Names and pronunciation
(a-mox-i-sill′in) Amoxil , Moxatag
Source page 78
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Individual generic drug information
Extracted information for amoxicillin only.
(a-mox-i-sill′in) Amoxil , Moxatag
Source page 78
Func. class.: Antiinfective, antiulcer
Source page 78
Chem. class.: Aminopenicillin
Source page 78
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
Source page 78
Unlabeled uses: Lyme disease, anthrax treatment and prophylaxis, cervicitis, Chlamydia trachomatis, dental abscess/ infection, dyspepsia, nongonococcal urethritis, periodontitis, typhoid fever
Source page 78
Extracted information for amoxicillin only.
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
Source page 78
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
Source page 79
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)
Source pages 79, 80
Extracted information for amoxicillin only.
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
Source pages 78, 79
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
Source page 79
Extracted information for amoxicillin only.
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
Source page 80
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
Source page 80
Extracted information for amoxicillin only.
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
Source page 79
Filter the extracted dose blocks for this individual drug.
(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
Candidate age grouping · source pages 78, 79
(rheumatic fever prophylaxis) secondary to Streptococcus pyogenes
• Infant/child/adolescent: PO (immedi- ate-release) 25 mg/kg/dose (max 500 mg/dose) bid for 10 days Sinusitis
Candidate age grouping · source pages 78, 79
(rheumatic fever prophylaxis) secondary to Streptococcus pyogenes
• 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)
Candidate age grouping · source pages 78, 79
(rheumatic fever prophylaxis) secondary to Streptococcus pyogenes
• Infant ≥6 mo/child/adolescent: PO (immediate-release) 80-90 mg/kg/day divided q12h
Candidate age grouping · source pages 78, 79
(rheumatic fever prophylaxis) secondary to Streptococcus pyogenes
• 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)
Candidate age grouping · source pages 78, 79
(rheumatic fever prophylaxis) secondary to Streptococcus pyogenes
• 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)
Candidate age grouping · source pages 78, 79