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**DRUG:** Amoxicillin
## Overview
Amoxicillin is a broad-spectrum penicillinase-resistant aminopenicillin antibiotic used to treat a variety of bacterial infections.
## Primary Indications
* **Respiratory Tract Infections:** Otitis media, sinusitis, pharyngitis, tonsillitis, community-acquired pneumonia.
* **Genitourinary Tract Infections:** Uncomplicated urinary tract infections.
* **Skin and Soft Tissue Infections:** Cellulitis, impetigo.
* **Dental Infections:** Dental abscesses.
* **Lyme Disease:** Early localized and disseminated stages.
* **H. pylori Eradication:** In combination with other agents.
## Adult Dosing
* **General Infections:** 250 mg to 500 mg orally every 8 hours, or 875 mg orally every 12 hours.
* **Severe Infections or less susceptible organisms:** Up to 875 mg orally every 8 hours.
* **Dental Infections:** 500 mg orally every 8 hours for 3-7 days.
* **Lyme Disease (Early Localized):** 500 mg orally every 8 hours for 14-21 days.
* **Lyme Disease (Disseminated):** 500 mg orally every 8 hours for 14-28 days.
* **H. pylori Eradication (Regimen dependent):** Typically 1000 mg orally twice daily for 10-14 days in combination therapy.
## Pediatric Dosing
Dosing is generally based on weight.
* **Otitis Media, Sinusitis, Pneumonia, UTIs, Skin Infections:** 25 mg/kg/day to 45 mg/kg/day divided every 8 hours or 12 hours.
* Maximum dose: 875 mg per dose or 4000 mg/day.
* **Severe Infections or infections caused by less susceptible organisms:** 45 mg/kg/day divided every 8 hours.
* **H. pylori Eradication (Regimen dependent):** Consult specific pediatric guidelines; typically 20-40 mg/kg/day divided twice daily.
## Dose Adjustments
* **Renal Impairment:**
* CrCl > 30 mL/min: No dose adjustment needed.
* CrCl 10-30 mL/min: Reduce dose by 25-50%; maintain usual dosing interval. For standard dosing, administer 250-500 mg every 12 hours. For high-dose regimen, administer 875 mg every 12 hours or 500 mg every 8 hours.
* CrCl < 10 mL/min: Reduce dose by 50-75%; administer 250-500 mg every 24 hours. For high-dose regimen, administer 500 mg every 12 hours.
* Hemodialysis: Administer a supplemental dose after dialysis.
## Contraindications
* Hypersensitivity 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, headache.
* **Serious:** Anaphylaxis, severe skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis), Clostridioides difficile-associated diarrhea (CDAD), seizure (rare, with high doses or renal impairment), hemolytic anemia, interstitial nephritis.
## Key Drug Interactions
* **Probenecid:** May increase and prolong serum concentrations of amoxicillin.
* **Oral Contraceptives:** May decrease efficacy. Advise backup contraception.
* **Warfarin:** Potential for increased anticoagulant effect, monitor INR.
* **Allopurinol:** Increased incidence of rash.
* **Methotrexate:** May increase methotrexate toxicity.
## Monitoring
* Signs and symptoms of infection.
* Signs of hypersensitivity reactions.
* Bowel function for diarrhea, especially CDAD.
* Renal function, particularly in patients with pre-existing renal impairment.
* INR if co-administered with warfarin.
## Clinical Pearls
* Administer with or without food.
* Suspensions should be refrigerated and discarded after 14 days.
* For suspected beta-lactamase producing organisms, consider combination with a beta-lactamase inhibitor (e.g., clavulanate).
* Advise patients to report any severe allergic reactions immediately.
* Ensure adequate hydration, especially in pediatric patients.
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**Educational Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information, institutional protocols, and patient-specific factors before making clinical decisions.
