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 |
Ontology: Amoxicillin (C0002645)
Definition (CHV) | a kind of antibiotics |
Definition (CHV) | a kind of antibiotics |
Definition (NCI_NCI-GLOSS) | A drug used to treat some bacterial infections. Amoxicillin is a form of penicillin that is made in the laboratory. It kills certain types of bacteria. It is a type of antibiotic. |
Definition (NCI) | A broad-spectrum, semisynthetic aminopenicillin antibiotic with bactericidal activity. Amoxicillin binds to and inactivates penicillin-binding protein (PBP) 1A located on the inner membrane of the bacterial cell wall. Inactivation of PBPs interferes with the cross-linkage of peptidoglycan chains necessary for bacterial cell wall strength and rigidity. This interrupts bacterial cell wall synthesis and results in the weakening of the bacterial cell wall and causes cell lysis. |
Definition (MSH) | A broad-spectrum semisynthetic antibiotic similar to AMPICILLIN except that its resistance to gastric acid permits higher serum levels with oral administration. |
Definition (PDQ) | A broad-spectrum, semisynthetic aminopenicillin antibiotic with bactericidal activity. Amoxicillin binds to and inactivates penicillin-binding protein (PBP) 1A located on the inner membrane of the bacterial cell wall. Inactivation of PBPs interferes with the cross-linkage of peptidoglycan chains necessary for bacterial cell wall strength and rigidity. This interrupts bacterial cell wall synthesis and results in the weakening of the bacterial cell wall and causes cell lysis. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42310&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42310&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C237" NCI Thesaurus) |
Concepts | Antibiotic (T195) , Organic Chemical (T109) |
MSH | D000658 |
SnomedCT | 323707004, 323699003, 27658006, 372687004 |
LNC | LP15265-9, MTHU006036 |
English | Amoxycillin, Hydroxyampicillin, Amoxycillin [generic addn], amoxicillin, Amoxycillin [2], Amoxycillin [generic additions], AMOX, amoxicillin (medication), AMOXICILLIN, Amoxicillin [Chemical/Ingredient], amoxycillin, Amoxicilline, Amoxicillin [generic additions], Amoxycillin [2] (product), Amoxicillin [2], Amoxycillin [generic additions] (product), p-Hydroxyampicillin, Amoxycillin product, Amoxicillin (product), Amoxicillin (substance), Amoxycillin [2] (substance), Amoxycillin [generic additions] (substance), Amoxicillin, Amoxicillin product |
Swedish | Amoxicillin |
Czech | amoxicilin |
Finnish | Amoksisilliini |
Russian | GIDROKSIAMPITSILLIN, AMOKSITSILLIN, АМОКСИЦИЛЛИН, ГИДРОКСИАМПИЦИЛЛИН |
Japanese | アミノヒドロキシベンジルペニシリン, アモキシシリン, ヒドロキシアンピシリン |
Croatian | AMOKSICILIN |
Polish | Amoksycylina |
Spanish | amoxicilina (2) (producto), amoxicilina (2), amoxicilina (agregados genéricos) (producto), amoxicilina (agregados genéricos), amoxicilina (sustancia), amoxicilina, p-hidroxiampicilina, Amoxicilina, Hidroxiampicilina |
French | Amoxicilline |
German | Amoxicillin, Hydroxyampicillin |
Italian | Amoxicillina |
Portuguese | Amoxicilina, Hidroxiampicilina |