary to conduct laboratory tests – PCR analysis and bacteriological culture . But they take time to carry out, and treatment is usually needed now. Therefore, patients with mild ARVI are prescribed antiviral drugs and local antiseptics that act on all microbes, without tests.

According to the new clinical guidelines of the Ministry of Health of the Russian Federation ³ , published in February 2022, the priority group of drugs for the treatment of acute respiratory viral infections are direct antiviral drugs aimed at the cause of the disease. A new drug of this type is enisamia iodide (Nobasit ^® Forte). The active substance – enisamia iodide – blocks the penetration of the virus into the cell and limits its spread in the body ⁴ . The results of clinical studies have shown that taking enisamium iodide reduces the number of complications requiring antibiotic therapy by 4 times. It also reduces the risk of infection spreading to the lower respiratory tract ⁵ .

If the patient has purulent discharge or the condition has improved, and then worsened again, then antibacterial agents will be useful. Without analyzes, only 9 can be used0071 local forms of antibiotics – as part of nasal drops, sprays.

According to the clinical recommendations of the Ministry of Health, antibiotics for ARVI systemically (in the form of tablets, suspensions, injections) are prescribed only in the following cases :

● The development of acute tonsillitis against the background of a severe or moderate cold.

● Attachment of sinusitis, laryngitis, tracheitis, bronchitis. If the infection is mild, then even if it spreads beyond the upper respiratory tract, it is not recommended to use antibiotics earlier than 10–14 days.

● Development of pneumonia.

In all these cases, it is recommended to first refer the patient for analysis in order to confirm a bacterial infection and select the most effective antibiotic ³ .

How to take antibiotics correctly

To recover quickly and not harm the body, take antibiotics correctly:

● Buy a drug prescribed by a doctor from a pharmacy. The prescription usually lists the active ingredient, but if your doctor recommends a certain brand name, you should heed the advice. Not all medicines with one active substance act in the same way – it depends on the quality of raw materials, adherence to production technology, and auxiliary components.

● Follow the dosage and intervals indicated in the prescription or prescription sheet, even if they differ from the instructions in the package leaflet. The fact is that the instructions present average values, and the doctor selects the regimen and doses individually, guided by the state of your health. If you take an antibiotic more often or more than you need to, it will increase your risk of unwanted side effects. If you reduce the dose or forget to take the medicine on time, the bacteria will adapt, and the treatment will be useless – this antibiotic will have to be replaced with another one.

● The interval between antibiotic doses should be the same. If the doctor has prescribed to drink tablets three times a day, then they should be taken every 8 hours, and not for breakfast, lunch and dinner with a long night break.

● Ask your doctor or read the directions for when to take your antibiotic. Some drugs need to be taken before meals, they are poorly absorbed into the blood on a full stomach. Others should be taken after meals to prevent gastrointestinal side effects.

● Most medicines should only be taken with plain water, unless the directions say otherwise. Juice, tea, coffee, mineral water can reduce the effectiveness of the antibiotic. And their combination will create an environment that irritates the mucous membrane of the digestive tract.

● Do not split or crush the tablet before taking it, do not pour the powder from the capsule. The protective film prevents the destruction of the active substance by caustic gastric juice. If you find it difficult to swallow a large tablet, you can buy the same antibiotic in a lozenge or suspension form. It is worth remembering that such forms contain more auxiliary components that can cause allergies or increase blood glucose in a diabetic.

● Avoid alcohol during treatment. Many drugs do not interact well with alcohol (even if you drink a glass much later or earlier than the medication).

● Protect your digestive organs and kidneys. Taking medication creates an additional burden on the organs, so during the period of treatment, try not to overeat, do not eat a lot of fried, fatty, smoked. Replace fast food with homemade food.

● Do not stop taking the antibiotic if you feel better quickly and the doctor has prescribed a weekly course. To finally defeat the infection, the antimicrobial drug must be taken as much as the doctor prescribed.

If within three days of antibiotic therapy the condition does not improve or even worsens, consult a doctor, but do not change the drug yourself. Medical attention should be sought immediately if a skin rash, upset stool, headache, swelling, or other side effects appear on the background of an antibiotic.

What antibiotics to drink in case of SARS

An antibacterial agent for ARVI is prescribed by a general practitioner, otolaryngologist, pulmonologist. It is better to choose a drug according to the results of the analysis. The best way to find out which antibiotic the causative agent of the infection is most sensitive to is to do a bacteriological culture. The disadvantage of this analysis is a long wait: usually the results are ready only after 3-7 days. PCR is prepared much faster – from 24 hours, but the analysis does not show the sensitivity of a particular infectious agent to drugs.

If it is impossible to perform the analysis or there is no time to wait for the results for a long time, the doctor will prescribe an antibiotic, focusing on the most likely pathogens for a given localization of the infection.

Groups of antibiotics that are most often used for ARVI ⁶ :

● Semi-synthetic penicillins. For mild acute bacterial infections, amoxicillin is used, for moderate and chronic forms, amoxicillin / clavulanate.

● III-IV generation cephalosporins – ceftriaxone, ceftazidime, cefoperazone, cefepime – are used for chronic moderate and purulent infections.

● Macrolides – azithromycin, clarithromycin. They are used for allergies to penicillins.

● III-IV generation fluoroquinolones – levofloxacin, moxifloxacin. They replace antibiotics of the penicillin group in case of inefficiency.

Most drugs are available in the form of tablets (capsules), powders for suspension and injections. In outpatient practice, tablets and suspensions are more often used.

Why self-treatment is dangerous

Inappropriate antibiotic treatment can be harmful to health:

● Uncontrolled use of antibiotics increases the resistance of pathogenic microbes to them. If you abuse them for minor infections, they will most likely not help if you have a serious illness.

● Antibiotics often cause allergic reactions up to Quincke’s edema.

● A drug that you take without the knowledge of a doctor, in combination with medicines prescribed by a doctor, may give unpredictable results.

● Antibacterial drugs also kill the beneficial microflora of the body, which can lead to digestive disorders and gynecological inflammation.

● An additional unnecessary drug increases the load on the body and delays recovery.

How to avoid antibiotics

A bacterial infection requiring antibiotic treatment is a frequent continuation of a viral infection, its complication. The less tissues and the immune system are depleted by the virus, the lower the risk of developing such a scenario. From the first symptoms of SARS, start taking antiviral drugs. Especially effective are specific, directly acting on the virus. With colds and flu, enisamium iodide has proven itself well. This drug acts against most ARVI pathogens, facilitates the course of the disease, speeds up recovery and significantly reduces the risk of bacterial complications.

In order to prevent the development of a bacterial infection in ARVI, it is also important to facilitate nasal breathing and prevent sputum stagnation. To do this, drip vasoconstrictor drugs into the nose, in case of poor sputum separation, drink sputum thinners and expectorants, do inhalations.

Treat a viral infection in a timely manner, eliminate nasal congestion, facilitate coughing – this helps many to avoid taking antibiotics.

Historical note

In the middle of the twentieth century, antibiotics made a real revolution in medicine. Translated from Greek, their name means “against life” (“anti” and “bios”), but they only destroy bacteria. During the history of their existence, they have saved millions of new human lives.

Thanks to antibiotics, people:

● Significantly reduced maternal and child mortality rates in obstetrics, and later successfully introduced assisted reproductive technologies (IVF and others).

● We were able to cure previously incurable fatal and crippling diseases: tuberculosis, leprosy, syphilis and others.

● Learned how to perform the most complex operations without the fear of getting almost inevitable purulent-inflammatory complications.

Introduction of the first antibacterial drugs

Scottish bacteriologist Alexander Fleming is considered the “father” of antibiotics. During the experiments, he noticed: if you place different cultures of microbes next to each other, some begin to actively destroy others. In particular, fungi Penicillium notatum , which accidentally got into a Petri dish with cultures of staphylococci and streptococci, stopped the growth of these harmful bacteria.

The scientist undertook to investigate the mold and in 1929 isolated the first antimicrobial substance from it – penicillin . Animal experiments have shown encouraging results. Fleming’s assistant, who fell ill with purulent sinusitis, voluntarily tested the drug on himself and quickly felt a significant improvement in well-being. However, the scientist failed to develop technologies for the industrial production of the antibiotic.

This was done by the pathologist Howard Florey and the biochemist Ernst Chain. In early 1941, Flory managed to interest industrialists and the US government in the production of a new drug. By the end of 1942, the first large batch was released, marking the beginning of the era of antibiotics. After another 10 years, these drugs became available everywhere, thanks to a significant reduction in the cost of technology and the launch of new production facilities.

The world praised the merits of scientists: in 1945, Fleming, Flory and Chain were awarded the Nobel Prize for the discovery of penicillin and its therapeutic effect against infections. At 19In 1952, the Nobel Prize for the discovery of the anti-tuberculosis antibiotic streptomycin was received by an American microbiologist (formerly our compatriot) Zelman Waksman. ⁷

Modern realities

Today in Russia, about 30 groups of antibiotics are actively used, which include drugs of different origin:

● Natural (biosynthetic) – Derived from fungi or bacteria that are resistant to antibiotics.

● Semi-synthetic – natural substances modified by an enzymatic or chemical method. Such drugs are more effective.

● Synthetic – created artificially in the laboratory.

There are broad-spectrum antibiotics that act on many types of bacteria, and narrow-spectrum antibiotics that selectively destroy a small group of them. Until recently, they worked almost flawlessly. Now a serious global problem is antibiotic resistance – the resistance of microorganisms to drugs. Bacteria, like any living organism, learn to adapt to adverse conditions. ^8.9

Briefly about the main

➢ Antibiotics are antimicrobials that help fight bacterial infections.

➢ Antibacterial drugs are ineffective for any viral infection, including SARS.

➢ Antimicrobial drugs are connected to the treatment of acute respiratory viral infections if a bacterial infection is present along with a viral infection. She can join later.

➢ Take antibiotics only as directed by your doctor. Self-medication leads to unwanted side effects and increases the resistance of microbes to the drug.

Bibliography:

¹ Maltseva G.S., Grinchuk O.N., Place of antibiotic therapy for streptococcal infection // Medical Council – 2019.

² Sviryaeva E.N., Korneev K.V., Drutskaya M.S., Kuprash D.V. Mechanisms of restructuring the immune response in viral-bacterial coinfections of the respiratory tract // Biochemistry – V. 81, No. 11, 2016.

³ Clinical guidelines of the Ministry of Health of the Russian Federation: Acute respiratory viral infections (ARVI) in adults URL: https://cr. minzdrav.gov.ru/recomend/724_1 (date posted: 02/15/2022)

⁴ Instructions for medical use (Nobasit® Forte, film-coated tablets 500 mg; RU: LP-006416 dated 20.08.2020).

⁵ Lioznov D.A., Karnaukhova E.Yu., Zubkova T.G., Shakhlanskaya E.V. Evaluation of the effectiveness of the ARVI treatment regimen, including etiotropic (enisamia iodide) and symptomatic therapy // Therapeutic archive No. 3 – 2020 G..

⁶ Turovsky A.B., Karyuk Yu.A., Kondrashina V.V. Antibacterial therapy for ENT infections // Clinician – No. 3-4, 2013.

⁷ Danilov A.I., Litvinov A.V. The beginning of the era of antimicrobial therapy // Clinical microbiology and antimicrobial therapy – V. 12, No. 2, 2010.

⁸ Kletikova L.V., Bessarabov B.F., Kozlov A.B. Ecological and hygienic aspects of the use of antibiotics // Scientific search – No. 2 (8), 2013.

⁹ Geppe N.A., Dronov I.