Names and pronunciation
(a-mox-i-sill′in) Amoxil , Moxatag
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Drug reference
(a-mox-i-sill′in) Amoxil , Moxatag
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Func. class.: Antiinfective, antiulcer
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Chem. class.: Aminopenicillin
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ACTION: Interferes with cell wall rep- lication of susceptible organisms; bacte- ricidal: lysis mediated by bacterial cell wall autolysins
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USES: Treatment of skin, respiratory, GI, GU infections, otitis media, gonorrhea; for gram-positive cocci (Staphylococcus aureus, Streptococcus pyogenes, Strep tococcus faecalis, Streptococcus pneu moniae), gram-negative cocci (Neisseria gonorrhoeae, Neisseria meningitidis), gram-positive bacilli (Corynebacterium diphtheriae, Listeria monocytogenes), gram-negative bacilli (Haemophilus influenzae, Escherichia coli, Proteus mirabilis, Salmonella); gastric ulcer, β-lactase–negative organisms, prophy- laxis of bacterial endocarditis; for treat- ment of ulcers due to Helicobacter pylori
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Unlabeled uses: Lyme disease, anthrax treatment and prophylaxis, cervicitis, Chlamydia trachomatis, dental abscess/ infection, dyspepsia, nongonococcal urethritis, periodontitis, typhoid fever
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CONTRAINDICATIONS: Hyper- sensitivity to penicillins Precautions: Pregnancy, breastfeeding, neonates, hypersensitivity to cephalospo- rins, carbapenems; severe renal disease, mononucleosis, phenylketonuria, diabe- tes, geriatric patients, asthma, child, coli- tis, dialysis, eczema, pseudomembranous colitis, syphilis
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SIDE EFFECTS CNS: Seizures, agitation, confusion, dizzi- ness, insomnia GI: Nausea, vomiting, diarrhea, pseudo- membranous colitis HEMA: Anemia, bone marrow depression, granulocytopenia, hemolytic anemia, eosinophilia, thrombocytopenia, agranulo- cytosis INTEG: Urticaria, rash SYST: Anaphylaxis, serum sickness, overgrowth of infection, anaphylaxis, hypersensitivity
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INTERACTIONS Increase: rash—allopurinol Increase: amoxicillin level—probenecid; used for this reason Increase: anticoagulant action—warfarin Increase: methotrexate levels—metho- trexate; monitor for toxicity Decrease: contraceptive effect possible— hormonal contraceptives Drug/Lab Test Increase: AST/ALT, alkaline phosphatase, LDH, eosinophils Decrease: HB, WBC, platelets Interference: urine glucose test (Clini test, Benedict’s reagent)
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DOSAGE AND ROUTES Tonsillitis and/or pharyngitis (rheumatic fever prophylaxis) secondary to Streptococcus pyogenes • Adult/adolescent/child ≥12 yr: PO (Moxatag 775-mg extended-release tab- lets) 775 mg/day, given within 1 hr of completing a meal, for 10 days • Adult: PO (immediate-release) 1 g/ day or 500 mg bid for 10 days • Infant/child/adolescent: PO (immedi- ate-release) 25 mg/kg/dose (max 500 mg/dose) bid for 10 days Sinusitis • Child ≥2 yr/adolescent: PO (immedi- ate release) standard-dose therapy, 45 mg/kg/day divided q12h; high-dose therapy, 80-90 mg/kg/day divided q12h (max 2 g/dose) • Child <2 yr: PO Treat with amoxicillin/ clavulanate, not amoxicillin alone Acute otitis media • Adult: PO (immediate-release) 500 mg q12h or 250 mg q8h for mild/moder- ate infections; 875 mg q12h or 500 mg q8h for severe infections • Infant ≥6 mo/child/adolescent: PO (immediate-release) 80-90 mg/kg/day divided q12h • Infant 4-5 mo: PO (immediate-release) 80-90 mg/kg/day divided q12h for 10 days • Infant #3 mo: PO (immediate- release) 30 mg/kg/day divided q12h Most respiratory Infections • Adult: PO (immediate-release) 500 mg q12h or 250 mg q8h (mild-moderate infections); 875 mg 12 hr or 500 mg q8hr (severe infections) • Infant >3 mo/child/adolescent: PO (immediate-release) 20 mg/kg/day di- vided q8h (max 250 mg/dose) or 25 mg/ kg/day divided q12h (max 500 mg/dose) • Neonate/infant #3 mo: PO (immediate- release) 30 mg/kg/day divided q12h H. pylori • Adult: PO 1000 mg bid with lansopra- zole 30 mg bid with clarithromycin 500 mg bid × 14 days or 1000 mg bid with omeprazole 20 mg bid, with clarithromy- cin 500 mg bid × 14 days or 1000 mg bid with esomeprazole 40 mg daily with clarithromycin 500 mg bid × 10 days; or 1000 mg tid with lansoprazole 30 mg tid × 14 days Gonorrhea • Adult/child ≥40 kg: PO × 3 g single dose • Child >2 yr and <40 kg: PO 50 mg/kg with probenecid 25 mg/kg single dose Endocarditis prevention • Adult: PO 2 g 60 min prior to proce- dure • Child: PO 50 mg/kg 60 min prior to procedure, max adult dose UTI, including cystitis Mild to moderate infections caused by highly susceptible organisms • Adult: PO (immediate-release) 500 mg q12h or 250 mg q8h • Infant >3 mo/child/adolescent: PO (immediate-release) 20 mg/kg/day di- vided q8h (max 250 mg/dose) or 25 mg/ kg/day divided q12h (max 500 mg/dose) • Neonate/infant #3 mo: PO (immediate- release) 30 mg/kg/day divided q12h Renal disease • Adult: PO CCr 10-30 mL/min 250-500 mg q12hr; CCr <10 mL/min 250-500 mg q24hr; do not use 775-, 875-mg strength if CCr <30 mL/min Available forms: Capsules 250, A 500 mg; chewable tablets 125, 200, 250, 400 mg; tablets, 500, 875 mg; extended-release tablets (Moxatag) 775 mg; powder for suspension 125, 200, 250, 400 mg/5 mL; suspension 50 mg/mL
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Administer: PO route • Identify allergies before use • Suspension: shake well before each dose; use calibrated spoon, oral syringe, or measuring cup; may be used alone, mixed in drinks; use immediately; dis- card unused portion after 14 days, store in refrigerator • Give around the clock; capsules may be emptied, mixed with liquids if needed without regard to food • Extended release: do not crush, chew, break; take with food
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Assess: • C&S may be drawn before product therapy; product may be given as soon as culture is taken • CDAD: bowel pattern before, during treatment; diarrhea, cramping, blood in stool; report to prescriber immediately, product should be discontinued, may occur even weeks after discontinuing product • Skin eruptions after administration of penicillin to 1 wk after discontinuing product; rash is more common if allopuri- nol is taken concurrently • Pregnancy/breastfeeding: identify if pregnancy is planned or suspected or if breastfeeding; use only if clearly needed; appears in breast milk, use cautiously in breastfeeding; advise those taking oral contraceptives to use alternative contra- ceptive since contraceptive may be de- creased • Anaphylaxis: rash, itching, dyspnea, facial/laryngeal edema
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Evaluate: • Therapeutic response: absence of in- fection; prevention of endocarditis, reso- lution of ulcer symptoms
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That capsules may be opened, con- tents taken with fluids; that chewable form is available; to take as prescribed, not to double dose • All aspects of product therapy: to complete entire course of medication to ensure organism death; that culture may be taken after completed course of med- ication • To report sore throat, fever, fatigue, diar- rhea (superinfection or agranulocytopenia), blood in stool, abdominal pain (pseudomem- branous colitis) • That product must be taken in equal intervals around the clock to maintain blood levels; to take without regard to food, that capsules may be opened, contents taken with fluids; that chewable form is available; to take as prescribed, not to double dose • To wear or carry emergency ID if al- lergic to penicillins TREATMENT OF ANAPHY- LAXIS: Withdraw product, maintain airway; administer EPINEPHrine, ami nophylline, O2, IV corticosteroids
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PHARMACOKINETICS PO: Peak 1-2 hr, duration 6-8 hr, half- life 1-11⁄3 hr extended in renal disease, metabolized in liver, excreted in urine, crosses placenta, enters breast milk
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• Adult/adolescent/child ≥12 yr: PO (Moxatag 775-mg extended-release tab- lets) 775 mg/day, given within 1 hr of completing a meal, for 10 days
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• Adult: PO (immediate-release) 1 g/ day or 500 mg bid for 10 days
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• Infant/child/adolescent: PO (immedi- ate-release) 25 mg/kg/dose (max 500 mg/dose) bid for 10 days Sinusitis
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• Child ≥2 yr/adolescent: PO (immedi- ate release) standard-dose therapy, 45 mg/kg/day divided q12h; high-dose therapy, 80-90 mg/kg/day divided q12h (max 2 g/dose)
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• Child <2 yr: PO Treat with amoxicillin/ clavulanate, not amoxicillin alone Acute otitis media
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• Adult: PO (immediate-release) 500 mg q12h or 250 mg q8h for mild/moder- ate infections; 875 mg q12h or 500 mg q8h for severe infections
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• Infant ≥6 mo/child/adolescent: PO (immediate-release) 80-90 mg/kg/day divided q12h
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• Infant 4-5 mo: PO (immediate-release) 80-90 mg/kg/day divided q12h for 10 days
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• Infant #3 mo: PO (immediate- release) 30 mg/kg/day divided q12h Most respiratory Infections
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• Adult: PO (immediate-release) 500 mg q12h or 250 mg q8h (mild-moderate infections); 875 mg 12 hr or 500 mg q8hr (severe infections)
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• Infant >3 mo/child/adolescent: PO (immediate-release) 20 mg/kg/day di- vided q8h (max 250 mg/dose) or 25 mg/ kg/day divided q12h (max 500 mg/dose)
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• Neonate/infant #3 mo: PO (immediate- release) 30 mg/kg/day divided q12h H. pylori
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• Adult: PO 1000 mg bid with lansopra- zole 30 mg bid with clarithromycin 500 mg bid × 14 days or 1000 mg bid with omeprazole 20 mg bid, with clarithromy- cin 500 mg bid × 14 days or 1000 mg bid with esomeprazole 40 mg daily with clarithromycin 500 mg bid × 10 days; or 1000 mg tid with lansoprazole 30 mg tid × 14 days Gonorrhea
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• Adult/child ≥40 kg: PO × 3 g single dose
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• Child >2 yr and <40 kg: PO 50 mg/kg with probenecid 25 mg/kg single dose Endocarditis prevention
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• Adult: PO 2 g 60 min prior to proce- dure
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• Child: PO 50 mg/kg 60 min prior to procedure, max adult dose UTI, including cystitis Mild to moderate infections caused by highly susceptible organisms
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• Adult: PO (immediate-release) 500 mg q12h or 250 mg q8h
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• Infant >3 mo/child/adolescent: PO (immediate-release) 20 mg/kg/day di- vided q8h (max 250 mg/dose) or 25 mg/ kg/day divided q12h (max 500 mg/dose)
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• Neonate/infant #3 mo: PO (immediate- release) 30 mg/kg/day divided q12h Renal disease
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• Adult: PO CCr 10-30 mL/min 250-500 mg q12hr; CCr <10 mL/min 250-500 mg q24hr; do not use 775-, 875-mg strength if CCr <30 mL/min Available forms: Capsules 250, A 500 mg; chewable tablets 125, 200, 250, 400 mg; tablets, 500, 875 mg; extended-release tablets (Moxatag) 775 mg; powder for suspension 125, 200, 250, 400 mg/5 mL; suspension 50 mg/mL
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