Amoxicillin shares the uses of other aminopenicillins and is used principally for the treatment of infections caused by susceptible gram-negative bacteria (e.g., Haemophilus influenzae , Escherichia coli , Proteus mirabilis , Salmonella ).36,67,73,864,2337 Amoxicillin also is used for the treatment of infections caused by susceptible gram-positive bacteria (e.g., Streptococcus pneumoniae , enterococci, nonpenicillinase-producing staphylococci, Listeria );36,67,864,2337 however, like other aminopenicillins, amoxicillin generally should not be used for the treatment of streptococcal or staphylococcal infections when a natural penicillin would be effective.63,64,67,80,864,869,904,906
Acute Otitis Media 
Amoxicillin is used for the treatment of acute otitis media (AOM) caused by S. pneumoniae , H. influenzae , or M. catarrhalis .683,36,2180,2250,2310,2311,2343,2389,2398,2432,2433,2434 Amoxicillin usually is considered the drug of first choice for initial empiric treatment of AOM, unless the infection is suspected of being caused by β-lactamase-producing bacteria resistant to the drug, in which case the fixed combination of amoxicillin and clavulanate potassium is recommended.683,1656,1657,1661,1664,2180,2181,2250,2310,2311,2343,2361,2362,2398,2400,2433,2446,2479,2482 The American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), US Centers for Disease Control and Prevention (CDC), and others state that, despite the increasing prevalence of multidrug-resistant S. pneumoniae and presence of β-lactamase-producing H. influenzae or M catarrhalis in many communities, amoxicillin remains the anti-infective of first choice for treatment of uncomplicated AOM since it is highly effective, has a narrow spectrum of activity, is well distributed into middle ear fluid, is well tolerated, has an acceptable taste, and is inexpensive.683,2178,2343,2398,2403,2404,2413,2414,2433,2476,2479,2482 Amoxicillin (when given in a dosage of 80-90 mg/kg daily) usually is effective in the treatment of AOM caused by S. pneumoniae , including infections involving strains with intermediate resistance to penicillins, and also usually is effective in the treatment of AOM caused by most strains of H. influenzae .683,2398,2403,2433,2475
AAP, AAFP, and others recommend that patients who fail to respond to an initial amoxicillin regimen (given in a dosage of 80-90 mg/kg daily) should be retreated using a regimen of amoxicillin and clavulanate potassium (90 mg/kg of amoxicillin and 6.4 mg/kg of clavulanate daily).683,2314,2343,2361,2398,2400,2414,2441
For additional information regarding treatment of AOM, including information on diagnosis and management strategies, anti-infectives for initial treatment, duration of initial treatment, and anti-infectives for retreatment and for information on current recommendations regarding management of otitis media with effusion (OME), see Uses: Otitis Media, in the Aminopenicillins General Statement 8:12.16.08.
Anthrax
Amoxicillin is used as an alternative for postexposure prophylaxis of anthrax † following exposure to Bacillus anthracis spores, for treatment of anthrax† when a parenteral regimen is not available (e.g., when there are supply or logistic problems because large numbers of individuals require treatment in a mass casualty setting), and for treatment of cutaneous anthrax†.671,672,673,2502,2505,2506 Strains of B. anthracis with naturally occurring penicillin resistance have been reported rarely, and there are published reports of B. anthracis strains that have been engineered to have penicillin and tetracycline resistance as well as resistance to other anti-infectives (e.g., macrolides, chloramphenicol, rifampin).2499,2501,2502,2510 Therefore, it has been postulated that exposures to B. anthracis that occur in the context of biologic warfare or bioterrorism may involve bioengineered resistant strains and this concern should be considered when selecting initial therapy for the treatment of anthrax that occurs as the result of bioterrorism-related exposures or for postexposure prophylaxis following such exposures.2502,2506,2510 For additional information on treatment of anthrax and recommendations for postexposure prophylaxis following exposure to anthrax spores, see Uses: Anthrax, in Ciprofloxacin 8:12.18.
Postexposure Prophylaxis
Ciprofloxacin or doxycycline generally are considered the initial drugs of choice for postexposure prophylaxis following suspected or confirmed exposure to aerosolized B. anthracis spores that occurs in the context of biologic warfare or bioterrorism.671,672,673,2499,2502,2505,2506,2508 If exposure is confirmed and results of in vitro testing indicate that the organism is susceptible to penicillin, then consideration can be given to changing the postexposure prophylaxis regimen to a penicillin (e.g., oral amoxicillin, oral penicillin V).671,672,673,2499,2502,2506,2508,2509 Although monotherapy with a penicillin is not recommended for the treatment of clinically apparent inhalational anthrax when high concentrations of the organism are likely to be present, penicillins may be considered an option for anti-infective prophylaxis when ciprofloxacin and doxycycline are contraindicated, since the likelihood of β-lactamase induction resulting in an increase in penicillin MICs is lower when only a small number of vegetative cells are present.2506,2509
The possible benefits of postexposure prophylaxis against anthrax should be weighed against the possible risks to the fetus when choosing an anti-infective for postexposure prophylaxis in pregnant women.2509 CDC and other experts state that ciprofloxacin should be considered the drug of choice for initial postexposure prophylaxis in pregnant women exposed to B. anthracis spores and that, if in vitro studies indicate that the organism is susceptible to penicillin, then consideration can be given to changing the postexposure regimen to amoxicillin.672,2502,2509 Women who become pregnant while receiving anti-infective prophylaxis should continue the existing regimen and consult with a healthcare provider or public health official to discuss whether an alternative regimen might be more appropriate.2509
Cutaneous Anthrax
Although natural penicillins (e.g., oral penicillin V, IM penicillin G benzathine, IM penicillin G procaine) generally have been considered drugs of choice for the treatment of mild, uncomplicated cutaneous anthrax caused by susceptible strains of B. anthracis that occurs as the result of naturally occurring or endemic exposure to anthrax,2500,2501,2502 the initial drugs of choice for the treatment of cutaneous anthrax that occurs following exposure to B. anthracis spores in the context of biologic warfare or bioterrorism are ciprofloxacin or doxycycline.671,672,673,2506 If penicillin susceptibility is confirmed, consideration can be given to changing to a penicillin (oral amoxicillin or oral penicillin V) in infants and children, pregnant or lactating women, or when the drugs of choice are not tolerated or not available;671,672,673,2506 oral amoxicillin may be preferred, especially in infants and children.671,672,673
For more specific information on the uses of amoxicillin, see Uses in the Aminopenicillins General Statement 8:12.16.08.
For information on the uses of amoxicillin in fixed combination with clavulanic acid, see Amoxicillin and Clavulanate Potassium 8:12.16.08.
Reconstitution and Administration
Amoxicillin trihydrate is administered orally.36 Amoxicillin has also been given IV as the sodium salt,75,446,448,456,459,1122 but a parenteral dosage form of amoxicillin is currently not available in the US.
Amoxicillin may be administered orally without regard to meals.36,73,228,342,428,457,466 However, in studies evaluating the film-coated tablet containing 875 mg of amoxicillin, the tablet was administered at the start of a light meal.36
The required dose of reconstituted amoxicillin oral suspension should be placed directly on the child's tongue for swallowing.36 Alternatively, the required dose of oral suspension may be added to formula, milk, fruit juice, water, or ginger ale and then administered immediately.36
Amoxicillin powder for oral suspension should be reconstituted at the time of dispensing by adding the amount of water specified on the bottle to provide a suspension containing 125, 200, 250, or 400 mg of amoxicillin per 5 mL or 50 mg of amoxicillin per mL.36 After tapping the bottle to thoroughly loosen the powder for oral suspension, the water should be added to the powder in 2 portions and the suspension agitated well after each addition.36 The suspension should be agitated well just prior to administration of each dose.36
Dosage
Dosage of amoxicillin, which is available for oral use as the trihydrate, is expressed in terms of anhydrous amoxicillin.36
General Adult Dosage
The usual adult dosage of amoxicillin for the treatment of mild to moderate infections of the ear, nose, or throat; skin and skin structure; or genitourinary tract is 500 mg every 12 hours or 250 mg every 8 hours.36 A dosage of 875 mg every 12 hours or 500 mg every 8 hours should be used for the treatment of severe infections of the ear, nose, or throat; skin and skin structure; or genitourinary tract in adults.36 The usual adult dosage of amoxicillin for the treatment of mild, moderate, or severe lower respiratory tract infections is 875 mg every 12 hours or 500 mg every 8 hours.36
A single 3-g oral dose of amoxicillin has been used effectively for the initial treatment of acute, uncomplicated urinary tract infections in nonpregnant women†.866,905,1007,1009,1017,1071,1096,1127
General Pediatric Dosage
When oral amoxicillin is used in neonates and infants 12 weeks of age or younger, the manufacturer states that a dosage up to 30 mg/kg daily can be given in divided doses every 12 hours.36
The usual dosage of oral amoxicillin for pediatric patients 3 months of age or older for the treatment of mild to moderate infections of the ear, nose, throat, skin and skin structure, or genitourinary tract is 20 mg/kg daily in divided doses every 8 hours or 25 mg/kg daily in divided doses every 12 hours.36 The usual dosage of oral amoxicillin for pediatric patients 3 months of age or older for the treatment of mild, moderate, or severe lower respiratory tract infections or for the treatment of severe infections of the ear, nose, throat, skin and skin structure, or genitourinary tract is 40 mg/kg daily in divided doses every 8 hours or 45 mg/kg daily in divided doses every 12 hours.36
When oral amoxicillin is used for the treatment of mild to moderate infections in children beyond the neonatal period, the American Academy of Pediatrics (AAP) recommends a dosage of 25-50 mg/kg daily given in 3 divided doses.292
When oral amoxicillin is used for step-down therapy in the treatment of severe infections in children beyond the neonatal period, AAP recommends a dosage of 80-100 mg/kg daily given in 3 divided doses.292 For highly susceptible pathogens, AAP states that a dosage of 90 mg/kg daily given in 2 divided doses can be used.292
Acute Otitis Media
For the treatment of uncomplicated acute otitis media (AOM), the recommended dosage of oral amoxicillin is 80-90 mg/kg daily given in 2 or 3 divided doses†.683,2398,2400,2414,2475 The drug usually is given for 10 days,683,2398,2400,2414,2475 but the optimal duration of therapy is uncertain.683 AAP recommends that a 10-day regimen be used for the treatment of AOM in children younger than 2 years of age and in those with severe symptoms.683 For the treatment of mild to moderate AOM in older children, AAP states that 7- and 10-day regimens appear equally effective in those 2-5 years of age and a treatment duration of 5-7 days may be adequate in those 6 years of age or older.683
Although amoxicillin has been given in a dosage of 40-45 mg/kg daily for 10 days for the treatment of AOM,36,2398,2400 AAP, AAFP, US Centers for Disease Control and Prevention (CDC), and others recommend use of the higher amoxicillin dosage.683,2314,2343,2361,2398,2400,2414,2441 The higher amoxicillin dosage (80-90 mg/kg daily) is especially important in patients with AOM known or suspected of being caused by Streptococcus pneumoniae with reduced susceptibility to penicillins and in patients with a history of anti-infective treatment of AOM within the previous few months.2314,2343,2361,2398,2400,2414,2441
Pharyngitis and Tonsillitis
For the treatment of pharyngitis and tonsillitis caused by Streptococcus pyogenes (group A β-hemolytic streptococci; GAS), the American Heart Association (AHA) and AAP recommend that oral amoxicillin be given in a dosage of 50 mg/kg (up to 1 g) once daily for 10 days.292,375 The Infectious Diseases Society of America (IDSA) recommends that oral amoxicillin be given in a dosage of 50 mg/kg (up to 1 g) once daily for 10 days or 25 mg/kg (up to 500 mg) twice daily for 10 days.580
Gonorrhea and Associated Infections
Some manufacturers state that adults and children weighing 40 kg or more may receive a single 3-g oral dose of amoxicillin for the treatment of acute, uncomplicated gonorrhea caused by susceptible nonpenicillinase-producing Neisseria gonorrhoeae .36 and that children weighing less than 40 kg who are 2 years of age or older may receive a single 50-mg/kg (maximum 3 g) dose of oral amoxicillin given with a single 25-mg/kg (up to 1 g) oral dose of probenecid.36 However, CDC has not recommended use of penicillins for the treatment of gonorrhea for over 30 years because of the widespread prevalence of penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) resistant to penicillins.344
Chlamydial Infections
For the treatment of chlamydial urogenital infections during pregnancy, the recommended dosage of oral amoxicillin is 500 mg 3 times daily for 7 days.344
Lyme Disease
Amoxicillin is a drug of choice for the treatment of erythema migrans and certain other manifestations of Lyme disease†.292,329,331 (See Lyme Disease under Uses, in the Aminopenicillins General Statement 8:12.16.08.)
If amoxicillin is used for the treatment of erythema migrans in patients with Lyme disease, IDSA, AAP, American Academy of Neurology (AAN), American College of Rheumatology (ACR), and others recommend that adults receive 500 mg 3 times daily for 14 days and that children receive 50 mg/kg daily given in 3 divided doses (maximum 500 mg per dose) for 14 days.292,329,331
For the treatment of Lyme carditis† in outpatients when an IV regimen is not required, adults should receive amoxicillin 500 mg 3 times daily for 14-21 days and children should receive amoxicillin 50 mg/kg daily in 3 divided doses (maximum 500 mg per dose) for 14-21 days.329,331 This dosage of amoxicillin also can be used for follow-up to complete 14-21 days of treatment in patients who required initial treatment with an IV regimen.329,331
For the treatment of Lyme arthritis†, adults should receive amoxicillin 500 mg 3 times daily for 28 days and children should receive amoxicillin 50 mg/kg daily in 3 divided doses (maximum 500 mg per dose) for 28 days.329,331
Helicobacter pylori Infection
For the treatment of Helicobacter pylori infection and duodenal ulcer disease (active or 1-year history of duodenal ulcer) in adults, the recommended dosage of amoxicillin is 1 g twice daily in combination with clarithromycin (500 mg twice daily) and lansoprazole (30 mg twice daily) for 14 days (triple therapy).36,2283,2288 When used in combination with clarithromycin (500 mg twice daily) and omeprazole (20 mg twice daily) for the treatment of H. pylori infection and duodenal ulcer disease (active or 1-year history of duodenal ulcer), the recommended dosage of amoxicillin is 1 g twice daily for 10 days (triple therapy).2289 An additional 18 days of omeprazole monotherapy is recommended for ulcer healing and symptom relief in patients with an active duodenal ulcer at the time therapy is initiated.2289
For the treatment of H. pylori infection and duodenal ulcer disease (active or 1-year history of duodenal ulcer) in adults who are either allergic to or intolerant of clarithromycin or in whom resistance to clarithromycin is known or suspected, the recommended dosage of amoxicillin is 1 g 3 times daily in combination with lansoprazole 30 mg 3 times daily for 14 days (dual therapy).36,2283
When amoxicillin has been used in other multiple-drug regimens† for the treatment of H. pylori infection and peptic ulcer disease in combination with at least one other agent that has activity against H. pylori , oral dosages of 500 mg 3 or 4 times daily (or 1 g 2 or 3 times daily) generally have been used;1845,1849,2114,2255,2256,2257,2258,2259,2260,2283,2284 higher dosages of amoxicillin in such regimens reportedly have not been associated with improved results.1849,2114 Studies in which H. pylori was eradicated successfully generally have employed regimens consisting of a bismuth salt (e.g., bismuth subsalicylate), a nitroimidazole anti-infective (e.g., metronidazole), and another anti-infective agent (e.g., amoxicillin, tetracycline)1845,1849,1866,1879,1887,1890,1891,2255,2256,2257,2272,2277 or combined therapy with a proton-pump inhibitor (e.g., lansoprazole, omeprazole) and 1 or 2 anti-infective agents (e.g., clarithromycin, amoxicillin).2256,2258,2260,2283,2284,2288
In a limited number of children with H. pylori -associated peptic ulcer disease† (e.g., gastritis, duodenitis/ duodenal ulcer), oral amoxicillin 25-50 mg/kg daily in divided doses (e.g., 250-500 mg 3 times daily) has been administered as part of multiple-drug regimens that included a nitroimidazole anti-infective (e.g., metronidazole) and/or a bismuth salt (e.g., bismuth subsalicylate).1850 Further study is needed to establish an optimal drug regimen for treatment of H. pylori infection in children.1849,1850,1853,2107,2108,2114,2271,2272,2277
Prevention of Bacterial Endocarditis
If oral amoxicillin is used for prevention of bacterial endocarditis† in patients with certain cardiac conditions who are undergoing certain dental procedures or certain other procedures (see Prevention of Bacterial Endocarditis under Uses: Prophylaxis, in the Aminopenicillins General Statement 8:12.16.08), AHA recommends that adults receive a single dose of 2 g and that children receive a single dose of 50 mg/kg given 30-60 minutes prior to the procedure.451
When selecting anti-infectives for prevention of bacterial endocarditis, the current recommendations published by AHA should be consulted.451
Anthrax
AAP recommends that infants and children 1 month of age or older receive oral amoxicillin in a dosage of 75 mg/kg daily (up to 1 g daily) given in divided doses every 8 hours if the drug is used as an alternative for postexposure prophylaxis of anthrax† following exposure to aerosolized Bacillus anthracis in the context of biologic warfare or bioterrorism when penicillin-susceptible strains are involved or is used as an alternative for treatment of cutaneous anthrax† without systemic involvement or treatment of inhalational anthrax† when these infections are caused by penicillin-susceptible strains.671
CDC recommends that adults (including pregnant and postpartum women) receive oral amoxicillin in a dosage of 1 g every 8 hours if the drug is used as an alternative for postexposure prophylaxis of anthrax† in the context of biologic warfare or bioterrorism when penicillin-susceptible B. anthracis are involved or is used as an alternative for treatment of cutaneous anthrax† without systemic involvement when the infection is caused by penicillin-susceptible strains.672,673
If oral amoxicillin is used as an alternative for postexposure prophylaxis of anthrax† or for the treatment of anthrax† when a parenteral regimen is not available (e.g., when there are supply or logistic problems because large numbers of individuals require treatment in a mass casualty setting), some experts (e.g., US Working Group on Civilian Biodefense) recommend that adults receive 500 mg 3 times daily and that children receive 80 mg/kg daily (maximum 1.5 mg daily) given in 3 divided doses at 8-hour intervals.2502,2515 Anti-infective postexposure prophylaxis should be continued until exposure to B. anthracis has been excluded.2499,2502 If exposure is confirmed, postexposure vaccination with anthrax vaccine (if available) may be indicated in conjunction with prophylaxis.2499 Because of the possible persistence of anthrax spores in lung tissue following an aerosol exposure, CDC and other experts recommend that postexposure prophylaxis be continued for at least 60 days.671,672,673,2499,2502,2505,2508
If oral amoxicillin is used as an alternative for the treatment of mild, uncomplicated cutaneous anthrax† caused by susceptible B. anthracis , some experts (e.g., US Working Group on Civilian Biodefense) recommend that adults receive 500 mg 3 times daily and that children receive 80 mg/kg daily (maximum 1.5 g daily) given in 3 divided doses at 8-hour intervals.2502,2506 CDC has recommended that cutaneous anthrax in infants and children younger than 2 years of age should be treated initially IV.2515 Although 5-10 days of anti-infective therapy may be adequate for the treatment of mild, uncomplicated cutaneous anthrax that occurs as the result of natural or endemic exposures to anthrax, CDC and other experts recommend that therapy be continued for 60 days if the cutaneous infection occurred as the result of exposure to aerosolized anthrax spores since the possibility of inhalational anthrax would also exist.671,672,673,2502,2506 Anti-infective therapy may limit the size of the cutaneous anthrax lesion and it usually becomes sterile within the first 24 hours of treatment, but the lesion will still progress through the black eschar stage despite effective treatment.2500 2501,2502
Duration of Therapy
The duration of amoxicillin therapy depends on the type and severity of infection and should be determined by the clinical and bacteriologic response of the patient.36 For most infections, except gonorrhea, therapy should be continued for at least 48-72 hours after the patient becomes asymptomatic or evidence of eradication of the infection has been obtained.36 Persistent infections may require several weeks of therapy.36 Amoxicillin usually is continued for 60 days for postexposure prophylaxis or treatment of inhalational or cutaneous anthrax in the context of biologic warfare or bioterrorism.
If amoxicillin is used in the treatment of infections caused by group A β-hemolytic streptococci, therapy should be continued for at least 10 days to decrease the risk of rheumatic fever and glomerulonephritis.36
If amoxicillin is used in the treatment of chronic urinary tract infections, frequent bacteriologic and clinical appraisal is necessary during therapy and may be required for several months after therapy.36
Dosage in Renal Impairment
In patients with renal impairment, doses and/or frequency of administration of amoxicillin should be modified in response to the degree of renal impairment, severity of the infection, and susceptibility of the causative organisms.36,376,473,1320,1373 The manufacturer states that adults with severe renal impairment and creatinine clearances less than 30 mL/minute should not receive the commercially available film-coated tablets containing 875 mg of amoxicillin.36 The recommended dosage of amoxicillin for adults with creatinine clearances of 10-30 mL/minute is 250 or 500 mg every 12 hours, depending on the severity of the infection, and the recommended dosage for adults with creatinine clearances less than 10 mL/minute is 250 or 500 mg every 24 hours, depending on the severity of the infection.36
Patients undergoing hemodialysis should receive 250 or 500 mg of amoxicillin every 24 hours, depending on the severity of the infection, and should receive an additional dose of the drug during and after each dialysis period.36
The manufacturer states that data are insufficient to recommend dosage for pediatric patients with renal impairment.36
Spectrum
Based on its spectrum of activity, amoxicillin is classified as an aminopenicillin.62,76,88,575 For information on the classification of penicillins based on spectra of activity, see the Preface to the Penicillins 8:12.16.
Amoxicillin generally has the same spectrum of activity and the same level of activity against susceptible organisms as ampicillin;61,64,68,73,75,226,228,229,575 however, amoxicillin is more active in vitro on a weight basis than ampicillin against enterococci and Salmonella but less active than ampicillin against Shigella and Enterobacter .73,149,150,151,228,229,1314 For specific information on the spectrum of activity of amoxicillin and resistance to the drug, see the sections on Spectrum and on Resistance in the Aminopenicillins General Statement 8:12.16.08.
Pharmacokinetics
For additional information on absorption of amoxicillin and for information on distribution and elimination of the drug, see Pharmacokinetics in the Aminopenicillins General Statement 8:12.16.08.
Absorption
Amoxicillin is generally stable in the presence of acidic gastric secretions,36,73,341,428 and 74-92% of a single oral dose of the drug is absorbed from the GI tract.61,73,320,366,487 Amoxicillin is more completely absorbed from the GI tract than is ampicillin,73,328,351,366,428,493 and peak serum concentrations of amoxicillin are generally 2-2.5 times higher than those attained with an equivalent oral dose of ampicillin.73,81,328,428,445,479,493 As oral dosage of amoxicillin is increased, the fraction of the dose absorbed from the GI tract decreases only slightly and peak serum concentrations and areas under the serum concentration-time curves (AUCs) increase linearly with increasing dosage.433
Peak serum concentrations are usually reached 1-2 hours after oral administration of amoxicillin capsules, film-coated tablets, chewable tablets, or oral suspension in fasting and nonfasting adults.36,81,328,346,455,466,494 Following oral administration of a single 250- or 500-mg dose of amoxicillin, peak serum concentrations range from 3.5-5 or 5.5-11 mcg/mL, respectively.36,428,479,493 In one study in healthy, fasting adults who received a single 500-mg oral dose of amoxicillin, serum concentrations of the drug averaged 3.3, 6.7, 9.3, 5.8, and 0.6 mcg/mL at 30 minutes, 1 hour, 2 hours, 3 hours, and 4 hours, respectively, after the dose.229 The manufacturer states that serum concentrations attained following administration of 125- or 250-mg chewable tablets are similar to those attained when the same dose is given as the oral suspension containing 125 or 250 mg of the drug per 5 mL.36 In healthy adults who received a single 400-mg dose of amoxicillin given as a 400-mg chewable tablet or the oral suspension containing 400 mg of the drug per 5 mL (dose given at the start of a light meal), peak serum concentrations were attained approximately 1 hour after the dose and averaged 5.18 or 5.92 mcg/mL, respectively, and AUC averaged 17.9 or 17.1 mcg•hr/mL, respectively.36
In one study in children 4-45 months of age receiving amoxicillin oral suspension in a dosage of 15 mg/kg daily, serum amoxicillin concentrations ranged from 2.4-8.5, 1.9-11.3, 1.7-6.4, 0.17-1.9, and 0.14-3.3 mcg/mL at 30 minutes, 1 hour, 2 hours, 4 hours, and 6 hours, respectively, after a dose.462
Although presence of food in the GI tract reportedly results in lower and delayed peak serum concentrations of amoxicillin,226,228,466 the total amount of drug absorbed does not appear to be affected.73,228,342,428,457,466
Chemistry and Stability
Chemistry
Amoxicillin is an aminopenicillin which differs structurally from ampicillin only in the addition of an hydroxyl group on the phenyl ring.68,89,575
Amoxicillin is commercially available as the trihydrate.1,36 Potency of amoxicillin trihydrate is calculated on the anhydrous basis.1,36 Amoxicillin occurs as a white, practically odorless, crystalline powder and is sparingly soluble in water.1 When reconstituted as directed, amoxicillin oral suspensions have a pH of 5-7.5.1
Amoxicillin is commercially available for oral administration as capsules, film-coated tablets, chewable tablets, or powder for oral suspension.36 Amoxicillin also is commercially available for oral administration in fixed-ratio combinations with clavulanate potassium.1437 (See Amoxicillin and Clavulanate Potassium 8:12.16.08.)
Each 125-, 200-, 250-, or 400-mg amoxicillin chewable tablet contains 0.0019 mEq (0.044 mg), 0.0005 mEq (0.0107 mg), 0.0037 mEq (0.085 mg), or 0.0009 mEq (0.0215 mg) of sodium, respectively.36 The 200- and 400-mg chewable tablets contain aspartame which is metabolized in the GI tract to provide 1.82 or 3.64 mg of phenylalanine, respectively, following oral administration.36
Stability
Amoxicillin capsules, 125- and 250-mg chewable tablets, and powder for oral suspension should be stored in tight containers at 20°C or lower;36 amoxicillin 200- and 400-mg chewable tablets and amoxicillin film-coated tablets should be stored in tight containers at 25°C or lower.36
Following reconstitution, amoxicillin oral suspensions should preferably be refrigerated at 2-8°C, but refrigeration is not necessary and the suspensions are stable for 14 days at room temperature or 2-8°C.36,1785
Additional Information
For further information on chemistry and stability, mechanism of action, spectrum, resistance, pharmacokinetics, uses, cautions, drug interactions, laboratory test interferences, and dosage and administration of amoxicillin, see the Aminopenicillins General Statement 8:12.16.08.
Only references cited for selected revisions after 1984 are available electronically.
1. The United States pharmacopeia, 21st rev, and The national formulary, 16th ed. Rockville, MD: The United States Pharmacopeial Convention; 1985:56-7,59-63,83-5,158-9,237-8,256-7,313-4,483-5,659-60, 694,703-5,759-60,792-802,841,1062-3,1442,1446,1449, 1451,1457,1463,1465-6,1468,1479.
36. SmithKline Beecham Pharmaceuticals. Amoxil®)(amoxicillin) capsules, tablets, chewable tablets, and powder for oral suspension prescribing information. Philadelphia, PA: 1999 Apr.
61. Kucers A, Bennett NM. The use of antibiotics. 3rd ed. London: William Heinemann Medical Books Ltd.; 1979:3-186.
62. Hou JP, Poole JW. ***bgr***-Lactam antibiotics: their physiochemical properties and biological activities in relation to structure. J Pharm Sci . 1971; 60:503-27. [PubMed 4336386]
63. Neu HC. Penicillins: microbiology, pharmacology, and clinical use. In: Kagan BM, ed. Antimicrobial therapy. 3rd ed. Philadelphia: WB Saunders Company; 1980:20-34.
64. Mandell GL, Sande MA. Antimicrobial agents: penicillins and cephalosporins. In: Gilman AG, Goodman L, Gilman A, eds. Goodman and Gilman***rsquo***s the pharmacological basis of therapeutics. 6th ed. New York: Macmillan Publishing Company; 1980:1126-61.
67. Wilkowske CJ. The penicillins. Mayo Clin Proc . 1977; 52:616-24. [PubMed 242733]
68. Rolinson GN, Sutherland R. Semisynthetic penicillins. Adv Pharmacol Chemother . 1973; 11:152-220.
73. Brogden RN, Speight TM, Avery GS. Amoxycillin: a review of its antibacterial and pharmacokinetic properties and therapeutic use. Drugs . 1975; 9:88-140. [PubMed 1126306]
75. Brogden RN, Heel RC, Speight TM et al. Amoxycillin injectable: a review of its antibacterial spectrum, pharmacokinetics and therapeutic use. Drugs . 1979; 18:169-84. [PubMed 387371]
76. Reeves DS, Bullock DW. The aminopenicillins: development and comparative properties. Infection . 1979; 7(Suppl 5):S425-32. [PubMed 389819]
80. Barza M. Antimicrobial spectrum, pharmacology and therapeutic use of antibiotics. Part 2: penicillins. Am J Hosp Pharm . 1977; 34:57-67. [PubMed 318800]
81. Bergan T. Penicillins. In: Schonfeld H, ed. Antibiotics and chemotherapy. Vol 25. Basel: S. Karger; 1978:1-122.
88. Selwyn S. The mechanisms and range of activity of penicillins and cephalosporins. In: Selwyn S, ed. The beta-lactam antibiotics: penicillins and cephalosporins in perspective. London: Hodder and Stoughton; 1980:56-90.
89. Wolff ME, ed. Burger***rsquo***s medicinal chemistry. 4th ed. New York: John Wiley ***amp*** Sons; 1980:84-157.
149. Crump J, Cansdale S. Enterobacter resistant to amoxycillin/clavulanate. Lancet . 1982; 2:500. [PubMed 6125666]
150. Brumfitt W, Hamilton-Miller JM, Dixson S et al. Enterobacter resistant to amoxycillin/clavulanate. Lancet . 1982; 2:768-9.
151. Mittermayer HW. Enterobacter resistant to amoxycillin/clavulanate. Lancet . 1982; 2:769. [PubMed 6125838]
226. Sutherland R, Croydon EA, Rolinson GN. Amoxycillin: a new semi-synthetic penicillin. Br Med J . 1972; 3:13-6. [PubMed 4402672][PubMedCentral]
228. Rolinson GN. Laboratory evaluation of amoxicillin. J Infect Dis . 1974; 129(Suppl):S139-45. [PubMed 4601188]
229. Neu HC. Antimicrobial activity and human pharmacology of amoxicillin. J Infect Dis . 1974; 129(Suppl):S123-31.
292. American Academy of Pediatrics. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015.
320. Barza M, Weinstein L. Pharmacokinetics of the penicillins in man. Clin Pharmacokinet . 1976; 1:297-308. [PubMed 797501]
328. Ruedy J. The effects of peritoneal dialysis on the physiological disposition of oxacillin, ampicillin and tetracycline in patients with renal disease. Can Med Assoc J . 1966; 94:257-61. [PubMed 5903164][PubMedCentral]
329. Lantos PM, Rumbaugh J, Bockenstedt LK et al. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clin Infect Dis . 2021; 72:e1-e48. [PubMed 33417672]
331. . Antibacterial drugs for Lyme disease. Med Lett Drugs Ther . 2021; 63:73-75. [PubMed 33976091]
341. Selwyn S. Applied pharmacology, adverse effects and drug interactions. In: Selwyn S, ed. The beta-lactam antibiotics: penicillins and cephalosporins in perspective. London: Hodder and Stoughton; 1980:91-126.
342. Melander A. Influence of food on the bioavailability of drugs. Clin Pharmacokinet . 1978:3:337-51.
344. Workowski KA, Bachmann LH, Chan PA et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep . 2021; 70:1-187. [PubMed 34292926]
346. Barbhaiya R, Thin RN, Turner P et al. Clinical pharmacological studies of amoxycillin: effect of probenecid. Br J Vener Dis . 1979; 55:211-3. [PubMed 466384][PubMedCentral]
351. Rozencweig M, Staquet M, Klastersky J. Antibacterial activity and pharmacokinetics of bacampicillin and ampicillin. Clin Pharmacol Ther . 1976; 19:592-7. [PubMed 6181]
355. Anderson PO. Drugs and breast feeding***mdash***a review. Drug Intell Clin Pharm . 1977; 11:208-23.
366. Cole M, Kening MD, Hewitt VA. Metabolism of penicillins to penicilloic acids and 6-aminopenicillanic acid in man and its significance in assessing penicillin absorption. Antimicrob Agents Chemother . 1973; 3:463-8. [PubMed 4364176][PubMedCentral]
375. Gerber MA, Baltimore RS, Eaton CB et al. Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation . 2009; 119:1541-51. [PubMed 19246689]
376. Yogev R, Schultz WE, Rosenman SB. Penetrance of nafcillin into human ventricular fluid: correlation with ventricular pleocytosis and glucose levels. Antimicrob Agents Chemother . 1981; 19:545-8. [PubMed 7247377][PubMedCentral]
428. Brogden RN, Speight TM, Avery GS. Amoxycillin: a preliminary report of its pharmacokinetic properties and therapeutic efficacy. Drugs . 1974; 7:326-36. [PubMed 4604079]
433. Sjovall J. Dose dependence in human absorption of aminopenicillins. Infection . 1979; 7(Suppl 5):S458-62. [PubMed 511357]
445. Sjovall J, Magni L, Bergan T. Pharmacokinetics of bacampicillin compared with those of ampicillin, pivampicillin, and amoxycillin. Antimicrob Agents Chemother . 1978; 13:90-6. [PubMed 626496][PubMedCentral]
446. Strausbaugh LJ, Girgis NI, Mikhail IA et al. Penetration of amoxicillin into cerebrospinal fluid. Antimicrob Agents Chemother . 1978; 14:899-902. [PubMed 742877][PubMedCentral]
448. Nolan CM, Chalhub EG, Nash DG et al. Treatment of bacterial meningitis with intravenous amoxicillin. Antimicrob Agents Chemother . 1979; 16:171-5. [PubMed 485128][PubMedCentral]
451. Wilson W, Taubert KA, Gewitz M et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation . 2007; 116:1736-54. [PubMed 17446442]
455. Arancibia A, Guttmann J, Gonzalez G et al. Absorption and disposition kinetics of amoxicillin in normal human subjects. Antimicrob Agents Chemother . 1980; 17:199-202. [PubMed 7387142][PubMedCentral]
456. Clumeck N, Thys JP, Vanhoof R et al. Amoxicillin entry into human cerebrospinal fluid: comparison with ampicillin. Antimicrob Agents Chemother . 1978; 14:531-2. [PubMed 102244][PubMedCentral]
457. Eshelman FN, Spyker DA. Pharmacokinetics of amoxicillin and ampicillin: crossover study of the effect of food. Antimicrob Agents Chemother . 1978; 14:539-43. [PubMed 363052][PubMedCentral]
459. Lacut JY, Humbert G, Aubertin J et al. Treatment of purulent meningitis in adults with injectable amoxycillin: clinical and pharmacokinetic results. Curr Ther Res Clin Exp . 1981; 29:36-46.
462. Ginsburg CM, McCracken GH, Thomas ML et al. Comparative pharmacokinetics of amoxicillin and ampicillin in infants and children. Pediatrics . 1979; 64:627-31. [PubMed 492836]
466. Welling PG, Huang H, Kock PA et al. Bioavailability of ampicillin and amoxicillin in fasted and nonfasted subject. J Pharm Sci . 1977; 66:549-52. [PubMed 323461]
473. Oe PL, Simonian S, Verhoef J. Pharmacokinetics of the new penicillins. Chemotherapy . 1973; 19:279-88. [PubMed 4787741]
479. Gordon RC, Regamey C, Kirby WM. Comparative clinical pharmacology of amoxicillin and ampicillin administered orally. Antimicrob Agents Chemother . 1972; 1:504-7. [PubMed 4680813][PubMedCentral]
487. Zarowny D, Ogilvie R, Tamblyn D et al. Pharmacokinetics of amoxicillin. Clin Pharmacol Ther . 1974; 16:1045-51. [PubMed 4433471]
493. Kirby WM, Gordon RC, Regamey C. The pharmacology of orally administered amoxicillin and ampicillin. J Infect Dis . 1974; 129(Suppl):S154-5.
494. Lode H, Janisch P, Kupper G et al. Comparative clinical pharmacology of three ampicillins and amoxicillin administered orally. J Infect Dis . 1974; 129(Suppl):S156-70. [PubMed 4834960]
496. Kafetzis DA, Siafas CA, Georgakopoulos PA et al. Passage of cephalosporins and amoxicillin into the breast milk. Acta Paediatr Scand . 1981; 70:285-8. [PubMed 7246123]
575. Martin AR. Antibiotics. In: Doerge RF, ed. Wilson and Gisvold***rsquo***s textbook of organic medicinal and pharmaceutical chemistry. 8th ed. Philadelphia: JB Lippincott Company; 1982:228-47.
580. Shulman ST, Bisno AL, Clegg HW et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis . 2012; 55:1279-82. Updates may be available at IDSA website at www.idsociety.org. [PubMed 23091044]
611. Idsoe O, Guthe T, Willcox RR et al. Nature and extent of penicillin side-reactions, with particular reference to fatalities from anaphylactic shock. Bull World Health Organ . 1968; 38:159-88. [PubMed 5302296][PubMedCentral]
614. Nordbring F. Review of side-effects of aminopenicillins. Infection . 1979; 7(Suppl 5):S503-6. [PubMed 511364]
615. Erffmeyer JE. Adverse reactions to penicillin. Ann Allergy . 1981; 47:288-300. [PubMed 6171185]
671. Bradley JS, Peacock G, Krug SE et al. Pediatric anthrax clinical management. Pediatrics . 2014; 133:e1411-36. [PubMed 24777226]
672. Meaney-Delman D, Zotti ME, Creanga AA et al. Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women. Emerg Infect Dis . 2014; 20:e1-6. [PubMed 24457117]
673. Hendricks KA, Wright ME, Shadomy SV et al. Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis . 2014; 20 [PubMed 24447897]
683. Lieberthal AS, Carroll AE, Chonmaitree T et al. The diagnosis and management of acute otitis media. Pediatrics . 2013; 131:e964-99. [PubMed 23439909]
720. Isbister JP. Penicillin allergy: a review of the immunological and clinical aspects. Med J Aust . 1971; 1:1067-74. [PubMed 4398272]
723. Weinstein AJ. Treatment of bacterial infections in pregnancy. Drugs . 1979; 17:56-65. [PubMed 421673]
769. Sullivan TJ, Wedner HJ, Shatz GS et al. Skin testing to detect penicillin allergy. J Allergy Clin Immunol . 1981; 68:171-80. [PubMed 6267115]
781. Hoigne ***Racute***, Hopf B, Sonntag R. Penicillins, cephalosporins and tetracyclines. In: Dukes MNG, ed. Meyler***rsquo***s side effects of drugs. 9th ed. New York: Elsevier/North Holland Inc; 1980:411-22.
864. Andriole VT, Ryan JL. An approach to formulary considerations of antimicrobial agents: the penicillins. Hosp Formul . 1981; (Aug):816-20.
866. Conn HF, ed. Current therapy: latest approved methods of treatment for the practicing physician, 1982. Philadelphia: WB Saunders Company; 1982:15-9, 29-31, 40-7, 59-67, 72-84, 94-9, 116-23, 134-7, 186-8, 196-200, 521-6.
869. Chambers HF. Penicillins. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett***rsquo***s principles and practice of infectious diseases. 5th ed. New York: Churchill Livingstone; 2000: 261-74.
904. Hermans PE. General principles of antimicrobial therapy. Mayo Clin Proc . 1977; 52:603-10. [PubMed 20538]
905. Ball AP. Clinical use of penicillins. Lancet . 1982; 2:197-9. [PubMed 6123896]
906. Eichenwald HF, McCracken GH. Antimicrobial therapy in infants and children. Part I. Review of antimicrobial agents. J Pediatr . 1978; 93:336-56.
1007. Bailey RR. Single dose antibacterial treatment for uncomplicated UTIs. Drugs . 1979; 17:219-21. [PubMed 456292]
1009. Rubin RH, Fang LS, Jones SR et al. Single-dose amoxicillin therapy for urinary tract infection: multicenter trial using antibody-coated bacteria localization technique. JAMA . 1980; 244:561-4. [PubMed 6993706]
1017. Savard-Fenton M, Fenton BW, Reller LB et al. Single-dose amoxicillin therapy with follow-up urine culture: effective initial management for acute uncomplicated urinary tract infections. Am J Med . 1982; 73:808-13. [PubMed 6924538]
1071. Ellis-Pegler RB. Antimicrobial therapy in general practice. Drugs . 1981; 21:309-14. [PubMed 6894422]
1096. Fang LS, Tolkoff-Rubin NE, Rubin RH. Clinical management of urinary tract infection. Pharmacotherapy . 1982; 2:91-9. [PubMed 6765394]
1122. Dalhoff A, Koeppe P. Comparative pharmacokinetic analysis of amoxycillin using open two and three-compartment models. Eur J Clin Pharmacol . 1982; 22:273-9. [PubMed 7106161]
1127. Souney P, Polk BF. Single-dose antimicrobial therapy for urinary tract infections in women. Rev Infect Dis . 1982; 4:29-34. [PubMed 6918057]
1145. Sheehan G, Harding GK, Ronald AR. Advances in the treatment of urinary tract infection. Am J Med . 1984; 76:141-7. [PubMed 6372463]
1193. Glaxo Inc. Zinacef(R)(sterile cefuroxime sodium) prescribing information. Research Triangle Park, NC; 1983 Sep.
1314. Letchford AJ. Testing amoxycillin and ampicillin as separate antibiotics. Lancet . 1982; 2:1284. [PubMed 6128585]
1320. Appel GB, Neu HC. The nephrotoxicity of antimicrobial agents (first of three parts). N Engl J Med . 1977; 296:663-70. [PubMed 402574]
1373. Bennett WM, Aronoff GR, Morrison G et al. Drug prescribing in renal failure: dosing guidelines for adults. Am J Kidney Dis . 1983; 3:155-93. [PubMed 6356890]
1437. SmithKline Beecham. Augmentin(R)(amoxicillin/clavulanate potassium) powder for oral suspension and chewable tablets prescribing information and Augmentin(R)(amoxicillin/clavulanate potassium) tablets prescribing information. In: Physicians***rsquo*** desk reference. 53rd ed. Montvale, NJ: Medical Economics Company Inc; 1999:3028-34.
1649. American Medical Association Council on Scientific Affairs. Aspartame: review of safety issues. JAMA . 1985; 254:400-2. [PubMed 2861297]
1650. Gossel TA. A review of aspartame: characteristics, safety and uses. US Pharm . 1984; 9:26, 28-30.
1651. Food and Drug Administration. Aspartame as an inactive ingredient in human drug products; labeling requirements. Proposed rule. (21 CFR Part 201) Fed Regist . 1983; 48:54993-5. (IDIS 178728)
1652. Food and Drug Administration. Food additives permitted for direct addition to food for human consumption: aspartame. Final rule. (21 CFR Part 172) Fed Regist . 1983; 48:31376-82. (IDIS 172957)
1653. Anon. Aspartame and other sweeteners. Med Lett Drugs Ther . 1982; 24:1-2. [PubMed 7054648]
1656. Marchant CD, Shurin PA, Johnson CE et al. A randomized controlled trial of amoxicillin plus clavulanate compared with cefaclor for treatment of acute otitis media. J Pediatr . 1986; 109:891-6. [PubMed 3534203]
1657. Van Hare GF, Shurin PA, Marchant CD et al. Acute otitis media caused by Branhamella catarrhalis : biology and therapy. Rev Infect Dis . 1987; 9:16-27. [PubMed 3493519]
1661. Van Hare GF, Shurin PA. The increasing importance of Branhamella catarrhalis in respiratory infections. Pediatr Infect Dis J . 1987; 6:92-4. [PubMed 3547295]
1664. Bluestone CD. Otitis media and sinusitis in children: role of Branhamella catarrhalis . Drugs . 1986; 31(Suppl 3):132-41. [PubMed 3732081]
1785. Wymox(R)prescribing information. In: Barnhart ER, publisher. Physicians***rsquo*** desk reference. 44th ed. Medical Economics Company Inc: Oradell, NJ; 1990(Suppl A):A68-9.
1845. Ateshkadi A, Lam NP, Johnson CA. Helicobacter pylori and peptic ulcer disease. Clin Pharm . 1993; 12:34-48. [PubMed 8428432]
1849. Marshall BJ. Treatment strategies for Helicobacter pylori infection. Gastroenterol Clin North Am . 1993; 22:183-98. [PubMed 8449566]
1850. Israel DM, Hassall E. Treatment and long-term follow-up of Helicobacter pylori -associated duodenal ulcer disease in children. J Pediatr . 1993; 123:53-8. [PubMed 8320625]
1853. Glassman MS. Helicobacter pylori infection in children. A clinical overview. Clin Pediatr (Phila) . 1992; 31:481-7. [PubMed 1643767]
1866. George LL, Borody TJ, Andrews P et al. Cure of duodenal ulcer after eradication of H. pylori . Med J Aust . 1990; 153:145-9. [PubMed 1974027]
1879. Borody T, Andrews P, Mancuso N et al. Helicobacter pylori reinfection 4 years post-eradication. Lancet . 1992; 339:1295. [PubMed 1349686]
1887. Graham DY, B***ouml***rsch GM. The who***rsquo***s and when***rsquo***s of therapy for Helicobacter pylori . Am J Gastroenterol . 1990; 85:1552-5. [PubMed 2252013]
1890. Graham DY, Lew GM, Klein PD et al. Effect of treatment of Helicobacter pylori infection on the long-term recurrence of gastric or duodenal ulcer. A randomized, controlled study. Ann Intern Med . 1992; 116:705-8. [PubMed 1558340]
1891. Axon AT. Helicobacter pylori therapy: effect on peptic ulcer disease. J Gastroenterol Hepatol . 1991; 6:131-7. [PubMed 1912418]
2107. Rosioru C, Glassman MS, Halata MS et al. Esophagitis and Helicobacter pylori in children: incidence and therapeutic implications. Am J Gastroenterol . 1993; 88:510-3. [PubMed 8470630]
2108. Oderda G, Forni M, Dell***rsquo***Olio D et al. Cure of peptic ulcer associated with eradication of Helicobacter pylori . Lancet . 1990; 335:1599.
2114. Reviewers***rsquo*** comments (personal observations); 1993 Oct 26.
2178. Giebink GS, Canafax DM, Kempthorne J. Antimicrobial treatment of acute otitis media. J Pediatr . 1991; 119:495-500. [PubMed 1880671]
2180. Anon. Drugs for treatment of acute otitis media in children. Med Lett Drug Ther . 1994; 36:19-21.
2181. Pichichero ME. Assessing the treatment of alternatives for acute otitis media. Pediatr Infect Dis J . 1994; 13:S27-34. [PubMedCentral]
2250. Klass PE, Klein JO. Therapy of bacterial sepsis, meningitis and otitis media in infants and children: 1992 poll of directors of programs in pediatric infectious diseases. Pediatr Infect Dis J . 1992; 11:702-5. [PubMed 1448307]
2254. Anon. The choice of antibacterial drugs. Med Lett Drugs Ther . 2001; 43:69-78. [PubMed 11518876]
2255. Walsh JH, Peterson WL. The treatment of Helicobacter pylori infection in the management of peptic ulcer disease. N Engl J Med . 1995; 333:984-91. [PubMed 7666920]
2256. Hackelsberger A, Malfertheiner P. A risk-benefit assessment of drugs used in the eradication of Helicobacter pylori infection. Drug Saf . 1996; 15:30-52. [PubMed 8862962]
2257. Rauws EAJ, van der Hulst RWM. Current guidelines for the eradication of Helicobacter pylori in peptic ulcer disease. Drugs . 1995; 6:984-90.
2258. Soll AH. Medical treatment of peptic ulcer disease. JAMA . 1996; 275:622-9. [PubMed 8594244]
2259. van der Hulst RWM, Keller JJ, Rauws EAJ et al. Treatment of Helicobacter pylori infection: a review of the world literature. Helicobacter . 1996; 1:6-19. [PubMed 9398908]
2260. Lind T, Veldhuyzen van Zanten S, Unge P et al. Eradication of Helicobacter pylori using one-week triple therapies combining omeprazole with two antimicrobials: the MACH I study. Helicobacter . 1996; 1:138-44. [PubMed 9398894]
2271. Bourke B, Jones N, Sherman P. Helicobacter pylori infection and peptic ulcer disease in children. Pediatr Infect Dis J . 1996; 15:1-13. [PubMed 8684868]
2272. Rowland M, Drumm B. Helicobacter pylori infection and peptic ulcer disease in children. Curr Opin Pediatr . 1995; 7:553-9. [PubMed 8541956]
2277. Bujanover Y, Reif S, Yahav J. Helicobacter pylori and peptic disease in the pediatric patient. Pediatr Clin North Am . 1996; 43:213-34. [PubMed 8596681]
2283. TAP Pharmaceuticals. Prevacid(R)(lansoprazole) delayed-release capsules prescribing information. Deerfield, IL: 1997 Aug.
2284. Langtry HD, Wilde MI. Lansoprazole: an update of its pharmacological properties and clinical efficacy in the management of acid-related disorders. Drugs . 1997; 54:473-500. [PubMed 9279507]
2288. TAP Pharmaceuticals. PrevPac(R)(lansoprazole 30-mg capsules, amoxicillin 500-mg capsules, and clarithromycin 500-mg tablets) prescribing information. Deerfield, IL; 1997 Dec.
2289. Astra Merck. Prilosec(R)(omeprazole) delayed release capsules prescribing information. West Point, PA; 1998 Jun.
2310. Klein JO. Selection of oral antimicrobial agents for otitis media and pharyngitis. Infect Dis Clin Pract . 1995; 4(Suppl 2):S88-94.
2311. Pichichero ME, Cohen R. Shortened course of antibiotic therapy for acute otitis media, sinusitis and tonsillopharyngitis. Pediatr Infect Dis J . 1997; 16:680-95. [PubMed 9239773]
2314. Mehra S, Van Moerkerke M, Welck J et al. Short course therapy with cefuroxime axetil for group A streptococcal tonsillopharyngitis in children. Pediatr Infect Dis J . 1998; 17:452-7. [PubMed 9655533]
2337. Anon. The choice of antibacterial drugs. Med Lett Drugs Ther . 2001; 43:69-78. [PubMed 11518876]
2343. Committee on Infectious Diseases, American Academy of Pediatrics. 2000 Red book: report of the Committee on Infectious Diseases. 25th ed. Elk Grove Village, IL: American Academy of Pediatrics; 1997:230-4,374-9,452-60,526-44,547-59,652,659.
2361. McCracken GH. Treatment of acute otitis media in an era of increasing microbial resistance. Pediatr Infect Dis J . 1998; 17:576-9. [PubMed 9655564]
2362. Klein JO. Otitis Media. Clin Infect Dis J . 1994; 19:823-33.
2389. Bauchner H, Adams W, Barnett E et al. Therapy for acute otitis media: preference of parents for oral or parenteral antibiotics. Arch Pediatr Adolesc Med . 1996; 150:396-9. [PubMed 8634735]
2398. Dowell SF, Butler JC, Giebink GS et al. Acute otitis media: management and surveillance in an era of pneumococcal resistance***mdash***a report from the drug-resistant Streptococcal pneumoniae Therapeutic Working Group. Pediatr Infect Dis J . 1999; 18:1-9. [PubMed 9951971]
2400. Klein JO. Current recommendations on the therapy of otitis media. Pediatr Infect Dis J . 1998; 17:1058-9. [PubMed 9849999]
2403. Klein JO. Clinical implications of antibiotic resistance for management of acute otitis media. Pediatr Infect Dis J . 1998; 17:1084-9. [PubMed 9850003]
2404. Blumer JL. Pharmacokinetics and pharmacodynamics of new and old antimicrobial agents for acute otitis media. Pediatr Infect Dis J . 1998; 17:1070-5. [PubMed 9850001]
2413. Jacobs MR. Antibiotic-resistant Streptococcus pneumoniae in acute otitis media: overview and update. Pediatr Infect Dis J . 1998; 17:947-52. [PubMed 9802651]
2414. Poole MD. Implications of drug-resistant Streptococcus pneumoniae for otitis media. Pediatr Infect Dis J . 1998; 17:953-6. [PubMed 9802652]
2432. Berman S. Otitis media in children. N Engl J Med . 1995; 332:1560-5. [PubMed 7739711]
2433. Bluestone CD. Current therapy for otitis media and criteria for evaluation of new antimicrobial agents. Clin Infect Dis . 1992; 14(Suppl 2):S197-203. [PubMed 1617038]
2434. White LL, Holimon TD, Tepedino JT et al. Antimicrobials prescribed for otitis media in a pediatric Medicaid population. Am J Health-Syst Pharm . 1996; 53:2963-9. [PubMed 8974159]
2441. Block SL, Harrison CJ, Hedrick JA et al. Penicillin-resistant Streptococcus pneumoniae in acute otitis media: risk factors, susceptibility patterns and antimicrobial management. Pediatr Infect Dis J . 1995; 14:751-9. [PubMed 8559623]
2446. Oh PI, Maerov P, Pritchard D et al. A cost-utility analysis of second-line antibiotics in the treatment of acute otitis media in children. Clin Ther . 1996; 18:160-82. [PubMed 8851461]
2475. Cohen R, Navel M, Grunberg J et al. One dose ceftriaxone vs. ten days of amoxicillin/clavulanate therapy for acute otitis media: clinical efficacy and change in nasopharyngeal flora. Pediatr Infect Dis J . 1999; 18:403-9. [PubMed 10353511]
2476. Ball P. Therapy for pneumococcal infection at the millennium: doubts and certainties. Am J Med . 1999; 107(Suppl 1A):77S-85S. [PubMed 10451013]
2479. Hoppe HL, Johnson CE. Otitis media: focus on antimicrobial resistance and new treatment options. Am J Health-Syst Pharm . 1998; 55:1881-97. [PubMed 9784768]
2482. Bluestone CD. Ear and mastoid infections. In: Gorbach SL, Bartlett JG, Blacklow NR, eds. Infectious Diseases. Philadelphia, PA: WB Saunders; 1998:530-9.
2499. Centers for Disease Control and Prevention. Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep . 2000; 49(No. RR-15):1-22. [PubMed 10993565][Fulltext MMWR]
2500. Dixon TC, Meselson M, Guillemin J et al. Anthrax. N Engl J Med . 1999; 341:815-26. [PubMed 10477781]
2501. Turnball PCB. Guidelines for surveillance and control of anthrax in human and animals. 3rd ed. Geneva, Switzerland: World Health Organization, Department of Communicable Diseases Surveillance and Response. Publication No. WHO/EMC/ZSI./98.6. 1998. From WHO website. [Web]
2502. Inglesby TV, O***rsquo***Toole T, Henderson DA et al for the Working Group on Civilian Biodefense. Anthrax as a biological weapon 2002: updated recommendations for management. JAMA . 2002; 287:2236-52. [PubMed 11980524]
2505. Centers for Disease Control and Prevention. Update: Investigation of anthrax associated with intentional exposure and interim public health guidelines, October 2001. MMWR Morb Mortal Wkly Rep . 2001; 50:889-93. [PubMed 11686472]
2506. Centers for Disease Control and Prevention. Update: Investigation of bioterrorism-related anthrax and interim guidelines for exposure management and antimicrobial therapy, October 2001. MMWR Morb Mortal Wkly Rep . 2001; 50:909-19. [PubMed 11699843]
2507. Food and Drug Administration. Notice regarding doxycycline and penicillin G procaine administration for inhalational anthrax (post-exposure). 2001 Oct 30. From FDA website. [Web]
2508. US Army Medical Research Institute of Infectious Disease. USAMRIID***rsquo***s medical management of biologic casualties handbook. 4th ed. USAMRIID: Fort Detrick, MD; 2001 Feb.
2509. Centers for Disease Control and Prevention. Updated recommendations for antimicrobial prophylaxis among asymptomatic pregnant women after exposure to Bacillus anthracis . 2001; 50:960.
2510. Swartz MN. Recognition and management of anthrax***mdash***an update. N Engl J Med . 2001; 345:1621-6. [PubMed 11704686]
2515. Centers for Disease Control and Prevention. Notice to readers: update: interim recommendations for antimicrobial prophylaxis for children and breastfeeding mothers and treatment of children with anthrax. MMWR Morb Mortal Wkly Rep . 2001; 50:1014-6. [PubMed 11724160]