Aminopenicillins

Aka: Aminopenicillins, Ampicillin, Amoxicillin, Augmentin, Unasyn

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II. Preparations: Amoxicillin and Ampicillin

  1. Ampicillin
    1. Child: 50-200 mg/kg/day IV divided qid
  2. Amoxicillin
    1. Maximum dose: Maximum dose: 3-4 grams/day
    2. Adult: 875 to 1000 mg orally twice daily
    3. Child
      1. Low dose: 45 mg/kg/day divided twice daily
      2. High dose: 90 mg/kg/day divided twice daily

III. Preparations: Added Beta-Lactamase resistance

  1. Ampicillin Sulbactam (Unasyn)
    1. Adult: 1.5-3 grams IV every 6 hours
  2. Amoxicillin Clavulanate (Augmentin)
    1. Adult: 875 mg PO bid
    2. Child: 45 mg/kg/day divided PO bid

IV. Mechanism

  1. Same as for Natural Penicillins
  2. Penetrates outer membrane of some Gram Negatives
  3. Clavulanic acid and sulbactam bind Beta-Lactamases

V. Pharmacokinetics

  1. Keep Augmentin suspension refrigerated
  2. Clavulanate suspension breaks down at room Temperature
    1. Turns brown with breakdown
    2. Loses 90% of potency after 2 days at room Temperature

VI. Pathophysiology: Bacterial Resistance Mechanisms Overcome

  1. Beta-Lactamase Production
  2. Alteration of Penicillin binding Protein

VII. Activity Spectrum

  1. General
    1. Gram Positive Cocci
    2. Gram Negative Rods
    3. Spirochetes (e.g. Treponema pallidum)
  2. Conditions
    1. Otitis Media
    2. Sinusitis
    3. CNS Infection
    4. Urinary Tract Infection
    5. Infectious Enteritis
    6. Borrelia Burgdorferi (Lyme Disease)
    7. Helicobacter Pylori

VIII. Adverse effects

  1. Similar to Natural Penicillins
  2. Maculopapular rash
    1. Onset 5-7 days after initiating medication
    2. Typically not IgE mediated (non-allergic)
      1. No immediate allergy (e.g. Urticaria), systemic symptoms or mucous membrane involvement
    3. Typically safe to use Amoxicillin in future if non-allergic rash alone
      1. Consider IgE Skin Testing if unclear rash etiology
    4. References
      1. Orman and Hayes in Herbert (2017) EM:Rap 17(7): 7-8
  3. Diarrhea (modifications can decrease stools to 12%)
    1. Dose exactly by kilogram for children
    2. Avoid food before dose
    3. Consider eating yogurt with each dose

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Cost: Medications

ampicillin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
AMPICILLIN 500 MG CAPSULE Generic $0.48 each
amoxicillin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
AMOXICILLIN 125 MG/5 ML SUSP Generic $0.02 per ml
AMOXICILLIN 200 MG/5 ML SUSP Generic $0.03 per ml
AMOXICILLIN 250 MG CAPSULE Generic $0.06 each
AMOXICILLIN 250 MG TAB CHEW Generic $0.27 each
AMOXICILLIN 250 MG/5 ML SUSP Generic $0.02 per ml
AMOXICILLIN 400 MG/5 ML SUSP Generic $0.02 per ml
AMOXICILLIN 500 MG CAPSULE Generic $0.07 each
AMOXICILLIN 500 MG TABLET Generic $0.13 each
AMOXICILLIN 875 MG TABLET Generic $0.14 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

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