Amoxicillin is a broad spectrum antibiotic indicated for the treatment of commonly occurring bacterial infections If you require a prescription, please visit our online doctor
Treatment of Infection: Amoxicillin is a broad spectrum antibiotic indicated for the treatment of commonly occurring bacterial infections such as:
Upper respiratory tract infections
Acute and chronic bronchitis
Chronic bronchial sepsis
Lobar and bronchopneumonia
Cystitis, urethritis, pyelonephritis
Bacteriuria in pregnancy
Gynaecological infections including puerperal sepsis and septic abortion
Typhoid and paratyphoid fever
Skin and soft tissue infections
Dental abscess (as an adjunct to surgical management)
Helicobacter pylori eradication in peptic (duodenal and gastric) ulcer disease.
In children with urinary tract infection the need for investigation should be considered.
Prophylaxis of endocarditis: Amoxil may be used for the prevention of bacteraemia, associated with procedures such as dental extraction, in patients at risk of developing bacterial endocarditis.
Consideration should be given to official local guidance (e.g. national requirements) on the appropriate use of antibacterial agents. 'Susceptibility of the causative organisms to the treatment should be tested (if possible), although the therapy may be initiated before the results are available.
Go to top of the page4.2 Posology and method of administration
Treatment of Infection:
Adult dosage (including elderly patients):
Standard adult dosage: 250 mg three times daily, increasing to 500 mg three times daily for more severe infections.
High dosage therapy (maximum recommended oral dosage 6 g daily in divided doses): A dosage of 3 g twice daily is recommended in appropriate cases for the treatment of severe or recurrent purulent infection of the respiratory tract.
Short course therapy: Simple acute urinary tract infection: two 3 g doses with 10-12 hours between the doses. Dental abscess: two 3 g doses with 8 hours between the doses. Gonorrhoea: single 3 g dose.
Glomerular filtration rate >30ml/min No adjustment necessary.
Omeprazole 40mg daily, Amoxicillin750mg-1G BID, Metronidazole 400mg TID x 7 days
Children's dosage (up to 10 years of age):
Standard children's dosage: 125 mg three times daily, increasing to 250 mg three times daily for more severe infections.
Renal impairement in children under 40 kg:
Creatnine clearance >30mL/min: No adjustment necessary.
Creatinine clearance 10-30mL/min: 15 mg/kg given b.i.d (maximum 500mg/twice daily).
Creatinine clearance <10mL/min: 15 mg/kg given as a single daily dose (maximum 500mg).
Amoxil Paediatric Suspension is recommended for children under six months of age.
In severe or recurrent acute otitis media, especially where compliance may be a problem, 750 mg twice a day for two days may be used as an alternative course of treatment in children aged 3 to 10 years.
In renal impairment the excretion of the antibiotic will be delayed and, depending on the degree of impairment, it may be necessary to reduce the total daily dosage.
Prophylaxis of endocarditis: see table on next page.
Treatment should be continued for 2 to 3 days following the disappearance of symptoms. It is recommended that at least 10 days treatment be given for any infection caused by beta-haemolytic streptococci in order to achieve eradication of the organism.
Dental procedures: prophylaxis for patients undergoing extraction, scaling or surgery involving gingival tissues and who have not received a penicillin in the previous month.
(N.B. Patients with prosthetic heart valves should be referred to hospital - see below).
Patient not having general anaesthetic.
3 g 'Amoxil' orally, 1 hour before procedure. A second dose may be given 6 hours later, if considered necessary.
Under 10: half adult dose.
Under 5: quarter adult dose.
Note 1. If prophylaxis with 'Amoxil' is given twice within one month, emergence of resistant streptococci is unlikely to be a problem. Alternative antibiotics are recommended if more frequent prophylaxis is required, or if the patient has received a course of treatment with a penicillin during the previous month.
To minimise pain on injection, 'Amoxil' may be given as two injections of 500 mg dissolved in sterile 1% lidocaime solution (see Administration).
Patient having general anaesthetic: if oral antibiotics considered to be appropriate.
Initially 3 g 'Amoxil' orally 4 hours prior to anaesthesia, followed by 3 g orally (or 1 g IV or IM if oral dose not tolerated) as soon as possible after the operation.
Patient having general anaesthetic: if oral antibiotics not appropriate.
1 g 'Amoxil' IV or IM immediately before induction; with 500 mg orally, 6 hours later.
Dental procedures: patients for whom referral to hospital is recommended:
a) Patients to be given a general anaesthetic who have been given a penicillin in the previous month.
b) Patients to be given a general anaesthetic who have a prosthetic heart valve.
c) Patients who have had one or more attacks of endocarditis.
Initially: 1 g 'Amoxil' IV or IM with 120 mg gentamicin IV or IM immediately prior to anaesthesia (if given) or 15 minutes prior to dental procedure.
Followed by (6 hours later): 500 mg 'Amoxil' orally.
Under 10: the doses of 'Amoxil' should be half the adult dose; the dose of gentamicin should be 2 mg/kg.
Under 5: the doses of 'Amoxil' should be quarter the adult dose; the dose of gentamicin should be 2 mg/kg.
See Note 2.
Note 3. 'Amoxil' and gentamicin should not be mixed in the same syringe.
Note 4. Please consult the appropriate data sheet for full prescribing information on gentamicin.
Genitourinary Surgery or Instrumentation: prophylaxis for patients who have no urinary tract infection and who are to have genito-urinary surgery or instrumentation under general anaesthesia.
In the case of Obstetric and Gynaecological Procedures and Gastrointestinal Procedures' routine prophylaxis is recommended only for patients with prosthetic heart valves.
Initially: 1 g 'Amoxil' IV or IM with 120 mg gentamicin IV or IM, immediately before induction.
Followed by (6 hours later): 500 mg 'Amoxil' orally or IV or IM according to clinical condition.
See Notes 2, 3 and 4 above.
Surgery or Instrumentation of the Upper Respiratory Tract
Patients other than those with prosthetic heart valves.
1 g 'Amoxil' IV or IM immediately before induction; 500 mg 'Amoxil' IV or IM 6 hours later.
Under 10: half adult dose.
Under 5: quarter adult dose.
See Note 2 above.
Note 5. The second dose of 'Amoxil' may be administered orally as 'Amoxil' Syrup SF/DF.
Patients with prosthetic heart valves.
Initially: 1 g 'Amoxil' IV or IM with 120 mg gentamicin IV or IM, immediately before induction; followed by (6 hours later) 500 mg 'Amoxil' IV or IM.
Under 10: the dose of 'Amoxil' should be half the adult dose; the gentamicin dose should be 2 mg/kg.
Under 5: the dose of 'Amoxil' should be quarter the adult dose; the dose of gentamicin should be 2 mg/kg.
See Notes 2, 3, 4 and 5 above.
Go to top of the page4.3 Contraindications
Amoxil is a penicillin and should not be given to penicillin-hypersensitive patients. Attention should be paid to possible cross-sensitivity with other beta-lactam antibiotics eg. cephalosporins.
Go to top of the page4.4 Special warnings and precautions for use
Before initiating therapy with amoxicillin, careful enquiry should be made concerning previous hypersensitivity reactions to penicillins, cephalosporins.
Serious and occasionally fatal hypersensitivity (anaphylactoid) reactions have been reported in patients on penicillin therapy. These reactions are more likely to occur in individuals with a history of hypersensitivity to beta-lactam antibiotics (see 4.3).
Erythematous (morbilliform) rashes have been associated with glandular fever in patients receiving amoxicillin.
Prolonged use may also occasionally result in overgrowth of non-susceptible organisms.
In patients with reduced urine output, crystalluria has been observed very rarely, predominantly with parenteral therapy. During the administration of high doses of amoxicillin, it is advisable to maintain adequate fluid intake and urinary output in order to reduce the possibility of amoxicillin crystalluria (see Section 4.9 Overdose)..
In patients with renal impairment, the rate of excretion of amoxicillin will be reduced depending on the degree of impairment and it may be necessary to reduce the total daily unit amoxicillin dosage accordingly (see section 4.2).
Go to top of the page4.5 Interaction with other medicinal products and other forms of interaction
Probenecid decreases the renal tubular secretion of amoxicillin. Concurrent use with amoxicillin may result in increased and prolonged blood levels of amoxicillin.
In common with other antibiotics, amoxicillin may affect the gut flora, leading to lower oestrogen reabsorption and reduced efficacy of combined oral contraceptives.
Concurrent administration of allopurinol during treatment with amoxicillincan increase the likelihood of allergic skin reactions.
Prolongation of prothrombin time has been reported rarely in patients receiving amoxicillin. Appropriate monitoring should be undertaken when anticoagulants are prescribed concurrently.
It is recommended that when testing for the presence of glucose in urine during amoxicillin treatment, enzymatic glucose oxidase methods should be used. Due to the high urinary concentrations of amoxicillin, false positive readings are common with chemical methods.
Go to top of the page4.6 Pregnancy and lactation
Use in pregnancy:
Animal studies with Amoxil have shown no teratogenic effects. The product has been in extensive clinical use since 1972 and its suitability in human pregnancy has been well documented in clinical studies. When antibiotic therapy is required during pregnancy, Amoxil may be considered appropriate when the potential benefits outweigh the potential risks associated with treatment.
Use in lactation:
Amoxicillin may be given during lactation. With the exception of the risk of sensitisation associated with the excretion of trace quantities of amoxicillinin breast milk, there are no known detrimental effects for the breast-fed infant.
Go to top of the page4.7 Effects on ability to drive and use machines
Adverse effects on the ability to drive or operate machinery have not been observed.
Go to top of the page4.8 Undesirable effects
The following convention has been utilised for the classification of undesirable effects:-
Very common (>1/10), common (>1/100, <1/10), uncommon (>1/1000,<1/100), rare (>1/10,000, <1/1000), very rare (<1/10,000)
The majority of side effects listed below are not unique to amoxicillin and may occur when using other pencillins.
Unless otherwise stated, the frequency of adverse events has been derived from more than 30 years of post-marketing reports.
Infections and infestations
Blood and lymphatic system disorders
Reversible leucopenia (including severe neutropenia or agranulocytosis), reversible thrombocytopenia and haemolytic anaemia.
Prolongation of bleeding time and prothrombin (see Section 4.5 - Interaction with other Medicinal Products and other Forms of Interaction)
Immune system disorders
As with other antibiotics, severe allergic reactions, including angioneurotic oedema, anaphylaxis (see Section 4.4 Special Warnings and Precautions for Use), serum sickness and hypersensitivity vasculitis.
If a hypersensitivity reaction is reported, the treatment must be discontinued. (See also Skin and subcutaneous tissue disorders)
Nervous system disorders
Hyperkinesia, dizziness and convulsions. Convulsions may occur in patients with impaired renal function or in those receiving high doses.
Clinical Trial Data
Diarrhoea and nausea.
Antibiotic associated colitis (including pseudomembraneous colitis and haemorrhagic colitis).
Black hairy tongue
Superficial tooth discolouration has been reported in children. Good oral hygiene may help to prevent tooth discolouration as it can usually be removed by brushing.
Hepatitis and cholestatic jaundice. A moderate rise in AST and/or ALT.
The significance of a rise in AST and/or ALT is unclear.
Skin and subcutaneous tissue disorders
Clinical Trial Data
Urticaria and pruritus
Very rare :
Skin reactions such as erythema multiforme, Stevens Johnson syndrome, toxic epidermal necrolysis, bullous and exfoliative dermatitis and acute generalised exanthematous pustulosis (AGEP)
(See also Immune system disorders).
Renal and urinary tract disorders
Very rare :
Crystalluria (see Section 4.9 Overdose).
*The incidence of these AEs was derived from clinical studies involving a total of approximately 6,000 adult and paediatric patients taking amoxicillin.
Go to top of the page4.9 Overdose
Gastrointestinal effects such as nausea, vomiting and diarrhoea may be evident and should be treated symptomatically with attention to the water/electrolyte balance. Amoxicillin crystalluria, in some cases leading to renal failure, has been observed (see Section 4.4 Special warnings and special precautions for use).
Amoxicillin may be removed from the circulation by haemodialysis.
Go to top of the page5. PHARMACOLOGICAL PROPERTIES
Go to top of the page5.1 Pharmacodynamic properties
Amoxil is a broad spectrum antibiotic.
It is rapidly bactericidal and possesses the safety profile of a penicillin.
The wide range of organisms sensitive to the bactericidal action of Amoxil include:
Go to top of the page5.2 Pharmacokinetic properties
Amoxil is well absorbed by the oral and parenteral routes. Oral administration, usually at convenient t.d.s. dosage, produces high serum levels independent of the time at which food is taken. Amoxil gives good penetration into bronchial secretions and high urinary concentrations of unchanged antibiotic.
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