Adult Dosing
Upper respiratory tract, genito-urinary tract, skin and soft tissue infections
- 250 mg IM/IV q6-8 hrs; can increase to 500 mg q6-8 hrs in severe infections
Lower respiratory tract infections
Bacterial septicemia
- 1,000 mg IV (as slow IV or IV infusion) q6 hrs
Endocarditis prophylaxis (Based on the recommendations of the British Society)
Dental Procedures
- Refer amoxicillin [Oral] monograph for prophylaxis by oral route
- Patient given general anesthetic
- Adults and Elderly: 1,000 mg amoxicillin IM immediately before induction; with 500 mg PO, 6 hours later
- Note: For patients undergoing extraction, scaling or surgery involving gingival tissues, and who have not received penicillin in the previous month
Endocarditis prophylaxis (Based on recommendations of the British Society)
Dental Procedures
- Patients for whom referral to hospital is recommended
- Adults and Elderly: Start 1,000 mg amoxicillin IM with 120 mg gentamicin IM, immediately prior to anesthesia (if given) or 15 minutes prior to dental procedure; followed by (6 hours later): 500 mg amoxicillin PO
- Note: For patients requiring GA given a penicillin in previous month; patients requiring GA having a prosthetic valve; patients with 1 attacks of endocarditis
Genito-urinary Surgery or Instrumentation
- Prophylaxis for patients who have no UTI and who are to have GU surgery or instrumentation under GA
- Adults and Elderly: Start 1,000 mg amoxicillin IM with 120 mg gentamicin IM, immediately before induction; followed by (6 hours later): 500 mg amoxicillin orally or IM as per clinical condition
Obstetric and Gynecological Procedures and Gastro-intestinal Procedures
- Routine prophylaxis is recommended only for patients with prosthetic valves
- Adults and Elderly: Start 1,000 mg amoxicillin IM with 120 mg gentamicin IM, immediately before induction; followed by (6 hours later): 500mg amoxicillin orally or IM as per clinical condition
Surgery or Instrumentation of the Upper Respiratory Tract
- Patients other than those with prosthetic valve
- Adults and Elderly: 1,000 mg amoxicillin IM immediately before induction; followed by 500 mg IV, 6 hours later
Surgery or Instrumentation of the Upper Respiratory Tract
- Patients with prosthetic heart valve
- Adults and Elderly: Start 1,000 mg amoxicillin IM with 120 mg gentamicin IM, immediately before induction; followed by (6 hours later):500mg Amoxil IM
Infective endocarditis
- 2 gm amoxicillin IV q4 hr and gentamicin 1 mg/kg IV/IM every 8 hr for 4 to 6 weeks (see gentamicin monograph)
Pediatric Dosing
Upper respiratory tract, genito-urinary tract, skin and soft tissue infections
- Child (< 20 kgs): 20 mg/kg/day IV/IM in divided doses q6-8 hrs; can increase to 40 mg/kg/day in severe infections
Lower respiratory tract infections
- Child (< 20 kgs): 40 mg/kg/day IV/IM in divided doses q6-8 hrs
Bacterial septicemia
- Child: 150-200 mg/kg/day divided q3-4 hrs
Endocarditis prophylaxis (Based on recommendations of the British Society)
Dental Procedures
- Refer amoxicillin [Oral] monograph for prophylaxis by oral route
- Patient given general anesthesia
- Child: <10 yrs: Give 1/2 of the adult dose
- Note: For patients undergoing extraction, scaling or surgery involving gingival tissues, and who have not received penicillin in the previous month
Endocarditis prophylaxis (Based on the recommendations of the British Society)
Dental Procedures
- Patients for whom referral to hospital is recommended
- Child: <10 yrs: Give amoxicillin 1/2 of the adult dose; dose of gentamicin should be 2mg/kg
- Note: For patients requiring GA given a penicillin in previous month; patients requiring GA having a prosthetic valve; patients with 1 attacks of endocarditis
Genito-urinary Surgery or Instrumentation
- Prophylaxis for patients who have no UTI and who are to have GU surgery or instrumentation under GA
- Child: <10 yrs: Give amoxicillin 1/2 of the adult dose; gentamicin dose should be 2 mg/kg (see gentamicin monograph)
Obstetric and Gynecological Procedures and Gastro-intestinal Procedures
- Routine prophylaxis is recommended only for patients with prosthetic valves
- Child: <10 yrs: Give amoxicillin 1/2 of the adult dose; gentamicin dose should be 2 mg/kg (see gentamicin monograph)
Surgery or Instrumentation of the Upper Respiratory Tract
- Patients other than those with prosthetic valve
- Child: <10 yrs: Give 1/2 of the adult dose
Surgery or Instrumentation of the Upper Respiratory Tract
- Patients with prosthetic heart valve
- Child: <10 yrs: Give amoxicillin 1/2 of the adult dose; gentamicin dose should be 2mg/kg
Infective endocarditis
- 300 mg/kg/day IV in 4-6 equally divided doses. Max: 12 gm/day. Use combination of streptomycin, imipenem/cilastatin or ceftriaxone based on microbiology of infection.
[Outline]
Dosing adjustments
Renal Dose Adjustment (Based on CrCl)
- Adults (IV)
- 10-50 mL/min: change interval to every 6-12 hr
- < 10 mL/min: change interval to every 12 hr
- HD: 1000 mg supplement, then 500-1000 mg q12-24 hrs
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined
- Serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported in patients on penicillin therapy; more likely to occur in individuals with a history of penicillin hypersensitivity and/or a history of sensitivity to multiple allergens
- Amoxicillin is not the treatment of choice for patients presenting with sore throat or pharyngitis (due to the possible cause of infectious mononucleosis)
- Maintain adequate hydration with high doses
- Abnormal prolongation of prothrombin time (increased INR) has occurred in patients receiving amoxycillin and oral anticoagulants; monitor when anticoagulants are prescribed concurrently
Cautions: Use cautiously in
- Hx of allergy of cephalosporins
- Renal impairment (risk of crystalluria with high doses)
- Cardiac failure
- Glandular fever
- Cytomegalovirus infection
- Patients with undiagnosed pharyngitis who may have mononucleosis (increased risk of developing skin rashes)
- CLL
- Syphilis
- Lymphatic leukaemia
Pregnancy Category:A
Breastfeeding: Limited data indicates that single maternal doses of 1000 mg produce low levels in milk that would not be expected to cause adverse effects in breastfed infants. Disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush, has been reported with penicillins in some cases. This drug is considered compatible with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 ) and based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 20 August 2010)