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Amoxicillin (β-lactam antibiotic) 1200px-Amoxicillin.svg…
Amoxicillin (β-lactam antibiotic) 
Pharmacokinetics
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metabolism and excretion
after oral administration, ~60% of unchanged form and its metabolites are excreted in urine within 6 to 8 hours via tubular secretion and glomerular filtration
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distribution: diffuses easily into tissues and body fluids except brain and spinal fluid unless meningitis is present; crosses placenta and small percentage excreted in breast milk
in blood serum, approximately 18-20% protein-bound
methods of administration: orally via capsule, tablet, chewable tablet, or suspension; intravenously as the sodium salt; however, not administered intravenously in U.S.
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Pharmacodynamics
mechanism of action
binds to one or more of the penicillin binding proteins (PBPs) on bacteria to inhibit bacterial cell wall synthesis, leading to bacterial death
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in Gram negative bacteria, amoxicillin can diffuse through porin channels on outer membrane of cell wall because it is hydrophilic; therefore, effective against certain Gram negative bacteria
spectrum of activity: semisynthetic, broad spectrum antibiotic that has bactericidal activity against many Gram-positive and Gram-negative microorganisms; analog of ampicillin
indications
upper respiratory tract infections like pharyngitis, tonsillitis
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lower respiratory tract infections like community acquired pneumonia, bronchititis
for adults with community-acquired pneumonia, administer amoxicillin with azithromycin or clarithromycin
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Drug interactions
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macrolides, sulfonamides, chloramphenicol, tetracyclines may interfere with bactericidal effects of amoxicillin
laboratory test interactions: false positives when testing for presence of glucose in urine using Benedict's Solution or Fehling's Solution
do not take amoxicillin shortly after receiving live typhoid vaccine; may render vaccine ineffective
when taken with selected anticoagulants especially vitamin K antagonists (warfarin), bleeding times may be prolonged (increased INR)
be cautious when taking amoxicillin with oral contraceptives because effectiveness of birth control pills may decrease
when taken with allopurinol, may develop rash
available dosages
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oral chewable tablet strengths: 125 mg, 200mg, 250mg, 400 mg
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oral solution: 50 mg/5mL, 125 mg/5mL, 200 mg/5mL, 250 mg/5mL, 400 mg/5mL
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toxicity: overdose is rare but GI symptoms and disturbances of fluid and electrolyte balance may be evident; convulsions may occur in patients with impaired renal function
treatment of intoxication: treat GI complications symptomatically; monitor water/electrolyte balance; amoxicillin can be removed from body through hemodialysis
dosages
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triple therapy: 1 g amoxicillin every 12 hours for 14 days with lansoprazole (30 mg) and clarithromycin (500 mg)
children 3 months - 17 years and under 40 kg: 45 mg/kg/day divided every 12 hours or 40 mg/kg/day divided every 8 hours
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dosages
typical child dosage (3 months- 17 years or children less than 40 kg): 45 mg/kg/day in divided doses every 12 hours or 40 mg/kg/day in divided doses every 8 hours
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