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.

Amoxicillin – StatPearls – NCBI Bookshelf

Continuing Education Activity

Amoxicillin is one of the most commonly used antibiotics in the primary care setting. It is an amino-penicillin, created by adding an extra amino group to penicillin to battle antibiotic resistance. Amoxicillin covers a wide variety of gram-positive bacteria, with some added gram-negative coverage compared to penicillin. Like penicillin, it covers most Streptococcus species and has improved coverage of Listeria monocytogenes and Enterococcus spp. It also has coverage over Haemophilus influenzae, some Escherichia coli, Actinomyces spp., Clostridium species, Salmonella spp., Shigella spp., and Corynebacteria species. This activity covers amoxicillin, a beta-lactam antimicrobial that interprofessional team members need to review its indications, coverage, contraindications, and adverse event profile to manage patients with infectious disease optimally.

Objectives:

• Outline the indications for initiating amoxicillin as an anti-infective strategy for patient care.

• Identify the mechanism of action of amoxicillin and its target coverage.

• Summarize the adverse effects of amoxicillin.

• Explain the importance of antimicrobial stewardship and how it affects antimicrobial selection to improve care coordination among the interprofessional team when initiating amoxicillin antimicrobial therapy.

Access free multiple choice questions on this topic.

Indications

Amoxicillin is one of the most commonly used antibiotics in the primary care setting. It is an amino-penicillin, created by adding an extra amino group to penicillin to battle antimicrobial resistance. Amoxicillin covers a wide variety of gram-positive bacteria, with some added gram-negative coverage compared to penicillin. Like penicillin, it covers most Streptococcus species and is also effective against Listeria monocytogenes and Enterococcus species. It also covers Haemophilus influenza, some Escherichia coli, Actinomyces species, Clostridium species, Salmonella species, Shigella species, and Corynebacteria species.

FDA-approved Indications

• Amoxicillin is indicated in treating infections due to susceptible (only beta-lactamase–negative) isolates of the selected bacteria in the conditions listed below.

• Ear, nose, and throat infections: Treatment of tonsillitis, pharyngitis, and otitis media in adults and pediatric patients ≥12 years of age. The microbiological spectrum is infections due to beta-lactamase-negative Streptococcus species (alpha- and beta-hemolytic isolates only), Streptococcus pneumoniae, Staphylococcus species, or Haemophilus influenza.[1]

• Helicobacter pylori eradication: Triple therapy for Helicobacter pylori with clarithromycin, amoxicillin, and lansoprazole to eradicate Helicobacter pylori reduces the risk of duodenal ulcer recurrence. Dual treatment with amoxicillin and lansoprazole is also FDA approved to eradicate Helicobacter pylori infection.[2]

• Lower respiratory tract infections: Treatment of lower respiratory tract infection due to beta-lactamase-negative Streptococcus species (alpha- and beta-hemolytic strains only), pneumococcus, Staphylococcus species, or Haemophilus influenzae. For community-acquired pneumonia, IDSA recommends a combination of amoxicillin and macrolide.[3]

• Acute Bacterial Sinusitis: Treating infections due to beta-lactamase-negative Streptococcus species (alpha- and beta-hemolytic isolates only), Streptococcus pneumoniae, Staphylococcus species, or Haemophilus influenzae.[4]

• Skin and skin structure infections: Immediate release: Treatment of skin and skin structure infections due to beta-lactamase-negative Streptococcus species (alpha and beta-hemolytic strains only), Staphylococcus species, or Escherichia coli.[5]

• Urinary tract infection: Treatment of the genitourinary tract infections. Organisms include beta-lactamase-negative Escherichia coli, Proteus mirabilis, or Enterococcus faecalis.[6]

• The Centers for Disease Control and Prevention (CDC) recommends using amoxicillin for post-exposure prophylaxis for anthrax(second-line agent). [7]      

Off-label Clinical Uses

• Infectious endocarditis prophylaxis(cardiac conditions associated with the high risk such as the presence of prosthetic cardiac valve or congenital heart disease)[9]

• Actinomycosis[11]

Mechanism of Action

Amoxicillin is in the class of beta-lactam antimicrobials. Beta-lactams act by binding to penicillin-binding proteins that inhibit a process called transpeptidation (the cross-linking process in cell wall synthesis), leading to activation of autolytic enzymes in the bacterial cell wall. This process leads to lysis of the cell wall, thus destroying the bacterial cell. This type of activity is referred to as bactericidal killing.[12]

Amoxicillin administration can also be in combination with a beta-lactamase inhibitor. Some examples of these are clavulanic acid and sulbactam. These beta-lactamase inhibitors work by binding irreversibly to the catalytic site of an organism’s beta-lactamase enzyme, which causes resistance to the original beta-lactam ring of amoxicillin. These drugs do not have inherent bactericidal activity; however, they may broaden amoxicillin’s spectrum to organisms that produce the beta-lactamase enzyme when combined with amoxicillin.[13]

Administration

Bactericidal antimicrobials, such as amoxicillin, often are most effective in a “time-dependent” manner rather than a “concentration-dependent” manner. Time-dependent refers to the time that serum concentrations exceed the minimum-inhibitor-concentration (MIC) for the microorganism. Therefore, they are often dosed more frequently, rather than the concentration-dependent drugs, which can be dosed, for example, daily. The more “around-the-clock” dosing provides minor variation in peak and trough serum concentrations.[14]

Amoxicillin is an oral antimicrobial; whereas, ampicillin (which is structurally similar) can be given orally, intravenously, or intramuscularly. Amoxicillin comes in immediate-release or extended-release tablets. It also comes in a chewable tablet or a suspension. It may be mixed (after thoroughly shaking) and administered with formula, milk, water, fruit juice, ginger ale, or other cold drinks if given in suspension. The administration should take place immediately after mixing. Patients should not crush Extended-release tablets, and the administration should be within 1 hour after finishing a meal. Amoxicillin is sometimes preferred over penicillin in children because of its taste.

Dosing

• In adults, 750-1750 mg/day in divided doses every 8-12 hours.

• In Pediatric Patients > 3 Months of Age, 20-45 mg/kg/day in divided doses every 8-12 hours.

• Dosing for H. pylori Infection: Triple therapy: 1 gram amoxicillin, 500 mg clarithromycin, and 30 mg lansoprazole, all given twice daily (every 12 hours) for 14 days.

• Dual therapy: 1 gram amoxicillin and 30 mg lansoprazole, each given three times daily.

Dosing in Renal Impairment

• 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/min should not receive an 875-mg dose.

• Patients with a glomerular filtration rate of 10 to 30 mL/min should receive 500 mg or 250 mg every 12 hours, depending on the severity of the infection.

• Patients with a glomerular filtration rate less than 10 mL/min should receive 500 mg or 250 mg every 24 hours, depending on the severity of the infection.

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

Geriatric Consideration

• It is important to note that it is excreted in most people by the kidney, and some renal adjustment and extra caution may be necessary for renal insufficiency. Because elderly patients are more likely to have decreased renal function, the clinician should adjust the dose. It is reported to be partially dialyzable, and therefore, immediate-release tablets can be an option for dosing after hemodialysis.[15]

Pregnancy

• Amoxicillin is a pregnancy category B drug under the old FDA classification system, which means there have been no studies demonstrating clear risk. Amoxicillin is widely used in pregnant women. Based on available data, amoxicillin is usually considered compatible for use during pregnancy. The dose and duration of amoxicillin therapy in pregnant and postpartum women are the same as in nonpregnant adults.[16]

Breastfeeding

• An exclusively breastfed infant would be expected to receive a maximum daily dosage of about 0.1 mg/kg of amoxicillin with a maternal dose of 500 mg three times daily. This amounts to 0.25 to 0.5% of a typical infant amoxicillin dosage. As discussed above, amoxicillin produces low levels in milk that are not expected to cause adverse effects in breastfed infants. Occasionally, rash and disruption of the infant’s gastrointestinal flora, resulting in diarrhea or thrush, have been reported. Consequently, amoxicillin is acceptable in nursing mothers.[17]

Adverse Effects

Common Adverse Drug Reactions: Amoxicillin is well-tolerated, but some common complaints can be gastrointestinal (GI) symptoms, such as nausea, vomiting, and diarrhea.

Superinfections: Mucocutaneous candidiasis, clostridium difficile associated diarrhea. Of note, patients who take amoxicillin may have less diarrhea than those who take ampicillin because of better absorption in the gut.[18]

Nephrotoxicity: Crystalluria, interstitial nephritis[19][20]

Hypersensitivity
Reactions: Amoxicillin can lead to type-I, II, III, or IV reactions. It is essential to differentiate between a type-I and type-IV hypersensitivity reaction because one may be more dangerous than the other. A type-I hypersensitivity reaction is an IgE-mediated response to a sensitized patient that triggers widespread histamine release leading to an urticarial-like pruritic rash or severe anaphylaxis. A type-IV hypersensitivity reaction is not mediated by histamine release and is more papular or morbilliform and often not itchy. Professionals suggest that almost all patients that receive amoxicillin inadvertently for infectious mononucleosis develop a maculopapular rash caused by a type IV-mediated hypersensitivity reaction. These types of reactions are not known to cause anaphylaxis.[21]

Hepatotoxicity: instances of idiosyncratic liver injury have been reported in persons receiving amoxicillin.  The serum enzyme pattern associated with the liver injury is the hepatocellular pattern with marked elevations in AST and ALT. There are minimal elevations in alkaline phosphatase. Most patients recover rapidly after withdrawal of amoxicillin and rapid recovery after withdrawal. The cause of the liver injury associated with amoxicillin use is hypersensitivity. Rare cases of acute liver failure and vanishing bile duct syndrome have been reported. Corticosteroids have often been used to treat the allergic manifestations of penicillin-related immunoallergic hepatitis. Likelihood score: B (highly likely but rare cause of clinically apparent liver injury).[22]

Postmarketing Adverse Drug Reactions

Gastrointestinal: black hairy tongue, pseudomembranous colitis, hemorrhagic colitis[23]

Neurological: reversible hyperactivity, agitation, anxiety, insomnia, confusion, convulsions, aseptic meningitis[24]

Hematological: hemolytic anemia, thrombocytopenia, thrombocytopenic purpura, eosinophilia, leukopenia, and neutropenia[25]

Dermatological: serum sickness-like reactions, erythematous maculopapular rashes, exfoliative dermatitis, toxic epidermal necrolysis, hypersensitivity vasculitis[26]

Contraindications

• Any previous anaphylactic or serious skin reaction (for example, Stevens-Johnson syndrome) to amoxicillin or any other beta-lactam is a contraindication to amoxicillin. These reactions may have crossover sensitivity with cephalosporins or carbapenems. However, it is important to note that newer data has suggested a much lower cross-reactivity with cephalosporins and carbapenems than once suspected.

• An important consideration is determining if the patient’s allergic rash is a type-I or a type-IV hypersensitivity reaction. Occasionally patients will report a childhood allergy to amoxicillin, which is, in fact, a type-IV-mediated hypersensitivity reaction, often in the setting of infectious mononucleosis; this is not a contraindication to giving repeat amoxicillin. However, a type-1 mediated hypersensitivity reaction is a contraindication given that a repeat exposure puts the patient at risk for anaphylaxis.

• Skin testing has been approved to help assist in hypersensitivity to penicillins. Reports are that the risk of an allergic reaction in a patient with a positive skin test is roughly four percent. In contrast, a negative skin test has a relatively high sensitivity in ruling out a type-I hypersensitivity reaction.[27]

Monitoring

• It is essential to be aware of hypersensitivity reactions, and the patient should understand to notify their physician of any rashes. [27]

• In a patient on a short-term course of amoxicillin, no specific laboratory monitoring parameters are suggested. However, during prolonged administration, such as for osteomyelitis, it is essential to monitor renal and hepatic function and hematologic function periodically throughout treatment.[22]

• Mild diarrhea is often tolerable. However, prolonged diarrhea with fever and abdominal pain should prompt evaluation by a clinician for CDAD.[28]

• Penicillins in high doses can cause seizures which is a concern, especially in patients with renal failure.[29]

Toxicity

A prospective study of 51 pediatric patients at a poison-control center proposed that less than 250 mg/kg of amoxicillin overdosages are not associated with significant clinical symptoms(Product labeling FDA).

Clinical Features

• Interstitial nephritis resulting in oliguric renal failure has been reported in a small number of patients after overdosage with amoxicillin. [19][20]

• Crystalluria leading to renal failure has been reported after amoxicillin overdosage in adult and pediatric patients.[30]

Management

• In case of overdose, discontinue medication, treat symptomatically.

• Maintain airway, breathing, and circulation.

• For updated information about the overdose of amoxicillin, call a poison control center (1-800-222-1222)

Enhancing Healthcare Team Outcomes

Amoxicillin is a common antimicrobial often prescribed by nurse practitioners, primary care providers, and internists. The drug is safe, but it is essential always to get a good history of allergy before prescribing the medication. Due to the widespread use of amoxicillin, all healthcare providers should understand the mechanism, resistance patterns, adverse drug reactions, and toxicity management.[27][32]

The clinician usually initiates amoxicillin therapy for appropriate indication. However, a pharmacist should verify the dosing and duration are correct for the infection being treated and confirm that no drug interactions could impede treatment. Nursing staff can counsel on administration, verify adherence. Additionally, nurses should educate the patient not to discontinue amoxicillin when they start to feel better. If the nurse or pharmacist encounters any issues, they should address them with the prescriber immediately.

In case of significant overdose, triage nurses should admit the patient. Emergency physicians need to evaluate and manage nephrotoxicity. Nephrologist consultation is necessary for hemodialysis. Consult a medical toxicologist or poison control center for the latest information.[33] Infectious disease specialists should ensure proper management of pseudomembranous colitis resulting from irrational amoxicillin use. Additionally, infectious disease specialists should emphasize the importance of antimicrobial stewardship. Antimicrobial stewardship is a coordinated program that encourages the proper use of antimicrobials, enhances patient outcomes, decreases microbial resistance, and reduces the spread of infections caused by multidrug-resistant organisms. [34]

As depicted above, clinicians(MDs, DOs, NPs, PAs), specialists, pharmacists, nurses, and other healthcare providers should collaborate to maximize efficacy and minimize adverse drug reactions related to amoxicillin therapy. This type of interprofessional team approach and antimicrobial stewardship will improve the likelihood of more favorable patient outcomes.[35] [Level 2]

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

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Disclosure: Bobak Akhavan declares no relevant financial relationships with ineligible companies.

Disclosure: Niloufar Khanna declares no relevant financial relationships with ineligible companies.

Disclosure: Praveen Vijhani declares no relevant financial relationships with ineligible companies.

What you need to know about antibiotic use

Alexander Fleming’s discovery of the first antibiotic penicillin back in 1928 changed the further course of history and the development of medicine. Penicillin saved the lives of many people during World War II. We have been using antibiotics for almost a century. At their peak, these drugs were a panacea for many diseases. At one time, it was antibiotics that allowed the development of surgical treatments and thanks to them, such high medical achievements as open-heart surgery and chemotherapy are now possible. However, despite all the advances in technology and medicine, there is a real threat to return to the Middle Ages, when people died from the simplest infections and diseases. The reason for this is the rapidly spreading antibiotic resistance (resistance to antibiotics). It occurs when microorganisms develop/mutate in such a way that they can resist the drugs used to fight them.

The endless war between antibiotics and antimicrobial resistance does not stop for a single day. And many experts believe that in the current conditions, humanity is losing this war. We are hastening our defeat by the irresponsible use of antibiotics.

Misconceptions of antibiotic therapy:

1. They act on viruses. In viral infections, antibiotics do not work, do not help and do not improve anything except the material well-being of manufacturers and sellers of antibacterial agents.
2. Have a preventive effect in viral infections. Antibiotic therapy is not able to reduce the likelihood of bacterial complications. Complications still arise, but they are associated with bacteria that survived after an vainly prescribed antibiotic.
3. There are strong and weak. People really want to believe in the fact that if antibiotic “A” is a hundred times more expensive than antibiotic “B”, then it is also a hundred times more effective
4. “Sit down” immunity. None of the modern antibacterial agents has a depressant effect on the immune system. Here, as very often with us, cause and effect are confused. The disease is to blame for the suppression of immunity, which was the reason for the appointment of antibiotic therapy.
5. Antifungals should be taken along with antibiotics. Candidiasis – as a specific side effect of antibiotic therapy – is quite possible, and its development is indeed treatable using antifungal agents. But there is no evidence that antifungal drugs have a preventive effect and reduce the likelihood of candidiasis, there is no evidence.
6. When taking antibiotics, it is necessary to take medicines “for the intestines”.
   Inhibition of the intestinal flora, severe enough to warrant treatment, occurs with long-term use of broad-spectrum antibiotics. Diet, combined with discontinuation of antibiotic therapy, is sufficient treatment in most cases. Not surprisingly, most “magic bacteria” capsules are medicines with unproven efficacy.
7. Antiallergic agents are required for antibiotic therapy. Allergies associated with taking antibiotics are indeed not uncommon. Hence the important rule – the drug that causes an allergic reaction should be immediately canceled and replaced with a drug of another group.
8. If the antibiotic becomes worse after taking it, it should be immediately discontinued and replaced. Under the action of antibiotics, bacteria can be destroyed, and this is accompanied by the release of endotoxins into the blood. The body reacts to the release of endotoxins with chills, an increase in body temperature – all this on the first day of treatment manifests itself as a real deterioration in the condition. This development has come to be known as an “endotoxic reaction,” and physicians are specifically taught how to distinguish between endotoxic reactions and drug failures. If, after a swallowed tablet or injection of an antibiotic, the temperature rises and chills begin, this does not mean at all that this drug is not suitable and you need to run to the pharmacy for another. This means that you need to consult a doctor

Rules for Taking Antibiotics

If the physician in charge has deemed the prescription of antibiotics justified and appropriate, the most important thing is to ensure that their use brings maximum benefit and minimum harm. To do this, regardless of the type of antibacterial drugs prescribed, it is advisable to follow the following recommendations:

• The same antibiotic can be produced in low and high doses, so when buying a medicine, you should be careful and purchase the drug in doses strictly prescribed by your doctor.
• Before use, be sure to read the instructions: in the presence of diseases listed in the list of contraindications, you should consult a doctor for advice.
• Do not take on an empty stomach to avoid aggravating mucosal irritation.
• Be sure to take antibiotics with water.
• Avoid alcohol, absorbent and blood-thinning drugs.
• Even if the condition improves immediately, it is necessary to complete the course of treatment: bacteria that are not completely suppressed form resistance to the antibiotic, and further treatment will be ineffective.

Antibiotic treatment is likely to be effective if taken properly and all prescriptions are followed. You cannot prescribe antibiotics on your own. Timely vaccination avoids infectious diseases and the need for their treatment.

General practitioner Batovkina N.V.

Antibiotics after tooth implantation, it is necessary to drink what you need on the DANA website

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Taking antibiotics during dental implantation is a must, since the operation is by definition traumatic and requires appropriate pharmacological support. Throughout the procedure, there is a high probability of microorganisms getting into the open area of ​​​​the gums and periosteum, so antibacterial drugs are urgently needed as a preventive measure. About which antibiotics patients take before dental implantation, and which ones after, indications and possible side effects will be discussed in this article.

Antibiotics for dental implantation: indications for use

The main task of drugs is the prevention and removal of inflammatory processes during and after the procedure. They fight bacteria, preventing the latter from multiplying in the operated area, and are also carried by the circulatory system further throughout the body. Medications of this type are prescribed in the following cases:

• difficulties/complications occurred during the operation;
• several implants are installed at once;
• the patient has diabetes mellitus, suffers from immunodeficiency or chronic infectious diseases;
• patients had previously implanted or installed prostheses, pacemakers.

In general, medications are prescribed one to two days before the start of the procedure, due to the duration of action of antibacterial agents. It is 5 – 10 days from the moment the active substance enters the blood.

Several techniques are available to make the procedure less traumatic. One of them is obligatory, this is a computed tomography of the teeth. Examination before drawing up a treatment plan gives the maximum picture of the state of the dentition. The second is optional, but already used as a standard in dentistry. Not a single modern implantation procedure can do without it – it is a surgical template. Both technologies have a positive effect on the period of restoration of teeth after implantation.

Antibiotics for dental implants: mandatory or occasional?

Dentists recommend taking antibiotics before the procedure for almost every patient, but after implantation of an artificial root and prosthetics, such a measure is not always required. Indications for taking medications are as follows:

• poor oral hygiene;
• periodontal and gum disease;
• implant placement was preceded by tooth extraction;
• complex restoration of row integrity using the “all-in-4” or “all-in-6” method
• osteoplastic operations;
• the patient has cysts and granulomas.

In the cases described above, the doctor prescribes drugs to the patient that can significantly reduce the risk of complications and speed up the rehabilitation process.

When implanting teeth, tablets are more often prescribed, injectable preparations are practically not used.

Effective antibiotics after dental implantation: list and dosages

Prescribed drugs, by definition, should be affordable, have a minimum list of side effects and affect the maximum number of bacterial species. The most popular means will be described below.

Tsifran – combined antibacterial drug

Characterized by bactericidal action, affects aerobic and anaerobic microorganisms. It is indicated in the presence of infections in the oral cavity, in case of damage by bacteria to soft tissues and bone structures.

The drug has a fairly large list of side effects, which is more than offset by its democratic cost and availability. Not recommended for patients with individual intolerance to the components. One tablet is taken twice a day (with an interval of 12 hours).

Flemoxin and amoxiclav in dental implantation: purpose and pharmacological action

These medicines belong to the “penicillin group”, have a pronounced bactericidal effect on pathogenic microorganisms. A popular antibiotic after dental implantation, amoxiclav is prescribed for a course of 5 days, especially if the patient is diagnosed with oral infections. The dosage is determined on an individual basis, often 500 mg tablets are taken 2 to 3 times a day.

Amoxiclav is prescribed with extreme caution after dental implantation to those who suffer from diseases of the gastrointestinal tract, have problems with the liver or kidneys. It is strictly contraindicated in pregnant and lactating women.

Sumamed for dental implantation and other popular drugs

In addition to those described earlier, other oral medications are actively used in modern dentistry. Namely:

• sumamed after dental implantation
• Lincomycin for the prevention and treatment of osteomyelitis, periostitis
• metronidazole against protozoa and anaerobic microorganisms

How many days to take antibiotics after dental implants?

The duration of the course, the preparation and the dosage are prescribed by the dentist to the patient on an individual basis. It is possible to determine for yourself how much antibiotics to drink after tooth implantation, but the effectiveness and safety of such treatment is very doubtful. To select funds, the doctor analyzes the clinical picture and possible contraindications.

In general, the regimen is as follows: 1 tablet 500-1000 mg every 5-8 hours, the number of doses is 2 or 3 per day. This allows you to maintain the concentration of the antibiotic in the body at a sufficient level to effectively combat pathogenic microorganisms. The duration of the course is variable in each clinical case, but is always at least 5-7 days.