Introduction:
Amoxicillin is a widely used antibiotic that belongs to the penicillin class of drugs. It is effective against a broad range of bacterial infections and is commonly prescribed for conditions such as ear infections, sinusitis, pneumonia, and urinary tract infections. Other class of drug includes Penicillin V
Dosage Form:
Amoxicillin is available in several dosage forms, including capsules, tablets, chewable tablets, oral suspension (liquid form), and extended-release tablets
Chemical Name:
The chemical name is ―amoxicillin‖: (2S,5R,6R)-6-[(2R)-2-amino-2-(4-hydroxyphenyl)acetamido]-3,3- dimethyl-7-oxo-4-thia-1-azabicyclo[3.2.0]heptane-2-carboxylic acid
Generic Name:
The generic name of the drug is amoxicillin
Major Brands in Pakistan:
Some major brands of amoxicillin available in Pakistan include: Amoxil, Augmentin (amoxicillin with clavulanic acid), Moxatag, Bristamox
Storage Conditions:
Amoxicillin should be stored at room temperature, between 20°C to 25°C (68°F to 77°F). The oral suspension should be refrigerated and used within 14 days after reconstitution
Pharmacodynamics:
Mechanism of Action:
Amoxicillin works by inhibiting the synthesis of bacterial cell walls. It binds to penicillin-binding proteins inside the bacterial cell wall, preventing the cross-linking of peptidoglycan chains, which are essential for cell wall strength and rigidity, ultimately leading to cell lysis and death
Therapeutic Indications:
Amoxicillin is indicated for the treatment of a variety of bacterial infections, including otitis media, sinusitis, pharyngitis and tonsillitis, bronchitis, pneumonia, urinary tract infections, skin and soft tissue infections, and Helicobacter pylori eradication (in combination with other drugs)
Dose Adjustment Conditions: Renal Impairment:
CrCl >30 mL/min: No adjustment needed.
CrCl 10-30 mL/min: 250-500 mg every 12 hours.
CrCl <10 mL/min: 250-500 mg every 24 hours.
Hemodialysis: 250-500 mg every 24 hours, with an additional dose during and at the end of dialysis
Adverse Effects:
Common adverse effects include nausea, vomiting, diarrhea, rash, and anaphylaxis (rare but severe allergic reaction)
Drug Interactions:
Amoxicillin can interact with oral contraceptives (may reduce effectiveness), allopurinol (may increase the risk of skin rash), probenecid (can increase blood levels of amoxicillin), and anticoagulants (may increase bleeding risk)
Contraindications:
Amoxicillin is contraindicated in patients with a history of allergic reactions to penicillins, cephalosporins, or other beta-lactam antibiotics
Pharmacokinetics:
Absorption:
Amoxicillin is well-absorbed from the gastrointestinal tract, with an oral bioavailability of approximately 70-90%
Volume of Distribution:
The volume of distribution of amoxicillin is about 0.3 to 0.4 L/kg
Protein Binding:
Approximately 17-20% of amoxicillin is bound to plasma proteins
Metabolism:
Amoxicillin undergoes minimal metabolism, with most of the drug being excreted unchanged in the urine
Precautions:
Use cautiously in patients with a history of hypersensitivity reactions to penicillin. Monitor renal, hepatic, and hematologic function periodically during prolonged therapy. Consider the possibility of super infections with prolonged or repeated use
Use in Pregnancy:
Amoxicillin is classified as Pregnancy Category B by the FDA. It is generally considered safe for use during pregnancy, but it should only be used if clearly needed and prescribed by a healthcare provider
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