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Amoxicillin Screen Shot 2018-03-09 at 10.24.16 PM (General…
Amoxicillin
General pharmacokinetics and pharmacodynamics
Peak time: 1 - 2 hours. 3.1 hours in extended release
Excretion: 60% in urine
Protein binding ~20%
Poor CSF penetration
61.3 minute half life, extended release 90 minutes
Distributed into iver, lungs, prostate, muscle, middle ear, maxillary sinus secretions, bone, gallbladder,and bile.
Mechanism of Action: Competes with transpeptidase (a penicillin binding protein) to block trans peptidation of peptidoglycan thereby interfering with the formation of the bacterial membrane
Dental Applications and considerations
Pre appointment prophylaxis
2mg 30-60 mins ahead of appointment
Total joint replacement patients
Infective endocarditis
Used sometimes in combo with metronidazole in the treatment of periodontitis with positive culture for Actinobacillus actinomycetemcomitans
Post dental appointments
Surgical extractions in immunocompromised
Oralfacial infections
Invasive dental procedures
Can be used to treat sinusitis
Can be used to treat tonsillitis and/or pharyngitis seen orally
Clinical considerations
Dosing
Mild/moderate infection: 250 mg every 8 hours or 500 mg every 12 hours
Mild/moderate infection in respiratory tract: 500 mg every 8 hours or 875 mg every 12 hours
Severe infection: 500 mg every 8 hours or 875 mg every 12 hours
Extended-release: 775 mg once daily
Pediatric:
Children and adolescents over 40 kg: Adult dosing
25 to 50 mg/kg/day in divided doses every 8 hours(maximum 500mg)
Contraindications
Penicillin allergy
Stevens Johnson Syndrome
Toxicities
Superinfection: Extended use may result in fungal or bacterial superinfection (C. difficile and pseudomembranous colitis) has been observed especially post amoxicillin treatment greater than 2 months.
Erythematous rash develops in a high percentage of patients with infective mononucleosis
Renal impairment: Avoid extended release dosing.
Drug interactions
Category X
Bacillus Calmette-Guerin (used for bladder cancer): Amoxocillin diminishes the effects.
Category D
Sodium Picosulfate (used to treat constipation): Amoxicillin diminishes the effects of Sodium Picosulfate
Tetracycline (antibiotic): May diminish the therapeutic effect of Amoxicillin
Probenecid (used for gout): Increases serum concentration of Amoxicillin
Typhoid Vaccine: Amoxicillin diminishes the effects of the Typhoid vaccine strain Ty21a
Category C
Allopurinol (for gout): May enhance allergic/hypersensitivity reactions to Amoxicillin
Estriol (female sex hormone): Amoxicillin may diminish effects of Estriol.
Acemetacin (NSAID): May increase serum concentration of Amoxicillin
Methotrexate (chemo drug): Amoxicillin increases serum concentration of Methotrexate.
Mycophenolate (prevents organ rejection): Amoxicillins may decrease serum concentration of Mycophenolate
General Uses
GI tract infections: Effective against E.coli, P.mirabilis, and E.faecalis
H. pylori infections and recurrent duodenal ulcers
ENT infections: Effective against Streptococcus species, Staphylococcus species, and Haemophilus influenzae.
Lower respiratory infections: Effective against Streptococcus pneumoniae, Staphylococcus species, and H. influenzae.
Pharyngitis/Tonsilitis: Effective for treatment of tonsillitis and/or pharyngitis from S. pyogenes.
Skin infections: Can be used to treat acne vulgaris
Overview
Antimicrobial drug
Side effects: nausea, rash, yeast infections, diarrhea
Beta lactam
Taken orally or by IV (for more serious infections)
Generally dosed as 250mg or 500mg per pill.
