Axomocillin

# Axomocillin ## Overview - **Classification**: Broad-spectrum penicillin antibiotic - **Mechanism**: Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), leading to bacterial lysis. ## Primary Indications 1. **Community-acquired pneumonia (CAP)** - Treatment of respiratory tract infections. 2. **Acute otitis media (AOM)** - Common ear infection in pediatric and adult patients. 3. **Skin and soft tissue infections (SSTIs)** - Treatment of uncomplicated skin infections. ## Adult Dosing ### Standard Dosing **Community-acquired Pneumonia (CAP) / Skin and Soft Tissue Infections (SSTIs)** - **Dose**: **500 mg** - **Frequency**: Every **8 hours** - **Route**: Oral - **Duration**: 7-10 days **Acute Otitis Media (AOM)** - **Dose**: **875 mg** - **Frequency**: Every **12 hours** - **Route**: Oral - **Duration**: 5-7 days ### Dose Adjustments - **Renal Impairment**: - CrCl **>30 mL/min**: No adjustment needed. - CrCl **10-30 mL/min**: **500 mg** every **12 hours**. - CrCl **<10 mL/min**: **500 mg** every **24 hours**. - **Hepatic Impairment**: No specific dose adjustment recommended. Use with caution. - **Elderly Patients**: Adjust dose based on renal function. Monitor for adverse effects. ## Pediatric Dosing ### Neonates (0-28 days) - **Dose**: **25 mg/kg** - **Frequency**: Every **12 hours** - **Maximum**: **500 mg/dose** - **Special Notes**: Use **125 mg/5 mL** oral suspension. Ensure precise weight-based dosing. ### Infants (1-12 months) - **Dose**: **20-45 mg/kg/day** divided - **Frequency**: Every **8-12 hours** - **Maximum**: **875 mg/dose** - **Special Notes**: For AOM, **90 mg/kg/day** divided every 12 hours is often used. ### Children (1-12 years) - **Dose**: **20-45 mg/kg/day** divided - **Frequency**: Every **8-12 hours** - **Maximum**: Do not exceed adult maximum dose (**2.625 grams/day**). - **Special Notes**: Chewable tablets or oral suspension are available. ### Adolescents (13-18 years) - **Dose**: Follow adult dosing recommendations for specific indications. - **Maximum**: **2.625 grams/day** (adult maximum dose). ## Safety Information ### Contraindications - **Absolute**: History of hypersensitivity to penicillin or cephalosporin antibiotics. - **Absolute**: Previous Axomocillin-associated cholestatic jaundice or hepatic dysfunction. - **Relative**: Patients with mononucleosis (increased risk of maculopapular rash). ### Common Adverse Effects - **Very Common (>10%)**: Diarrhea, Nausea, Vomiting. - **Common (1-10%)**: Rash, Urticaria, Headache, Vaginitis. - **Serious but Rare**: Anaphylaxis, *Clostridioides difficile*-associated diarrhea (CDAD), Stevens-Johnson Syndrome (SJS), severe hepatotoxicity. ### Key Drug Interactions - **Methotrexate**: May increase methotrexate levels due to reduced renal excretion. Monitor for methotrexate toxicity. - **Probenecid**: Increases Axomocillin plasma levels by decreasing renal tubular secretion. Consider dose reduction of Axomocillin. - **Oral Contraceptives**: May rarely reduce efficacy; advise use of backup contraception. - **Warfarin**: May potentiate anticoagulant effect (alteration of gut flora). Monitor INR closely. ## Monitoring & Follow-up - **Before Treatment**: Assess for penicillin/cephalosporin allergies. Obtain baseline renal function (CrCl). - **During Treatment**: Monitor for signs of allergic reactions, severe diarrhea, or hepatic dysfunction. - **Clinical Signs**: Assess for resolution of infection symptoms. Seek medical attention for worsening symptoms. ## Clinical Pearls - 💡 **Tip 1**: Axomocillin can be taken with or without food. Taking with food may reduce GI upset. - 💡 **Tip 2**: Shake oral suspension well before each use. Store refrigerated and discard after 14 days. - 💡 **Tip 3**: Emphasize completing the full course of therapy to prevent antibiotic resistance, even if symptoms improve early. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.