Amoxicillin
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Amoxicillin (INN), formerly amoxycillin (BAN), abbreviated AMOX, is a moderate-spectrum, bacteriolytic, β-lactam antibiotic used to treat bacterial infections caused by susceptible microorganisms. It is usually the drug of choice within the class because it is better absorbed, following oral administration, than other β-lactam antibiotics. It is also a treatment for cystic acne. [1]
Amoxicillin is susceptible to degradation by β-lactamase-producing bacteria, and so may be given with clavulanic acid to decrease its susceptibility.
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[edit] Mode of action
Amoxicillin acts by inhibiting the synthesis of bacterial cell wall. It inhibits cross-linkage between the linear peptidoglycan polymer chains that make up a major component of the cell walls of both Gram-positive and Gram-negative bacteria
[edit] Formulations
Amoxicillin in trihydrate form is available as capsules, chewable and dispersable tablets plus syrup and pediatric suspension for oral use, and as the sodium salt for intravenous administration. It is one of the most common antibiotics prescribed for children, and the liquid forms are helpful where the patient might find it difficult to take tablets or capsules. It has three ionizable groups. A once daily dosing form (Moxatag) was approved by the American FDA in January 2008.
[edit] Side effects
Side effects are as those for other beta-lactam antibiotics. Side effects include nausea, vomiting, irritability, volatile mood swings, disorientation, aggressiveness and easy fatigue. Loose bowel movements (diarrhea) also may occur.
The onset of an allergic reaction to amoxicillin can be very sudden and intense - emergency medical attention must be sought as quickly as possible. The initial onset of such a reaction often starts with a change in mental state; skin rash with intense itching (often beginning in fingertips and around groin area and rapidly spreading) and sensations of fever, nausea and vomiting. Any other symptoms that seem even remotely suspicious must be taken very seriously.
[edit] Non-allergic amoxicillin rash
Somewhere between 3% to 10% of children taking amoxicillin (or ampicillin) show a late-developing (>72 hours after beginning medication and having never taken penicillin-like medication previously) possibly itchy rash, which is sometimes referred to as the "amoxicillin rash." The rash can also occur in adults.
The rash is described as maculopapular or morbilliform (measles-like; therefore, in medical literature, "amoxicillin-induced morbilliform rash"[2]). It starts on the trunk and can spread from there. This rash is unlikely to be a true allergic reaction, and is not a contra-indication for future amoxicillin usage, nor should current regimen necessarily be stopped. However, as mentioned above, this common amoxicillin rash and a dangerous allergic reaction cannot easily be distinguished by inexperienced persons, and therefore a health professional should be consulted if a rash develops. (Pichichero, 2005; Schmitt 2005) Also, reliability should not be entrusted completely into the first opinion. To be determine for sure the category of the rash, at least two different doctors should be consulted.
A non-allergic amoxicillin rash may also be an indicator of infectious mononucleosis: Some studies indicate that approximately 80-90% of patients with acute Epstein Barr virus infection treated with amoxicillin or ampicillin develop such a rash. [3]
 Non-allergic amoxicillin rash 8 days after first dose, 24 hours after rash began. Diagnosed by pediatric resident at local university hospital. |
 8 hours after first photo. Individual spots have grown and begun to merge. |
 23 hours after first photo. Color apparently fading, much of rash has spread to confluence. |
[edit] Proprietary preparations
Amoxicillin is one of the semi-synthetic penicillins discovered by Beecham scientists. The patent for amoxicillin has expired, thus amoxicillin is marketed under many trade names including: Actimoxi, Alphamox,Amocla, AMK, Amoksibos, Amoxiclav Sandoz, Amoxidal, Amoxil, Amoxin, Amoksiklav, Amoxibiotic, Amoxicilina, Apo-Amoxi, Augmentin, Bactox, Betalaktam, Cilamox, Curam, Dedoxil, Dispermox, Duomox, E-Mox (250mg and 500 mg), Enhancin, Gimalxina, Geramox, Hiconcil, Isimoxin, Klavox, Lamoxy, Moxatag, Moxilen, Moxypen, Moxyvit, Nobactam, Novamoxin, Ospamox, Panklav, Pamoxicillin, Panamox, Polymox, Samthongcillin, Clamoxyl, Senox, Sinacilin, Trimox, Tolodina, Wymox, Yucla, Zerrsox and Zimox.
[edit] References
- Middlebrook Pharmaceuticals (January 2009). "Moxatag - MiddleBrook Pharmaceuticals to Launch Moxatag in March 2009" (html). http://www.middlebrookpharma.com/NEWSROOM_antibiotics/newsdetail.aspx?newsid=1241226.
- GlaxoSmithKline (February 2006). "Amoxil - Prescribing information" (PDF). http://us.gsk.com/products/assets/us_amoxil.pdf.
- Neal, M. J. (2002). Medical pharmacology at a glance (4th ed.). Oxford: Blackwell Science. ISBN 0-632-05244-9.
- Pichichero ME (April 2005). "A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients". Pediatrics 115 (4): 1048–57. doi:. PMID 15805383. http://pediatrics.aappublications.org/cgi/content/full/115/4/1048.
- Schmitt, Barton D. (2005). Your child's health: the parents' one-stop reference guide to symptoms, emergencies, common illnesses, behavior problems, healthy development (2nd ed.). New York: Bantam Books. ISBN 0-553-38369-8.
- British National Formulary 45 March 2003
[edit] Footnotes
- ^ "Adolescent Acne: Management". http://www.medscape.com/viewarticle/430534_5.
- ^ e.g. Role of delayed cellular hypersensitivity and adhesion molecules in amoxicillin-induced morbilliform rashes
- ^ Kagan, B (1977). "Ampicillin rash". Western Journal of Medicine 126 (4): 333–335. PMID 855325. PMC 1237570. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1237570.
[edit] External links
- University of Michigan Mott's Children's Hospital article about "amoxicillin rash." (Very similar to Schmitt 2005 content)
- Amoxicillin Side Effect Experiences
