amoxicillin trihydrate

(a mox i sill' in)

Amoxil, Amoxil Pediatric Drops, Apo-Amoxi (CAN), DisperMox, Novamoxin
(CAN), Nu-Amoxi (CAN), Trimox

Pregnancy Category B

Drug class
Antibiotic (penicillin–ampicillin type)

Therapeutic actions
Bactericidal: Inhibits synthesis of cell wall of sensitive organisms, causing cell death.

Indications
• Infections due to susceptible strains of Haemophilus influenzae, Escherichia coli,
Proteus mirabilis, Neisseria gonorrhoeae, Streptococcus pneumoniae,
Enterococcus faecalis, streptococci, nonpenicillinase-producing staphylococci
• Helicobacter pylori infection in combination with other agents
• Post-exposure prophylaxis against Bacillus anthracis
• Unlabeled use: Chlamydia trachomatis in pregnancy

Contraindications and cautions

• Contraindicated with allergies to penicillins, cephalosporins, or other allergens.
• Use cautiously with renal disorders, lactation.

Available forms
Chewable tablets—125, 200, 250, 400 mg; tablets—500, 875 mg; capsules—250,
500 mg; powder for oral suspension—50 mg/mL; 125 mg/5 mL, 200 mg/5 mL, 250 mg/5
mL, 400 mg/5 mL; tablets for oral suspension—200, 400 mg
Available in oral preparations only.

Dosages
ADULTS AND PEDIATRIC PATIENTS > 40 KG
• URIs, GU infections, skin and soft-tissue infections: 250–500 mg PO q 8 hr or
875 mg PO bid.
• Post-exposure anthrax prophylaxis: 500 mg PO tid.
• Lower respiratory infections: 500 mg PO q 8 hr or 875 mg PO bid.
• Uncomplicated gonococcal infections: 3 g amoxicillin with 1 g probenecid PO.
• C. trachomatis in pregnancy: 500 mg PO tid for 7 days or 875 mg PO bid.
• Prevention of SBE in dental, oral, or upper respiratory procedures: 2 g 1 hr
before procedure.
• Prevention of SBE in GI or GU procedures: 2 g ampicillin plus 1.5 mg/kg
gentamicin IM or IV 30 min before procedure, followed by 1 g amoxicillin; for
low-risk patients, 2 g 1 hr before procedure.
 • H. pylori: 1 g bid with clarithromycin 500 mg bid and lansoprazole 30 mg bid for
14 days.
PEDIATRIC PATIENTS < 40 KG
• URIs, GU infections, skin, and soft-tissue infections: 20–40 mg/kg/day PO in
divided doses q 8 hr.
• Post-exposure anthrax prophylaxis: 80 mg/kg/day PO divided into 3 doses.
• Prevention of SBE: Dental, oral, or upper respiratory procedures: 50 mg/kg 1 hr
before procedure.
• Prevention of SBE in GI or GU procedures: 50 mg/kg ampicillin plus 2 mg/kg
gentamicin IM or IV 30 min before procedure followed by 25 mg/kg amoxicillin.
For moderate-risk patients, 50 mg/kg PO 1 hr before procedure.
PEDIATRIC PATIENTS
< 12 wk: Up to 30 mg/kg daily in divided doses q 12 hr.
> 3 mo:
• Mild to moderate URIs, GU infections, and skin infections: 20 mg/kg daily in
divided doses q 8 hr or 25 mg/kg in divided doses q 12 hr.
• For lower respiratory infections, or severe URIs, GU, or skin infections:
40 mg/kg daily in divided doses q 8 hr or 45 mg/kg daily in divided doses q 12 hr.

Pharmacokinetics
Route Onset Peak Duration
Oral Varies 1 hr 6–8 hr

Metabolism: T1/2: 1–1.4 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Unchanged in the urine

Adverse effects
• CNS: Lethargy, hallucinations, seizures
• GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue, black "hairy" tongue,
nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis,
pseudomembranous colitis, nonspecific hepatitis
• GU: Nephritis
• Hematologic: Anemia, thrombocytopenia, leukopenia, neutropenia, prolonged
bleeding time
• Hypersensitivity: Rash, fever, wheezing, anaphylaxis
• Other: Superinfections—oral and rectal moniliasis, vaginitis

Interactions
Drug-drug
• Increased effect with probenecid
• Decreased effectiveness with tetracyclines, chloramphenicol
• Decreased efficacy of hormonal contraceptives
Drug-food
• Delayed or reduced GI absorption with food
Nursing considerations
Assessment
• History: Allergies to penicillins, cephalosporins, or other allergens; renal
disorders; lactation
• Physical: Culture infected area; skin color, lesion; R, adventitious sounds; bowel
sounds; CBC, liver and renal function tests, serum electrolytes, Hct, urinalysis

Interventions
• Culture infected area prior to treatment; reculture area if response is not as
expected.
• Give in oral preparations only; absorption may be affected by presence of food;
drug should be taken 1 hr before or 2 hr after meals.
• Continue therapy for at least 2 days after signs of infection have disappeared;
continuation for 10 full days is recommended.
• Use corticosteroids, antihistamines for skin reactions.

Teaching points
• Take this drug around-the-clock. The drug should be taken on an empty stomach,
1 hr before or 2 hr after meals.
• Take the full course of therapy; do not stop because you feel better.
• This antibiotic is specific for this problem and should not be used to self-treat
other infections.
• These side effects may occur: Nausea, vomiting, GI upset (eat small, frequent
meals); diarrhea; sore mouth (perform frequent mouth care).
• Report unusual bleeding or bruising, sore throat, fever, rash, hives, severe
diarrhea, difficulty breathing.

Adverse effects in Italic are most common; those in Bold are life-threatening.