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Paul A. Pham Pharm.D. and John G. Bartlett M.D.
12-02-2009
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Available formulation in Zambia: Capsule or tablet: 250 mg; 500 mg (anhydrous). Powder for oral liquid: 125 mg (anhydrous)/5 ml.
- Hydroxylated derivative of ampicillin with similar antibacterial activity and improved oral bioavailability.
- Increased resistance observed with H.influenzae, N.gonorrhoeae, E.coli, Salmonella, and Shigella.
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Pneumonia (mild to moderate severity in HIV-negative pts): 1000 mg PO q8h.
- High failure rates in HIV+ children with severe pneumonia treated with amoxicillin.
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Otitis media: amoxicillin 90 mg/kg/d divided q8h (children); 1000 mg PO q8h x 5 d (adults).
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Acute bacterial sinusitis: amoxicillin 1 gm q8h x 10d
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Dental abscess and/or severe gingivitis: amoxicillin 500 mg PO q8h (if PCN allergic: erythromycin plus metronidazole).
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Impetigo: amoxicillin 500 mg q8h x 5 d (erythromycin if PCN allergic).
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Chlamydia: amoxicillin 500 mg PO three times a day x 7d (alternative to doxycycline and erythromycin).
Zambia Information Author: Paul A. Pham Pharm.D.
- Bronchopulmonary infections
- Urinary tract infections (cystitis, pyelonephritis)
- Duodenal ulcer caused by H. pylori (in combination with clarithromycin and a PPI)
- Acute bacterial sinusitis
- Uncomplicated gonorrhea (currently not the drug of choice)
- Otitis media (, nonbeta-lactamase producer)
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Proteus mirabilis infections
- Lower respiratory infection (PCN-sensitive community-acquired pneumonia: CAP)
- Skin and skin structure infections (would only routinely recommend for streptococcal cellulitis), and nose and throat infections, tonsillitis and/or pharyngitis secondary to S. pyogenes (amoxicillin ER).
- Lyme disease
- Enterococcus
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
| Amoxil | Amoxicillin trihydrate | ~GlaxoSmithKline | PO
cap
250mg | 0.27 |
|
|
|
| PO
cap
500mg | 0.60 |
|
|
|
| PO
cap
875mg | 1.00 |
|
|
|
| PO
chew tab
200mg | 0.50 |
|
|
|
| PO
chew tab
400mg | 0.60 |
|
|
|
| PO
susp
125mg/5mL | 0.11 per 5mL |
|
|
|
| PO
susp
250mg/5mL | 0.24 per 5mL |
|
|
|
| PO
susp
400mg/5mL | 0.54 per 5mL |
|
|
|
| IV
vial
250mg; 500mg; 1000 mg | Not available in the U.S. |
| Moxatag | Amoxicillin | Middle Brook Pharmaceutical | PO
ER tablet
775 mg | $9.00 |
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
- CAP: 500mgPO q8h (for sensitive S. pneumoniae); 1000 mg PO q8h (for pts at risk for drug resistant S. pneumoniae) PLUS a macrolide.
- Higher doses ( 3-4 gm/day) recommended for some intermediately-resistant pneumococcal infections.
- UTI (uncomplicated): 250-500mg PO q8h (consider 875mg q12h).
- Tonsillitis and/or pharyngitis: amoxicillin 250-500 mg PO q8h OR amoxicillin ER 775 mg once-daily with food x 10 days.
- Skin and soft tissue infections: 250mg-500mg PO q8h (consider 875mg q12h), this is adequate for streptococcal cellulitis but if concern for MSSA would use amoxicillin/clavulanate.
250 - 500 mg q8h.
250 - 500 mg q12-24h.
250 - 500 mg q12-24h.
250 - 500 mg q12-24h. On days of HD, dose post-HD or supplement 250 - 500 mg post-HD.
250 mg q12h.
No data. Consider 500 mg q12h.
- Rash (especially w/ infectious mononucleosis)
- Diarrhea
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C. difficile colitis
- Hypersensitivity reactions
- Jarisch-Herxheimer reaction with spirochetal infections
- Drug fever
- Coombs' test positive, hemolytic anemia
- Leukopenia
- Thrombocytopenia
- CNS: seizures and twitching (especially seen with high doses in patients with renal failure)
- Interstitial nephritis
- LFT elevations
- Allopurinol: may increase the risk of rash with amoxicillin co-administration.
- Oral contraceptives: may decrease the efficacy.
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Tetracyclines: in vitro antagonism when co-administered. In two studies involving a total of 79 patients with pneumococcal meningitis treated with either penicillin plus tetracyclines or penicillin monotherapy resulted in a higher mortality rate (79-85%) in the combination therapy compared to penicillin monotherapy (30-33%) [Arch Intern Med 1951:88:489, Ann Intern Med 1961; 55:545]. Interaction resulted in higher treatment failure for meningitis but not pneumonia (Arch Intern Med 1953; 91:197). Do not co-administer PCN with tetracycline.
- S. pneumoniae: PCN resistance rate was 10.3 % (using resistant break point MIC of 2 mcg/mL), but only 1.2 % (using an MICs of 8 mcg/mL for IV PCN for non-meningeal involvement, (MMWR 2008; 57: 1353). Without meningeal involvement, S. pneumoniae with MIC of 2 mcg/mL or lower can be treated with high dose PCN or amoxicillin (3-4 gm/day; CID 2005; 41: 139-48 ).
- Risk factors for drug resistant S. pneumoniae (DRSP): chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressing conditions or use of immunosuppressing drugs; use of antimicrobials within the previous 3 months.
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S. pneumoniae break points (non-meningeal, oral therapy PCN): < 0.06 mcg/mL (sensitive); 0.12-1.0 mcg/mL (intermediate); > 2 mcg/mL (resistant).
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S. pneumoniae break points (non-meningeal, parenteral therapy PCN): < 2 mcg/mL (sensitive); 4 mcg/mL (intermediate); > 8 mcg/mL (resistant).
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S. pneumoniae break points (meningeal isolates, PCN): < 0.06 mcg/mL (sensitive); > 0.12 mcg/mL (resistant).
Aminopenicillin derivative with comparable gram-positive & gram-negative coverage to ampicillin, but better absorption and GI tolerance with oral administration. This is the preferred oral penicillin for all infections w/ possible exception of Group A strep pharyngitis (PCN preferred) & shigellosis (ampicillin preferred). When rash occurs with amoxicillin in setting of infectious mononucleosis, this is not a true allergy and does not preclude future use of drug.
- Mandell LA, Wunderink RG, Anzueto A, et al. ;
Community-Acquired Pneumonia in Adults: Guidelines for Management ;
Clinical Infectious Diseases ;
2007 ; Vol.
44 ; pp.
S27-72;
ISSN:
1537-6591;
PUBMED: 17278083
Rating:
Basis for recommendation
Comments:Amoxicillin 1 g q8h OR amoxicillin-clavulanate 2 g q12h plus a macrolide is the preferred outpatient treatment regimen in pts at risk for drug resistant S. pneumoniae (DRSP). Pts with chronic illness, alcoholism, and abx within the last 3 months are at risk for DRSP.
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