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# Amoxicillin
## Overview
Amoxicillin is a broad-spectrum penicillin antibiotic used to treat bacterial infections.
## Primary Indications
* **Acute otitis media:** Often used as first-line therapy.
* **Streptococcal pharyngitis:** Effective for treating strep throat.
* **Pneumonia:** Used for community-acquired pneumonia.
* **Urinary tract infections:** Can be used for uncomplicated UTIs.
* **Skin and soft tissue infections:** Effective against certain susceptible bacteria.
* **H. pylori eradication:** As part of multi-drug regimens.
## Adult Dosing
* **General infections:** 250 mg to 500 mg orally every 8 hours, or 500 mg to 875 mg orally every 12 hours.
* **Severe infections:** May require higher doses.
* **H. pylori eradication:** Typically 1000 mg orally twice daily in combination with other agents.
* **Maximum dose:** Generally 4000 mg daily, though higher doses may be used under specific circumstances and with medical supervision.
## Pediatric Dosing
Dosing is based on weight and indication. Consult specific guidelines for precise dosing.
* **Acute otitis media:** 80 mg/kg/day to 90 mg/kg/day divided into two or three doses.
* **Strep throat:** 50 mg/kg/day divided into two or three doses.
* **Maximum pediatric dose:** Generally 90 mg/kg/day, not to exceed the adult maximum.
## Dose Adjustments
* **Renal Impairment:** Dose reduction is necessary for moderate to severe renal impairment (CrCl < 30 mL/min). Specific adjustments depend on the degree of impairment and local protocols.
## Contraindications
* Known hypersensitivity to amoxicillin, penicillins, or any component of the formulation.
* History of cholestatic jaundice or hepatic dysfunction associated with amoxicillin.
## Adverse Effects
* **Common:** Diarrhea, nausea, rash (non-allergic), vomiting.
* **Serious:** Severe allergic reactions (anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis, C. difficile-associated diarrhea, cholestatic jaundice, hepatitis.
## Key Drug Interactions
* **Probenecid:** May increase and prolong amoxicillin blood levels.
* **Allopurinol:** Increased risk of rash.
* **Oral contraceptives:** May reduce efficacy.
* **Warfarin:** Potential for altered INR, monitor closely.
## Monitoring
* **Clinical signs and symptoms of infection:** Monitor for improvement.
* **Signs of hypersensitivity:** Monitor for rash, angioedema, anaphylaxis.
* **Bowel function:** Monitor for diarrhea, especially C. difficile.
* **Liver function:** In patients with prolonged therapy or history of liver disease.
## Clinical Pearls
* Amoxicillin can be taken with or without food.
* Complete the full course of therapy even if symptoms improve.
* Oral suspension should be refrigerated and discarded after 14 days.
* Consider patient's history of penicillin allergy carefully; cross-reactivity with cephalosporins is possible but often overstated.
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**Disclaimer:** This information is intended for clinical decision support and does not replace the need to consult the official prescribing information and current clinical guidelines. Always verify current drug information before prescribing.
