• Treatment of:
  • Skin and skin structure infections,
  • Otitis media,
  • Sinusitis,
  • Respiratory infections,
  • Genitourinary infections.
• Endocarditis prophylaxis.
• Postexposure inhalational anthrax prophylaxis.
• Management of ulcer disease due to Helicobacter pylori.

Unlabeled Uses:

• Lyme disease.

Contraindicated in:

• Hypersensitivity to penicillins (cross-sensitivity exists to cephalosporins and other beta-lactams).

Use Cautiously in:

• Severe renal impairment (↓ dose if CCr <30 mL/min)
• Infectious mononucleosis, acute lymphocytic leukemia, or cytomegalovirus infection (↑ risk of rash)

Derm: rash, ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS, DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, urticaria.

GI: diarrhea, ↑ liver enzymes, CLOSTRIDIOIDES DIFFICILE-ASSOCIATED DIARRHEA (CDAD), nausea, vomiting.

Hemat: blood dyscrasias.

Neuro: SEIZURES (HIGH DOSES).
Misc: (INCLUDING ANAPHYLAXIS)HYPERSENSITIVITY REACTIONS , SERUM SICKNESS, superinfection.

Drug-Drug:

• Probenecid ↓ renal excretion and ↑ blood levels of amoxicillin—therapy may be combined for this purpose.
• May ↑ effect of warfarin.
• May ↓ effectiveness of oral contraceptives.
• Allopurinol may ↑ frequency of rash.

(Generic available)

• Capsules: 250 mg; 500 mg;
• Tablets: 500 mg; 875 mg;
• Chewable tablets (cherry, banana, peppermint flavors): 125 mg; 250 mg;
• Powder for oral suspension (strawberry [125 mg/5 mL] and bubblegum [200 mg/5 mL, 250 mg/5 mL, 400 mg/5 mL] flavors): 125 mg/5 mL; 200 mg/5 mL; 250 mg/5 mL; 400 mg/5 mL;
• In combination with: clarithromycin and lansoprazole in a compliance package; omeprazole and clarithromycin (Omeclamox-Pak); omeprazole and rifabutin (Talicia); clarithromycin and vonoprazan in a compliance package (Voquenza Triple Pak); vonoprazan in a compliance package (Voquenza Dual Pak). See Appendix [not included in this PDA edition].

Most Infections

• PO (Adults): 250–500 mg every 8 hr or 500–875 mg every 12 hr (not to exceed 2–3 g/day).
• PO (Children >3 mo): 25–50 mg/kg/day in divided doses every 8 hr or 25–50 mg/kg/day in divided doses every 12 hr; Acute otitis media due to highly resistant strains of S. pneumoniae: 80–90 mg/kg/day in divided doses every 12 hr; Postexposure inhalational anthrax prophylaxis: <40 kg: 45 mg/kg/day in divided doses every 8 hr; >40 kg: 500 mg every 8 hr.
• PO (Infants ≤3 mo and neonates): 20–30 mg/kg/day in divided doses every 12 hr.

Helicobacter pylori

• PO (Adults): Triple therapy: 1000 mg amoxicillin twice daily with lansoprazole 30 mg twice daily and clarithromycin 500 mg twice daily for 14 days or 1000 mg amoxicillin twice daily with omeprazole 20 mg twice daily and clarithromycin 500 mg twice daily for 14 days or amoxicillin 1000 mg twice daily with esomeprazole 40 mg daily and clarithromycin 500 mg twice daily for 10 days. Dual therapy: 1000 mg amoxicillin three times daily with lansoprazole 30 mg three times daily for 14 days.

Endocarditis Prophylaxis

• PO (Adults): 2 g 1 hr prior to procedure.
• PO (Children): 50 mg/kg 1 hr prior to procedure (not to exceed adult dose).

Gonorrhea

• PO (Adults and Children ≥40 kg): 3 g as a single dose.
• PO (Children >2 yr and <40 kg): 50 mg/kg with probenecid 25 mg/kg as a single dose.

Amoxil, Trimox

• Binds to bacterial cell wall, causing cell death.

• Bactericidal action; spectrum is broader than penicillins.

Spectrum:

• Active against:
  • Streptococci,
  • Pneumococci,
  • Enterococci,
  • Haemophilus influenzae,
  • Escherichia coli,
  • Proteus mirabilis,
  • Neisseria meningitidis,
  • N. gonorrhoeae,
  • Shigella,
  • Chlamydia trachomatis,
  • Salmonella,
  • Borrelia burgdorferi,
  • H. pylori.

Therapeutic Classification: anti-infectives, antiulcer agents

Pharmacologic Classification: aminopenicillins

Absorption: Well absorbed from duodenum (75–90%). More resistant to acid inactivation than other penicillins.

Distribution: Diffuses readily into most body tissues and fluids. CSF penetration increased when meninges are inflamed. Crosses placenta; enters breast milk in small amounts.

Metabolism/Excretion: 70% excreted unchanged in the urine; 30% metabolized by the liver.

Half-life: Neonates: 3.7 hr; Infants and Children: 1–2 hr; Adults: 0.7–1.4 hr.

Novamoxin

(plasma concentrations)

• Instruct patients to take medication around the clock and to finish the drug completely as directed, even if feeling better. Advise patients that sharing of this medication may be dangerous.
• Pedi: Teach parents or caregivers to calculate and measure doses accurately. Reinforce importance of using measuring device supplied by pharmacy or with product, not household items.
• Advise patient to report the signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy.
• Instruct patient to notify health care professional immediately if diarrhea, abdominal cramping, fever, or bloody stools occur and not to treat with antidiarrheals without consulting health care professional.
• Instruct the patient to notify health care professional if symptoms do not improve.
• Teach patients with a history of rheumatic heart disease or valve replacement the importance of using antimicrobial prophylaxis before invasive medical or dental procedures.
• Caution female patients taking oral contraceptives to use an alternate or additional nonhormonal method of contraception during therapy with amoxicillin and until next menstrual period.

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