II. Indications
III. Contraindications
-
Penicillin Allergy
- Cefadroxil and Cefprozil have similar side chains and risk of cross reactivity with Amoxicillin
IV. Mechanism
- See Aminopenicillin
V. Medications
- Amoxicillin Capsules (250 and 500 mg)
- Amoxicillin Tablets (500 and 875 mg)
- Amoxicillin Chewable Tablets (125, 200, 250 and 400 mg)
- Amoxicillin Suspension (125 mg/5ml and 250 mg/5ml)
- Stable in the refrigerator for up to 14 days
VI. Dosing
- Adult
- Typical Dosing (e.g. head and neck infections): 875 to 1000 mg orally twice daily
- Maximum dose: 3-4 grams/day
- Child
- Low dose (e.g. Pneumonia): 45 mg/kg/day divided twice daily
- High dose (e.g. Otitis Media): 90 mg/kg/day divided twice daily
-
Renal Dosing (adult dosing adjustments)
- eGFR 10 to 30 ml/min: 250 to 500 mg orally twice daily
- eGFR <10 ml/min: 250 to 500 mg orally daily (after Hemodialysis)
VII. Adverse Effects
- See Aminopenicillin
- See Penicillin
- Maculopapular rash
- Onset 5-7 days after initiating medication
- Typically not IgE mediated (non-allergic)
- No immediate allergy (e.g. Urticaria), systemic symptoms or mucous membrane involvement
- Typically safe to use Amoxicillin in future if non-allergic rash alone
- Consider IgE Skin Testing if unclear rash etiology
- References
- Orman and Hayes in Herbert (2017) EM:Rap 17(7): 7-8
-
Diarrhea
- More common with Augmentin
- Modifications can decrease stools
- Dose exactly by kilogram for children
- Avoid food before dose
- Consider eating yogurt with each dose
- Drug-Induced Enterocolitis Syndrome (DIES)
- Non-IgE mediated Hypersensitivity Reaction resulting in severe Vomiting, Diarrhea
- Rare complication, primarily in children, and similar to Food Protein Induced Enterocolitis Syndrome (FPIES)
- Presents with repeated delayed Vomiting >1 hour after medication without rash or respiratory symptoms
- May be associated with lethargy, pallor, Diarrhea and Dehydration
- Unique features include Neutrophilia and Methemoglobinemia
- References
- (2024) Presc Lett 31(11): 64-5
- Di Filippo (2023) Int J Mol Sci 24(9):7880 +PMID: 37175584 [PubMed]
VIII. Safety
- Pregnancy Category B
- Safe in Lactation
IX. Resources
- Amoxicillin Capsule (DailyMed)
X. References
- (2008) Comparison of Amoxicillin Products, Presc Lett, #240425
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- Miller (2002) J Midwifery Womens Health 47(6):426-34 +PMID: 12484664 [PubMed]
- Bush (2016) Cold Spring Harb Perspect Med 6(8):a025247 +PMID: 27329032 [PubMed]
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Related Studies
| 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 |