Amoxicillin

Aka: Amoxicillin, Amoxil

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II. Indications

  1. Otitis Media
  2. Acute Bacterial Sinusitis
  3. Pneumonia
  4. Group A Streptococcal Pharyngitis
  5. Helicobacter Pylori
  6. Endocarditis Prophylaxis

III. Contraindications

  1. Penicillin Allergy
    1. Cefadroxil and Cefprozil have similar side chains and risk of cross reactivity with Amoxicillin

IV. Mechanism

  1. See Aminopenicillin

V. Medications

  1. Amoxicillin Capsules (250 and 500 mg)
  2. Amoxicillin Tablets (500 and 875 mg)
  3. Amoxicillin Chewable Tablets (125, 200, 250 and 400 mg)
  4. Amoxicillin Suspension (125 mg/5ml and 250 mg/5ml)
    1. Stable in the refrigerator for up to 14 days

VI. Dosing

  1. Adult
    1. Typical Dosing (e.g. head and neck infections): 875 to 1000 mg orally twice daily
    2. Maximum dose: 3-4 grams/day
  2. Child
    1. Low dose (e.g. Pneumonia): 45 mg/kg/day divided twice daily
    2. High dose (e.g. Otitis Media): 90 mg/kg/day divided twice daily
  3. Renal Dosing (adult dosing adjustments)
    1. eGFR 10 to 30 ml/min: 250 to 500 mg orally twice daily
    2. eGFR <10 ml/min: 250 to 500 mg orally daily (after Hemodialysis)

VII. Adverse Effects

  1. See Aminopenicillin
  2. See Penicillin
  3. 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
  4. Diarrhea
    1. More common with Augmentin
    2. Modifications can decrease stools
      1. Dose exactly by kilogram for children
      2. Avoid food before dose
      3. Consider eating yogurt with each dose

VIII. Safety

  1. Pregnancy Category B
  2. Safe in Lactation

IX. Resources

  1. Amoxicillin Capsule (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=843f6053-63d9-47d2-81f1-b6aa78a7c20c

X. References

  1. (2008) Comparison of Amoxicillin Products, Presc Lett, #240425
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  3. Miller (2002) J Midwifery Womens Health 47(6):426-34 +PMID: 12484664 [PubMed]
  4. Bush (2016) Cold Spring Harb Perspect Med 6(8):a025247 +PMID: 27329032 [PubMed]

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Cost: Medications

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.

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