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# Amoxicillin
## Overview
Amoxicillin is a broad-spectrum penicillin-class antibiotic effective against many gram-positive and some gram-negative bacteria. It is typically available as oral capsules, tablets, or suspensions.
## Primary Indications
* Acute otitis media
* Streptococcal pharyngitis
* Pneumonia
* Uncomplicated urinary tract infections
* H. pylori eradication (in combination regimens)
* Prophylaxis for infective endocarditis in certain high-risk patients undergoing specific dental or surgical procedures.
## Adult Dosing
Dosing varies significantly by indication. General guidelines:
* **Bacterial infections:** 250 mg to 875 mg orally every 8 to 12 hours.
* **H. pylori eradication:** Typically part of a multi-drug regimen, e.g., 875 mg twice daily for 10-14 days.
* **Endocarditis prophylaxis:** 2 grams orally 1 hour before the procedure.
Maximum daily dose is generally 4 grams.
## Pediatric Dosing
Dosing is weight-based and varies by indication.
* **Bacterial infections:** 20 mg/kg/day to 90 mg/kg/day divided every 8 to 12 hours.
* Maximum daily dose: 4000 mg.
* **Otitis media and pharyngitis:** 50 mg/kg/day divided every 8 hours or 45 mg/kg/day divided every 12 hours.
* Higher doses (e.g., 80-90 mg/kg/day) may be considered for more severe infections or specific indications like otitis media.
Consult pediatric infectious disease guidelines for specific indications.
## Dose Adjustments
* **Renal Impairment:** Dose adjustment is necessary for patients with significant renal impairment (CrCl < 30 mL/min).
* If CrCl is 10-30 mL/min: Reduce dose by 25-50% or increase interval.
* If CrCl is < 10 mL/min: Reduce dose by 50-75% or increase interval.
* Hemodialysis: Give a dose after dialysis.
## Contraindications
* Known serious hypersensitivity (e.g., anaphylaxis) to amoxicillin, penicillins, or any component of the formulation.
* History of cholestatic jaundice or hepatic dysfunction associated with prior amoxicillin use.
## Adverse Effects
Common: Diarrhea, nausea, rash, vomiting.
Serious: Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, Clostridioides difficile-associated diarrhea, hepatotoxicity, neutropenia, thrombocytopenia.
## Key Drug Interactions
* **Probenecid:** May increase and prolong serum levels of amoxicillin.
* **Oral Contraceptives:** May decrease efficacy. Advise alternative or additional contraception.
* **Warfarin:** Amoxicillin may potentiate the effect of warfarin; monitor INR.
* **Allopurinol:** Increased incidence of rash.
## Monitoring
* Signs and symptoms of infection.
* Signs of hypersensitivity reactions.
* Bowel function (for C. difficile).
* Liver function tests and renal function tests may be considered with prolonged therapy or in patients with risk factors.
## Clinical Pearls
* Amoxicillin is generally well-tolerated but can cause significant allergic reactions.
* Ensure adequate hydration to minimize GI upset.
* For suspensions, reconstitute with the appropriate amount of water and shake well. Refrigerate after reconstitution and discard after the specified period (often 7-14 days).
* Complete the full course of therapy as prescribed, even if symptoms improve.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols for complete and up-to-date guidance before making any clinical decisions.
