Amoxicillin

Class
Antibiotics
Subclass
Penicillins
Substance name
Amoxicillin trihydrate
Brand names
Amoxil®, Moxatag®, Trimox®, Larotid®
Common formulations
Film-coated tablet, Capsule
Contained in
Amoxicillin / clavulanate (Augmentin®)
Amoxicillin / clavulanate XR (Augmentin XR®)
Dosage and administration
Adults patients
Treatment
Ear, nose, and throat infections • Mild-to-moderate
•
500 mg PO BID until 48-72 hours of symptoms resolution
Alternative
•
250 mg PO TID until 48-72 hours of symptoms resolution
Ear, nose, and throat infections • Severe
•
875 mg PO BID until 48-72 hours of symptoms resolution
Alternative
•
500 mg PO TID until 48-72 hours of symptoms resolution
Genitourinary tract infections • Mild-to-moderate
•
500 mg PO BID until 48-72 hours of symptoms resolution
Alternative
•
250 mg PO TID until 48-72 hours of symptoms resolution
Genitourinary tract infections • Severe
•
875 mg PO BID until 48-72 hours of symptoms resolution
Alternative
•
500 mg PO TID until 48-72 hours of symptoms resolution
Gonorrhea • Anogenital or urethral
•
3,000 mg PO once
H. pylori infection • Triple therapy
•
1,000 mg PO BID for 10-14 days
H. pylori infection • As part of dual therapy
•
1,000 mg PO TID for 10-14 days
Lower respiratory tract infections
•
875 mg PO BID until 48-72 hours of symptoms resolution
Alternative
•
500 mg PO TID until 48-72 hours of symptoms resolution
SSTIs • Mild-to-moderate
•
500 mg PO BID until 48-72 hours of symptoms resolution
Alternative
•
250 mg PO TID until 48-72 hours of symptoms resolution
SSTIs • Severe
•
875 mg PO BID until 48-72 hours of symptoms resolution
Alternative
•
500 mg PO TID until 48-72 hours of symptoms resolution
Actinomycosis, if penicillins are ineffective or contraindicated • Off-label
•
250 mg PO q6-8h for 6-12 months
Acute bacterial rhinosinusitis • Off-label
•
500 mg PO TID for 5-10 days
Alternative
•
875 mg PO BID for 5-10 days
Anthrax • Cutaneous, aerosol exposure • Off-label
•
1,000 mg PO TID for 42-60 days
Anthrax • Cutaneous, no aerosol exposure • Off-label
•
1,000 mg PO TID for 7-10 days
C. trachomatis infection in pregnant females • Off-label
•
500 mg PO TID for 7 days
Community-acquired pneumonia • Off-label
•
1,000 mg PO TID for at least 5 days and until achieving clinical stability
COPD • Acute exacerbation • Off-label
•
500 mg PO TID for 3-14 days
GAS pharyngitis • Off-label
•
1,000 mg PO daily, in 1-2 divided doses for 10 days
H. pylori infection • As part of concomitant therapy • Off-label
•
1,000 mg PO BID for 10-14 days
H. pylori infection • As part of sequential therapy • Off-label
•
1,000 mg PO BID for 5-7 days
Lyme disease • Erythema migrans • Off-label
•
500 mg PO TID for 14 days
Lyme disease • Arthritis • Off-label
•
500 mg PO TID for 28 days
Lyme disease • Carditis • Off-label
•
500 mg PO TID for 14-21 days
Lyme disease • Acrodermatitis chronica atrophicans • Off-label
•
500 mg PO TID for 21-28 days
Lyme disease • Borrelial lymphocytoma • Off-label
•
500 mg PO TID for 14 days
Paratyphoid fever • Off-label
•
1,000 mg PO TID for 28 days
Typhoid fever • Off-label
•
1,000 mg PO TID for 28 days
Adjunctive treatment
Adjunctive treatment for PPROM • Off-label
•
250 mg PO TID for 5 days
Prevention
Anthrax • Inhalational, post-exposure prophylaxis • Off-label
•
1,000 mg PO TID for 42-60 days
Infective endocarditis, after dental procedures • Off-label
•
2,000 mg PO × 1 30-60 minutes before the procedure
Other off-label uses
•
Treatment of Lyme disease (erythema migrans)
Indications for use
Labeled indications
Adults
•
Treatment of H. pylori infection (as part of dual therapy)
•
Treatment of H. pylori infection (triple therapy)
•
Treatment of ear, nose, and throat infections (mild-to-moderate)
•
Treatment of ear, nose, and throat infections (severe)
•
Treatment of genitourinary tract infections (mild-to-moderate)
•
Treatment of genitourinary tract infections (severe)
•
Treatment of gonorrhea (anogenital or urethral)
•
Treatment of lower respiratory tract infections
•
Treatment of SSTIs (mild-to-moderate)
•
Treatment of SSTIs (severe)
Off-label indications
Adults
•
Treatment of C. trachomatis infection in pregnant females
•
Treatment of H. pylori infection (as part of concomitant therapy)
•
Treatment of H. pylori infection (as part of sequential therapy)
•
Treatment of Lyme disease (acrodermatitis chronica atrophicans)
•
Treatment of Lyme disease (arthritis)
•
Treatment of Lyme disease (borrelial lymphocytoma)
•
Treatment of Lyme disease (carditis)
•
Treatment of Lyme disease (erythema migrans)
•
Treatment of actinomycosis, if penicillins are ineffective or contraindicated
•
Treatment of acute bacterial rhinosinusitis
•
Treatment of anthrax (cutaneous, aerosol exposure)
•
Treatment of anthrax (cutaneous, no aerosol exposure)
•
Treatment of COPD (acute exacerbation)
•
Treatment of community-acquired pneumonia
•
Treatment of GAS pharyngitis
•
Treatment of paratyphoid fever
•
Treatment of typhoid fever
•
Adjunctive treatment for PPROM
•
Prevention of anthrax (inhalational, post-exposure prophylaxis)
•
Prevention of infective endocarditis, after dental procedures
Safety risks
Contraindications
Hypersensitivity to amoxicillin or its components or other penicillins
Mononucleosis
•
Do not use amoxicillin in patients with mononucleosis because of the risk of amoxicillin-induced rash.
Warnings and precautions
Antimicrobial resistance
•
Maintain a high level of suspicion, as the use of amoxicillin in the absence of a proven or strongly suspected bacterial infection increases the risk of developing drug-resistant bacteria.
C. difficile infection
•
Use caution in patients with a history of diarrhea after antibiotic use.
Exacerbation of phenylketonuria
•
Use caution in patients with phenylketonuria, as chewable tablets contain phenylalanine.
Specific populations
Renal impairment
GFR ≥ 30 mL/min
•
Use acceptable. No dose adjustment required.
GFR 10-30 mL/min
•
Maximal dose of 250-500 mg. Do not exceed frequency of BID.
GFR < 10 mL/min
•
Maximal dose of 250-500 mg. Do not exceed frequency of once daily.
Renal replacement therapy
Continuous renal replacement
•
Dose as in GFR < 10 mL/min.
Intermittent hemodialysis
•
Administer an additional dose after each session. Dose as in GFR < 10 mL/min.
Peritoneal dialysis
•
Dose as in GFR < 10 mL/min.
Hepatic impairment
Any severity
•
Use acceptable. No dose adjustment required.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: A
•
Generally acceptable for use. The 2020 ERS/TSANZ task force statement suggests that amoxicillin is compatible with pregnancy for the management of airway diseases.
Breastfeeding
Use only if benefits outweigh potential risks.
Unknown drug levels in breastfed infants.
May potentially cause adverse effects in breastfed infants.
Adverse reactions
Common 1-10%
•
Amoxicillin-induced rash, change in taste, diarrhea, headache, nausea, vomiting
Uncommon < 1%
•
DRESS syndrome, erythema multiforme, abdominal pain, Stevens-Johnson syndrome
Unknown frequency
•
Agitation, agranulocytosis, anaphylaxis, angioedema, aseptic meningitis, Clostridioides difficile infection, ↓ blood neutrophil count, ↓ platelet count, hemolytic anemia, ↑ blood eosinophil count, ↑ serum transaminases, jaundice, mucocutaneous candidiasis, ⊕ urine amoxicillin crystals, anxiety, arthralgia, black hairy tongue, confusion, fever, insomnia, itching, myalgia, seizure, skin exfoliation, urticaria
Interactions
Drug(s)
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