Amoxicillin (Lexi-Drugs)

Special Alerts
  Beta-Lactam Antibiotics Safety AlertSeptember 2018
Pronunciation

(a moks i SIL in)

Brand Names: US

Moxatag [DSC]

Brand Names: Canada

AG-Amoxicillin; Amox 250 [DSC]; Amox 500 [DSC]; Amox S 125 [DSC]; Amox S 250 [DSC]; APO-Amoxi; APO-Amoxi Sugar Free; Auro-Amoxicillin; DOM-Amoxicillin; JAMP-Amoxicillin; Moxilean 50 [DSC]; MYLAN-Amoxicillin; Novamoxin; NTP-Amoxicillin [DSC]; PHL-Amoxicillin [DSC]; PMS-Amoxicillin; Polymox; PRO Amox-500; PRO-Amox-250

Pharmacologic Category

Antibiotic, Penicillin

Dosing: Adult

Note: Unless otherwise specified, all dosing recommendations based on immediate-release product formulations.

Usual dosage range:

Immediate release: Oral: 500 mg to 1 g every 8 to 12 hours

Extended release: 775 mg once daily

Actinomycosis (off-label use): Note: For initial therapy of mild infections or step-down therapy following parenteral treatment of severe infections.

Oral: 500 mg 3 to 4 times daily or 1 g 3 times daily (Martin 1984; Paulo 2018; Sharkaway 2018; Shikino 2015); higher doses of 4 to 6 g/day in divided doses have been utilized in case reports (Moghimi 2013; Valour 2014). Optimal duration of therapy is unknown; some experts suggest 2 to 12 months, depending on severity of infection and response to therapy (Sharkaway 2018).

Anthrax (alternative agent for penicillin-susceptible strains) (off-label use): Note: Consult public health officials for event-specific recommendations. A high index of suspicion for emergent beta-lactam resistance during therapy is warranted (Wilson 2018).

Inhalational exposure postexposure prophylaxis: Oral: 1 g every 8 hours for 60 days. Note: Anthrax vaccine should also be administered to exposed individuals (CDC [Hendricks 2014]).

Cutaneous, without systemic involvement: Oral: 1 g every 8 hours; duration is 60 days following biological weapon-related event and 7 to 10 days after naturally acquired infection. Note: Patients with cutaneous lesions of the head or neck or extensive edema should be treated with a parenteral regimen recommended for systemic involvement (CDC [Hendricks 2014]).

Asplenia, prophylaxis against bacterial infection in select high-risk patients (off-label use): Oral: Based on expert opinion: 500 mg twice daily. Duration varies based on patient-specific factors (Pasternack 2018).

Bronchiectasis (off-label use):

Treatment of pulmonary exacerbations in patients without beta-lactamase-positive Haemophilus influenzae or Pseudomonas aeruginosa: Oral: 500 mg 3 times daily (Barker 2018; Finegold 1981) or 1 g 3 times daily (Prigogine 1988) for up to 14 days (Barker 2018; ERS [Polverino 2017]).

Prevention of pulmonary exacerbations: Oral: 500 mg twice daily; dosing based on expert opinion (Barker 2018). Note: Recommended for patients with ≥3 exacerbations per year who are not colonized with P. aeruginosa and not candidates for long-term macrolide therapy (Barker 2018; ERS [Polverino 2017]).

Endocarditis, prophylaxis (dental or invasive respiratory tract procedures) (off-label use): Oral: 2 g 30 to 60 minutes before procedure. Note: Only recommended for patients with cardiac conditions associated with the highest risk of an adverse outcome from endocarditis and who are undergoing a procedure likely to result in bacteremia with an organism that has the potential ability to cause endocarditis (AHA [Wilson 2007]).

Helicobacter pylori eradication: Oral:

Clarithromycin triple regimen: Amoxicillin 1 g twice daily in combination with clarithromycin 500 mg twice daily, plus a standard-dose or double-dose proton pump inhibitor; continue regimen for 14 days. Note: Avoid use in patients with risk factors for macrolide resistance (eg, prior macrolide exposure or local clarithromycin resistance rates ≥15%, which is assumed in the United States) (ACG [Chey 2017]; Fallone 2016).

Concomitant regimen: Amoxicillin 1 g twice daily in combination with clarithromycin 500 mg twice daily, either metronidazole or tinidazole 500 mg twice daily, plus a standard-dose proton pump inhibitor twice daily; continue regimen for 10 to 14 days (ACG [Chey 2017])

Sequential regimen (alternative regimen): Amoxicillin 1 g twice daily plus a standard-dose proton pump inhibitor twice daily for 5 to 7 days; followed by clarithromycin 500 mg twice daily, either metronidazole or tinidazole 500 mg twice daily, plus a standard-dose proton pump inhibitor twice daily for 5 to 7 days; some experts prefer the 10-day regimen due to the lack of data showing superiority of the 14-day sequential regimen in North America (ACG [Chey 2017]; Crowe 2018).

Hybrid regimen (alternative regimen): Amoxicillin 1 g twice daily, plus a standard-dose proton pump inhibitor twice daily for 7 days; followed by amoxicillin 1 g twice daily, clarithromycin 500 mg twice daily, either metronidazole or tinidazole 500 mg twice daily, plus a standard-dose proton pump inhibitor twice daily for 7 days (ACG [Chey 2017]).

Levofloxacin triple regimen (salvage regimen): Amoxicillin 1 g twice daily in combination with a standard-dose proton pump inhibitor twice daily plus levofloxacin 500 mg once daily; continue regimen for 10 to 14 days (ACG [Chey 2017]).

Highdose dual therapy (salvage regimen): Amoxicillin 750 mg 4 times daily or 1 g 3 times daily; in combination with a standard-dose or double-dose proton pump inhibitor 3 to 4 times daily for 14 days (ACG [Chey 2017]).

Lyme disease (Borrelia spp. infection) (off-label use):

Early localized (eg, erythema migrans): Oral: 500 mg 3 times daily for 14 to 21 days (IDSA [Wormser 2006])

Early disseminated, carditis (initial therapy for mild disease [first-degree atrioventricular block with PR interval <300 msec] or step-down therapy after initial parenteral treatment for more severe disease once PR interval <300 msec): Oral: 500 mg 3 times daily for 14 to 21 days (Hu 2018; IDSA [Wormser 2006]); for step-down therapy, some experts prefer a total antibiotic duration of 21 to 28 days (Hu 2018).

Early disseminated, mild neurologic involvement (isolated facial nerve palsy [no evidence of meningitis]) (alternative agent): Oral: 500 mg 3 times daily for 14 to 21 days (IDSA [Wormser 2006]).

Late disease, arthritis without neurologic involvement: Oral: 500 mg 3 times daily for 28 days (IDSA [Wormser 2006])

Otitis media: Limited data: Oral: 500 mg every 8 hours or 875 mg every 12 hours (WHO 2001; manufacturer’s labeling). Optimal duration is uncertain; some experts suggest 5 to 10 days, depending on severity (Limb 2018).

Note: Some experts recommend amoxicillin/clavulanate over amoxicillin alone for patients with severe otalgia, fever, or when there is concern for beta-lactamase-producing H. influenzae or Streptococcus pneumoniae with decreased penicillin susceptibility (Limb 2018; WHO 2001)

Periodontitis, generalized aggressive (off-label use): Oral: 250 to 500 mg every 8 hours in combination with metronidazole for 10 to 14 days (Rabelo 2015; Silva-Senem 2013; Wilder 2018)

Pneumonia, community-acquired (CAP), outpatient empiric therapy: Oral: 1 g 3 times daily as part of an appropriate combination regimen. Duration is for a minimum of 5 days and varies based on disease severity and response to therapy; patients should be afebrile for ≥48 hours and clinically stable before therapy is discontinued (IDSA/ATS [Mandell 2007])

Prosthetic joint infection (off-label use): Note: For chronic antimicrobial suppression of prosthetic joint infection caused by beta-hemolytic streptococci, penicillin-susceptible Enterococcus spp., or Cutibacterium spp. (following pathogen-specific IV therapy in patients undergoing 1-stage exchange or debridement with retention of prosthesis).

Oral: 500 mg 3 times daily (IDSA [Osmon 2013]); duration depends on patient-specific factors (Berbari 2018).

Rhinosinusitis, acute bacterial: Note: For initial therapy of nonsevere infection in patients without risk factors for pneumococcal resistance or poor outcome (eg, age ≥65 years, recent hospitalization or antibiotic use, immunocompromising condition, residence in a region with high rates of resistance) (Patel 2018).

Oral: 500 mg every 8 hours or 875 mg every 12 hours for 5 to 7 days (AAO-HNS [Rosenfeld 2015]; Garbutt 2012; Lindbaek 1996; Patel 2018). In uncomplicated acute bacterial rhinosinusitis, initial observation and symptom management without antibiotic therapy is appropriate in most patients (AAO-HNS [Rosenfeld 2015]; ACG/CDC [Harris 2016]).

Skin and soft tissue infection:

Erysipelas, mild: Oral: 500 mg 3 times daily or 875 mg twice daily for 5 days, with extension to 14 days for slow response, severe infection, or immunosuppression (Spelman 2018; manufacturer’s labeling).

Erysipeloid, localized cutaneous: Oral: 500 mg 3 times daily for 7 to 10 days (IDSA [Stevens 2014])

Streptococcal pharyngitis (group A): Oral: 500 mg twice daily or 1 g once daily for 10 days (AHA [Gerber 2009]; IDSA [Shulman 2012])

Extended release: 775 mg once daily for 10 days

Manufacturer’s labeling. Dosing in the prescribing information may not reflect current clinical practice: Oral: Immediate release: 250 mg every 8 hours

Urinary tract infection: Note: Not recommended for empiric therapy given decreased efficacy compared to first-line agents and high prevalence of resistance (IDSA/ESCMID [Gupta 2011]).

Cystitis due to Enterococcus spp.: Oral: 500 mg every 8 hours or 875 mg every 12 hours for 5 days (Cole 2015; Hooton 2018a; Murray 2018; Swaminathan 2010).

Asymptomatic group B Streptococcus bacteriuria in pregnancy: Oral: 500 mg every 8 hours or 875 mg every 12 hours for 3 to 7 days (Hooton 2018b; IDSA [Nicolle 2005]). Note:Some experts recommend a treatment threshold of ≥104 CFU per mL (Puopolo 2018).

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment: Adult

Oral:

Immediate-release: Note: Avoid immediate-release 875 mg tablet in patients with GFR <30 mL/minute.

GFR ≥30 mL/minute: No dosage adjustment necessary.

GFR 10 to 30 mL/minute: 250 to 500 mg every 12 hours

GFR <10 mL/minute: 250 to 500 mg every 24 hours

Hemodialysis: Moderately dialyzable (20% to 50%); ~30% removed by 3-hour hemodialysis: 250 to 500 mg every 24 hours; administer after dialysis on dialysis days (Aronoff 2007)

Extended-release:

CrCl ≥30 mL/minute: There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied).

CrCl <30 mL/minute: Not recommended

Hemodialysis: Not recommended.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Pediatric

Note: Unless otherwise specified, all pediatric dosing recommendations based on immediate release product formulations (oral suspension, chewable tablet, tablet, and capsule).

General dosing, susceptible infection:

Mild to moderate infection:

Infants ≤3 months: Oral: 25 to 50 mg/kg/day in divided doses every 8 hours (Red Book [AAP 2015]). Note: Manufacturer’s labeling recommends a maximum daily dose of 30 mg/kg/day divided into 2 doses per day for this age group.

Infants >3 months, Children, and Adolescents:

AAP recommendations (Red Book [AAP 2015]): Oral: 25 to 50 mg/kg/day in divided doses every 8 hours; maximum dose: 500 mg/dose

Manufacturer’s labeling: Oral: 20 to 40 mg/kg/day in divided doses every 8 hours (maximum dose: 500 mg/dose) or 25 to 45 mg/kg/day in divided doses every 12 hours (maximum dose: 875 mg/dose)

Severe infection (as step-down therapy): Infants, Children, and Adolescents: Oral: 80 to 100 mg/kg/day in divided doses every 8 hours; maximum dose: 500 mg/dose for most indications (Red Book [AAP 2015])

Anthrax:

Cutaneous, without systemic involvement: Infants, Children, and Adolescents: Oral: 75 mg/kg/day in 3 divided doses. Maximum dose: 1,000 mg/dose. Duration of therapy: 7 to 10 days for naturally acquired infection, up to 60 days for biological weapon-related exposure (AAP [Bradley 2014]).

Inhalational, postexposure prophylaxis: Infants, Children, and Adolescents: Oral: 75 mg/kg/day in divided doses every 8 hours for 60 days after exposure; maximum dose: 1,000 mg/dose (AAP [Bradley 2014]).

Catheter (peritoneal dialysis), exit-site or tunnel infection: Infants, Children, and Adolescents: Oral: 10 to 20 mg/kg once daily; maximum dose: 1,000 mg/dose (ISPD [Warady 2012])

Endocarditis, prophylaxis: Note: AHA guidelines (Baltimore 2015) limit the use of prophylactic antibiotics to patients at the highest risk for infective endocarditis (IE) or adverse outcomes (eg, prosthetic heart valves, patients with previous IE, unrepaired cyanotic congenital heart disease, repaired congenital heart disease with prosthetic material or device during first 6 months after procedure, repaired congenital heart disease with residual defects at the site or adjacent to site of prosthetic patch or device, heart transplant recipients with cardiac valvulopathy):

Dental or oral procedures or respiratory tract procedures (eg, tonsillectomy, adenoidectomy): Infants, Children, and Adolescents: Oral: 50 mg/kg 30 to 60 minutes before procedure; maximum dose: 2,000 mg/dose (AHA [Wilson 2007])

H. pylori eradication: Children and Adolescents: Oral: 50 mg/kg/day in 2 divided doses for 10 to 14 days. Note: Duration dependent on regimen used; maximum daily dose: 2,000 mg/day. Administer in combination with a proton pump inhibitor or bismuth subsalicylate and at least one other antibiotic (clarithromycin and/or metronidazole) (NASPGHAN/ESPGHAN [Koletzko 2011]).

Lyme disease: Infants, Children, and Adolescents: Oral: 50 mg/kg/day in divided doses every 8 hours; maximum dose: 500 mg/dose (Halperin 2007; IDSA [Wormser 2006])

Otitis media, acute (AOM): Infants ≥2 months and Children: Oral: 80 to 90 mg/kg/day in divided doses every 12 hours; variable duration of therapy, if <2 years of age or severe symptoms (any age): 10-day course; if 2 to 5 years of age with mild to moderate symptoms: 7-day course; ≥6 years of age with mild to moderate symptoms: 5- to 7-day course; some experts recommend initiating with 90 mg/kg/day (AAP [Lieberthal 2013]; Red Book [AAP 2015]); a maximum dose is not provided in the Guidelines for The Diagnosis and Management of Acute Otitis Media (AAP [Lieberthal 2013]); however, some experts suggest a maximum daily dose of 4,000 mg/day for high-dose amoxicillin therapy (Bradley 2015).

Peritonitis (peritoneal dialysis), prophylaxis for patients requiring invasive dental procedures: Infants, Children, and Adolescents: Oral: 50 mg/kg administered 30 to 60 minutes before dental procedure; maximum dose: 2,000 mg/dose (ISPD [Warady 2012])

Pneumonia, community-acquired: Infants ≥3 months, Children, and Adolescents (IDSA [Bradley 2011]):

Empiric therapy for presumed bacterial pneumonia: Oral: 90 mg/kg/day in divided doses every 12 hours; maximum daily dose: 4,000 mg/day

Group A Streptococcus, mild infection or step-down therapy: Oral: 50 to 75 mg/kg/day in divided doses every 12 hours; maximum daily dose: 4,000 mg/day

Haemophilus influenzae, mild infection or step-down therapy: Oral: 75 to 100 mg/kg/day in divided doses every 8 hours; maximum daily dose: 4,000 mg/day

Streptococcus pneumonia (penicillin MIC ≤2 mcg/mL); mild infection or step-down therapy: Oral: 90 mg/kg/day in divided doses every 12 hours or 45 mg/kg/day in divided doses every 8 hours; maximum daily dose: 4,000 mg/day

Pneumococcal infection prophylaxis for anatomic or functional asplenia [eg, sickle cell disease (SCD)] (Price 2007; Red Book [AAP 2015]):

Before 2 months of age (or as soon as SCD is diagnosed or asplenia occurs) through 5 years of age: Oral: 20 mg/kg/day in divided doses every 12 hours; maximum dose: 250 mg/dose

Children ≥6 years and Adolescents: Oral: 250 mg every 12 hours; Note: The decision to discontinue penicillin prophylaxis after 5 years of age in children who have not experienced invasive pneumococcal infection and have received recommended pneumococcal immunizations is patient and clinician dependent.

Rhinosinusitis, acute bacterial; uncomplicated: Note: AAP guidelines recommend amoxicillin as first-line empiric therapy for pediatric patients 1 to 18 years with uncomplicated cases and where resistance is not suspected; however, the IDSA guidelines consider amoxicillin/clavulanate as the preferred therapy (IDSA [Chow 2012]; AAP [Wald 2013]):

Low dose: Children ≥2 years and Adolescents: Oral: 45 mg/kg/day in divided doses every 12 hours; Note: Only use for uncomplicated, mild to moderate infections in children who do not attend daycare and who have not received antibiotics within the last month (AAP [Wald 2013]).

High dose (use reserved for select patients; see Note): Children ≥2 years and Adolescents: Oral: 80 to 90 mg/kg/day in divided doses every 12 hours; maximum dose: 2,000 mg/dose; Note: Should only use for mild to moderate infections in children who do not attend daycare and who have not received antibiotics within the last month and live in communities with a high prevalence of nonsusceptible S. pneumoniae resistance (AAP [Wald 2013]).

Tonsillopharyngitis; Group A streptococcal infection, treatment and primary prevention of rheumatic fever:

Immediate release (oral suspension, chewable tablets, tablets, capsules): Children and Adolescents 3 to 18 years: Oral: 50 mg/kg once daily or 25 mg/kg twice daily for 10 days; maximum daily dose: 1,000 mg/day (AHA [Gerber 2009]; IDSA [Shulman 2012])

Extended release tablets: Children ≥12 years and Adolescents: Oral: 775 mg once daily for 10 days; Note: Patient must be able to swallow tablet whole.

UTI, prophylaxis (hydronephrosis, vesicoureteral reflux): Infants ≤2 months: Oral: 10 to 15 mg/kg once daily; some suggest administration in the evening (drug resides in bladder longer); Note: Due to resistance, amoxicillin should not be used for prophylaxis after 2 months of age (Belarmino 2006; Greenbaum 2006; Mattoo 2007).

Dosing: Renal Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling; however, the following guidelines have been used by some clinicians (Aronoff 2007): Oral:

Immediate release: Infants, Children, and Adolescents:

Mild to moderate infection: Dosing based on 25 to 50 mg/kg/day divided every 8 hours:

GFR >30 mL/minute/1.73 m2: No adjustment required

GFR 10 to 29 mL/minute/1.73 m2: 8 to 20 mg/kg/dose every 12 hours

GFR <10 mL/minute/1.73 m2: 8 to 20 mg/kg/dose every 24 hours

Hemodialysis: Moderately dialyzable (20% to 50%); ~30% removed by 3-hour hemodialysis: 8 to 20 mg/kg/dose every 24 hours; give after dialysis

Peritoneal dialysis: 8 to 20 mg/kg/dose every 24 hours

Severe infection (high dose): Dosing based on 80 to 90 mg/kg/day divided every 12 hours:

GFR >30 mL/minute/1.73 m2: No adjustment required

GFR 10 to 29 mL/minute/1.73 m2: 20 mg/kg/dose every 12 hours; do not use the 875 mg tablet

GFR <10 mL/minute/1.73 m2: 20 mg/kg/dose every 24 hours; do not use the 875 mg tablet

Hemodialysis: Moderately dialyzable (20% to 50%); ~30% removed by 3-hour hemodialysis: 20 mg/kg/dose every 24 hours; give after dialysis

Peritoneal dialysis: 20 mg/kg/dose every 24 hours

Extended release: Children ≥12 years and Adolescents: CrCl <30 mL/minute: Not recommended

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling.

Use: Labeled Indications

Ear, nose, and throat infections (pharyngitis/tonsillitis, otitis media):

Immediate release: Treatment of infections due to beta-lactamase-negative Streptococcus spp. (alpha- and beta-hemolytic isolates only), Streptococcus pneumoniaeStaphylococcus spp., or Haemophilus influenzae.

Extended release: Treatment of tonsillitis and/or pharyngitis due to Streptococcus pyogenes in adults and pediatric patients ≥12 years of age.

Genitourinary tract infections: Immediate release: Treatment of infections of the genitourinary tract due to beta-lactamase-negative Escherichia coliProteus mirabilis, or Enterococcus faecalis.

Helicobacter pylori eradication: Immediate release: Eradication of H. pylori to reduce the risk of duodenal ulcer recurrence as a component of combination therapy in patients with active or 1-year history of duodenal ulcer disease.

Lower respiratory tract infections (including pneumonia): Immediate release: Treatment of infections of the lower respiratory tract due to beta-lactamase-negative Streptococcusspp. (alpha- and beta-hemolytic strains only), S. pneumoniaeStaphylococcus spp., or H. influenzae.

Rhinosinusitis, acute bacterial: Immediate release: Treatment of infections due to beta-lactamase-negative Streptococcus spp. (alpha- and beta-hemolytic isolates only), S. pneumoniaeStaphylococcus spp., or H. influenzae.

Skin and skin structure infections: Immediate release: Treatment of infections of the skin and skin structure due to beta-lactamase-negative Streptococcus spp. (alpha- and beta-hemolytic strains only), Staphylococcus spp., or E. coli.

Use: Off-Label: Adult

  ActinomycosisLevel of Evidence [C]

Data from a small retrospective study suggest that amoxicillin may be beneficial for the treatment of actinomycosis Ref. Clinical experience also suggests that amoxicillin may be beneficial in managing actinomycosis Ref

  AnthraxLevel of Evidence [G]

Based on the Centers for Disease Control and Prevention (CDC) recommendations for the prevention and treatment of anthrax in adults, amoxicillin is an effective and recommended alternative drug in the management of postexposure prophylaxis of inhalational anthrax or treatment of cutaneous anthrax (without systemic involvement) in patients with documented susceptible organisms Ref.

  Asplenia, prophylaxis against bacterial infection in high-risk patientsLevel of Evidence [C]

Clinical experience suggests the utility of amoxicillin to prevent bacterial infections in high-risk patients with functional or anatomic asplenia Ref.

  BronchiectasisLevel of Evidence [C, G]

European Respiratory Society guidelines for the management of adult bronchiectasis recommend long-term treatment with an oral antibiotic (such as amoxicillin) (choice based on antibiotic susceptibility and patient tolerance) for adults with bronchiectasis and ≥3 exacerbations per year who are not infected with P. aeruginosa in whom macrolides are contraindicated. Data from a small number of patients suggest the utility of long-term amoxicillin to reduce severity of exacerbations in patients with bronchiectasis Ref.

Data from a limited number of patients studied suggest that amoxicillin may be beneficial in the treatment of acute exacerbations of bronchiectasis Ref. Clinical experience also suggests the utility of amoxicillin in managing bronchiectasis Ref.

  Endocarditis, prophylaxisLevel of Evidence [G]

Based on the American Heart Association (AHA) guidelines for the prevention of infective endocarditis, amoxicillin is effective and recommended for patients with certain cardiac conditions who are able to take oral medication to provide prophylaxis against infective endocarditis associated with dental or respiratory tract procedures and for patients undergoing genitourinary procedures to eradicate enterococci from the urine unless a known or suspected strain of resistant enterococci exists.

  Lyme disease (Borrelia spp. infection)Level of Evidence [G]

Based on the Infectious Diseases Society of America (IDSA) guidelines for the clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis, amoxicillin is effective and recommended for the treatment of early localized Lyme disease (eg, erythema migrans), early disseminated Lyme disease (isolated facial nerve palsy [when doxycycline is contraindicated] or mild carditis), or late Lyme disease (arthritis without neurologic involvement, acrodermatitis chronica atrophicans).

  Periodontitis, generalized aggressiveLevel of Evidence [B]

Data from a small, randomized, double-blind study support the use of amoxicillin, in combination with metronidazole as well as scaling and root planing, in the treatment of aggressive periodontitis Ref. In addition, results of a systematic review and meta-analysis support the use of amoxicillin, in combination with metronidazole and scaling and root planing, in the treatment of aggressive periodontitis Ref.

  Prosthetic joint infectionLevel of Evidence [G]

Based on the IDSA guidelines for the management of prosthetic joint infection (PJI), amoxicillin is an effective and recommended agent for chronic oral antimicrobial suppression of PJI with beta-hemolytic streptococci, Enterococcus spp. (penicillin susceptible), and Cutibacterium spp. after completion of parenteral therapy.

Level of Evidence Definitions
  Level of Evidence Scale
Clinical Practice Guidelines

Acne:

American Academy of Dermatology, “Guidelines of Care for the Management of Acne Vulgaris,” May 2016

Dyspepsia:

ACG/CAG “Guidelines for the Management of Dyspepsia,” June 2017

Helicobacter pylori Infection:

“ACG Clinical Guideline: Treatment of Helicobacter pylori Infection,” February 2017

Infectious Endocarditis Prophylaxis:

AHA/ACC, “2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease,” March 2014

Lyme Disease:

American Academy of Neurology (AAN), “Practice Parameter: Treatment of Nervous System Lyme Disease (an evidence-based review),” July 2007

IDSA, “The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis,” November 2006

Opportunistic Infections:

DHHS, Guidelines for the Prevention and Treatment of Opportunistic Infections Among HIV-Exposed and HIV-Infected Children, November 2013

HHS, Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents, September 2015

Pharyngitis, Group A Streptococci:

IDSA, “Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis,” September 2012

Pneumonia, Community-Acquired:

IDSA/ATS, “Consensus Guideline on Management of Community-Acquired Pneumonia in Adults,” 2007

IDSA/PIDS, “The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age,” 2011

Prosthetic Joint Infection:

IDSA, “Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guideline,” January 2013

Rhinosinusitis:

AAO-HNS, “Clinical Practice Guideline (Update): Adult Sinusitis,” 2015

IDSA, “Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults,” 2012

Sexually-Transmitted Disease:

CDC, “Sexually Transmitted Diseases Treatment Guidelines,” June 2015.

World Health Organization (WHO), “Guidelines for the Treatment of Chlamydia trachomatis,” 2016

Skin and Soft-tissue Infection:

IDSA, “Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections,” June 2014

Administration: Oral

Administer around-the-clock to promote less variation in peak and trough serum levels.

Extended release: Administer within 1 hour of finishing a meal; do not chew or crush tablet.

Suspension: Shake well before use; may be mixed with formula, milk, fruit juice, water, ginger ale, or cold drinks; administer dose immediately after mixing.

Administration: Pediatric

Oral:

Immediate release: May be administered on an empty or full stomach; may be mixed with formula, milk, cold drink, or juice; administer dose immediately after mixing; shake suspension well before use.

Extended release: Take within 1 hour of finishing a meal; do not chew or crush tablet.

Dietary Considerations

Some products may contain phenylalanine.

Storage/Stability

Store at room temperature. Reconstituted oral suspension remains stable for 14 days at room temperature or refrigerated (refrigeration preferred). Unit-dose antibiotic oral syringes are stable at room temperature for at least 72 hours (Tu 1988).

Preparation for Administration: Adult

Oral suspension: Refer to manufacturer’s product labeling for reconstitution instructions. Shake vigorously.

Preparation for Administration: Pediatric

Oral: Immediate release: Reconstitute powder for oral suspension with appropriate amount of water as specified on the bottle. Shake vigorously until suspended.

Medication Patient Education with HCAHPS Considerations

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience nausea, vomiting, or diarrhea. Have patient report immediately to prescriber signs of liver problems (dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or jaundice), signs of Clostridium difficile (C. diff)-associated diarrhea (abdominal pain or cramps, severe diarrhea or watery stools, or bloody stools), signs of Stevens-Johnson syndrome/toxic epidermal necrolysis (red, swollen, blistered, or peeling skin [with or without fever]; red or irritated eyes; or sores in mouth, throat, nose, or eyes), bruising, bleeding, or thrush (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

Medication Safety Issues
  Sound-alike/look-alike issues:
  International issues:
Contraindications

Serious hypersensitivity to amoxicillin (eg, anaphylaxis, Stevens-Johnson syndrome) or to other beta-lactams, or any component of the formulation

Canadian labeling: Additional contraindications (not in US labeling): Infectious mononucleosis (suspected or confirmed)

Warnings/Precautions

Concerns related to adverse effects:

• Anaphylactic/hypersensitivity reactions: Serious and occasionally severe or fatal hypersensitivity (anaphylactic) reactions have been reported in patients on penicillin therapy, including amoxicillin, especially with a history of beta-lactam hypersensitivity (including severe reactions with cephalosporins) and/or a history of sensitivity to multiple allergens.

• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.

Disease-related concerns:

• Infectious mononucleosis: A high percentage of patients with infectious mononucleosis develop an erythematous rash during amoxicillin therapy; avoid use in these patients.

• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment recommended in patients with GFR <30 mL/minute. Avoid extended release 775 mg tablet and immediate release 875 mg tablet in patients with GFR <30 mL/minute or patients requiring hemodialysis.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Dosage form specific issues:

• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP [“Inactive” 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer’s labeling.

• Chewable tablets: May contain phenylalanine; see manufacturer’s labeling.

Geriatric Considerations

Resistance to amoxicillin has been a problem in patients on frequent antibiotics or in nursing homes. Alternative antibiotics may be necessary in these populations. Adjust dose based on renal function.

Older adults are at increased risk for neurotoxicity (eg, seizures) related to penicillins due to decreased renal clearance or when penicillins are used concurrently with other medications known to decrease the seizure threshold (Schliamser 1991). Seizure activity can present from 12 hours to 9 days post-antibiotic initiation, therefore, monitoring for neurotoxicity is prudent.

It should be noted that the Infectious Diseases Society of America (IDSA) provides guidance on what constitutes a fever in older, long-term care facility residents: A single oral temperature >100°F (37.8°C); or repeated oral temperatures >99°F (37.2°C) or rectal temperatures >99.5°F (37.5°C) or an increase in temperature of >2°F (1.1°C) over the baseline temperature (High 2009).

Warnings: Additional Pediatric Considerations

Epstein-Barr virus infection (infectious mononucleosis), acute lymphocytic leukemia, or cytomegalovirus infection increases risk for amoxicillin-induced maculopapular rash. Appearance of a rash should be carefully evaluated to differentiate a nonallergic amoxicillin rash from a hypersensitivity reaction. Amoxicillin rash occurs in 5% to 10% of children receiving amoxicillin and is a generalized dull, red, maculopapular rash, generally appearing 3 to 14 days after the start of therapy. It normally begins on the trunk and spreads over most of the body. It may be most intense at pressure areas, elbows, and knees. A high percentage (43% to 100%) of patients with infectious mononucleosis have developed rash during therapy; amoxicillin-class antibiotics are not recommended in these patients.

Pregnancy Risk Factor

B

Pregnancy Considerations

Adverse events have not been observed in animal reproduction studies. Amoxicillin crosses the placenta (Muller 2009). Maternal use of amoxicillin has generally not resulted in an increased risk of adverse fetal effects; however, a possible association with cleft lip with cleft palate has been observed in some studies (more data is needed) (Lin 2012; Puhó 2007). Amoxicillin may be used for the management of Bacillus anthracis in pregnant women when penicillin susceptibility is documented (Meaney-Delman 2014). Amoxicillin is an alternative antibiotic for the treatment of chlamydial infections in pregnancy (CDC [Workowski 2015]). Amoxicillin can also be used in the management of preterm premature rupture of membranes and in certain situations prior to vaginal delivery in women at high risk for endocarditis (ACOG 120 2011; ACOG 139 2013).

Due to pregnancy-induced physiologic changes, some pharmacokinetic parameters of amoxicillin may be altered (Andrew 2007). Oral ampicillin-class antibiotics are poorly absorbed during labor.

Breast-Feeding Considerations

Amoxicillin is excreted in breast milk (Kafetzis 1981).

The relative infant dose (RID) of amoxicillin is 0.15% to 0.54% when calculated using the highest average breast milk concentration located and compared to an infant therapeutic dose of 25 to 90 mg/kg/day. In general, breastfeeding is considered acceptable when the RID is <10%; when an RID is >25% breastfeeding should generally be avoided (Anderson 2016; Ito 2000). Using the highest average milk concentration (0.9 mcg/mL), the estimated daily infant dose via breast milk is 0.135 mg/kg/day. This milk concentration was obtained following maternal administration of a single oral dose of amoxicillin 1,000 mg (Kafetzis 1981).

Self-limiting diarrhea, rash, and somnolence have been reported in nursing infants exposed to amoxicillin (Benyamini 2005; Goldstein 2009; Ito 1993); the manufacturer warns of the potential for allergic sensitization in the infant. In general, antibiotics that are present in breast milk may cause non-dose-related modification of bowel flora. Monitor infants for GI disturbances, such as thrush or diarrhea (WHO 2002).

Although the manufacturer recommends that caution be exercised when administering amoxicillin to breastfeeding women, amoxicillin is considered compatible with breastfeeding when used in usual recommended doses (WHO 2002). Amoxicillin has been recommended to treat mastitis in breastfeeding women when penicillin susceptibility is documented (WHO 2000) and also for the management of Bacillus anthracis (Meaney-Delman 2014).

Lexicomp Pregnancy & Lactation, In-Depth
Briggs’ Drugs in Pregnancy & Lactation
Adverse Reactions

1% to 10%:

Central nervous system: Headache (1%)

Gastrointestinal: Diarrhea (2%), nausea (1%), vomiting (1%)

Genitourinary: Vulvovaginal infection (2%)

Frequency not defined:

Cardiovascular: Hypersensitivity angiitis

Central nervous system: Agitation, anxiety, behavioral changes, confusion, dizziness, insomnia, reversible hyperactivity, seizure

Dermatologic: Acute generalized exanthematous pustulosis, erythematous maculopapular rash, erythema multiforme, exfoliative dermatitis, skin rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria

Gastrointestinal: Clostridioides difficile associated diarrhea, Clostridioides difficile colitis, hemorrhagic colitis, melanoglossia, mucocutaneous candidiasis, staining of tooth

Genitourinary: Crystalluria

Hematologic & oncologic: Agranulocytosis, anemia, eosinophilia, hemolytic anemia, immune thrombocytopenia, leukopenia, thrombocytopenia

Hepatic: Cholestatic hepatitis, cholestatic jaundice, hepatitis (acute cytolytic), increased serum alanine aminotransferase, increased serum aspartate aminotransferase

Hypersensitivity: Anaphylaxis

Immunologic: Serum sickness-like reaction

<1%, postmarketing, and/or case reports: Abdominal pain

Allergy and Idiosyncratic Reactions
Metabolism/Transport Effects

None known.

Drug Interactions 

Acemetacin: May increase the serum concentration of Penicillins. Risk C: Monitor therapy

Allopurinol: May enhance the potential for allergic or hypersensitivity reactions to Amoxicillin. Risk C: Monitor therapy

BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Risk C: Monitor therapy

Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy

Methotrexate: Penicillins may increase the serum concentration of Methotrexate. Risk C: Monitor therapy

Mycophenolate: Penicillins may decrease serum concentrations of the active metabolite(s) of Mycophenolate. This effect appears to be the result of impaired enterohepatic recirculation.Risk C: Monitor therapy

Probenecid: May increase the serum concentration of Penicillins. Management: Avoid the routine use of penicillins and probenecid, but this combination may be used advantageously in select cases with careful monitoring. Monitor for toxic effects of penicillins if probenecid is initiated or the dose is increased. Risk D: Consider therapy modification

Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification

Tetracyclines: May diminish the therapeutic effect of Penicillins. Risk D: Consider therapy modification

Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Vaccination with live attenuated typhoid vaccine (Ty21a) should be avoided in patients being treated with systemic antibacterial agents. Use of this vaccine should be postponed until at least 3 days after cessation of antibacterial agents. Risk D: Consider therapy modification

Vitamin K Antagonists (eg, warfarin): Penicillins may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy

Test Interactions

May interfere with urinary glucose tests (Benedict’s solution, Clinitest, Fehling’s Solution).

Some penicillin derivatives may accelerate the degradation of aminoglycosides in vitro, leading to a potential underestimation of aminoglycoside serum concentration.

Monitoring Parameters

With prolonged therapy, monitor renal, hepatic, and hematologic function periodically; assess patient at beginning and throughout therapy for infection; monitor for signs of anaphylaxis during first dose

Advanced Practitioners Physical Assessment/Monitoring

Assess culture and sensitivity report and patient allergy history prior to starting therapy. Obtain CBC, renal function tests, liver function tests periodically with prolonged therapy. Monitor for signs of anaphylaxis during first dose. Assess for effectiveness of treatment. Test for C.difficileif patient develops diarrhea.

Nursing Physical Assessment/Monitoring

Check labs results and report abnormalities. Monitor closely for signs of hypersensitivity (shortness-of-breath, dyspnea, chest pain, complaints of difficulty swallowing or throat tightness, or change in vital signs). Monitor for severe or bloody diarrhea and send a specimen to the lab for C.difficile. Monitor for improvement with infection.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

Generic: 250 mg, 500 mg

Suspension Reconstituted, Oral:

Generic: 125 mg/5 mL (80 mL, 100 mL, 150 mL); 200 mg/5 mL (50 mL, 75 mL, 100 mL); 250 mg/5 mL (80 mL, 100 mL, 150 mL); 400 mg/5 mL (50 mL, 75 mL, 100 mL)

Tablet, Oral:

Generic: 500 mg, 875 mg

Tablet Chewable, Oral:

Generic: 125 mg, 250 mg

Tablet Extended Release 24 Hour, Oral:

Moxatag: 775 mg [DSC] [contains cremophor el, fd&c blue #2 aluminum lake]

Generic: 775 mg [DSC]

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

Polymox: 250 mg, 500 mg

Generic: 250 mg, 500 mg

Suspension Reconstituted, Oral:

Moxilean 50: 50 mg/mL (15ml[DSC], 45ml[DSC])

Polymox: 125 mg/5 mL (150ml); 250 mg/5 mL (150ml)

Generic: 125 mg/5 mL (15ml, 60ml[DSC], 75ml, 100ea[DSC], 100ml, 150ml); 250 mg/5 mL (15ml, 60ea[DSC], 75ml, 100ml, 150ml)

Tablet Chewable, Oral:

Generic: 125 mg, 250 mg

Anatomic Therapeutic Chemical (ATC) Classification
  • J01CA04
Generic Available (US)

Yes

Pricing: US

Capsules (Amoxicillin Oral)

250 mg (per each): $0.13 – $0.25

500 mg (per each): $0.19 – $5.88

Chewable (Amoxicillin Oral)

125 mg (per each): $0.34

250 mg (per each): $0.67

Suspension (reconstituted) (Amoxicillin Oral)

125 mg/5 mL (per mL): $0.04

200 mg/5 mL (per mL): $0.09

250 mg/5 mL (per mL): $0.06

400 mg/5 mL (per mL): $0.10

Tablets (Amoxicillin Oral)

500 mg (per each): $0.50

875 mg (per each): $0.87

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer’s AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Mechanism of Action

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

Pharmacodynamics/Kinetics

Absorption: Oral:

Immediate-release: Rapid with or without food

Extended-release: Rate of absorption is slower compared to immediate-release formulations; food decreases the rate but not extent of absorption

Distribution: Readily into liver, lungs, prostate, muscle, middle ear effusions, maxillary sinus secretions, bone, gallbladder, bile, and into ascitic and synovial fluids; poor CSF penetration (except when meninges are inflamed)

Protein binding: ~20%

Half-life elimination: Adults: Immediate-release: 61.3 minutes; Extended-release: 90 minutes

Time to peak: Capsule, oral suspension: 1 to 2 hours; Chewable tablet: 1 hour; Extended-release: 3.1 hours

Excretion: Urine (60% as unchanged drug) lower in neonates

Dental Use

Antibiotic for standard prophylactic regimen for dental patients who are at risk for infective endocarditis; prophylaxis in total joint replacement patients undergoing dental procedures; antibiotic used to treat orofacial infections. Useful (as amoxicillin or amoxicillin/clavulanic acid) in combination with metronidazole in addition to scaling and root planing in the treatment of periodontitis associated with the presence of Actinobacillus actinomycetemcomitans (AA).

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

Prolonged use of penicillins may lead to development of oral candidiasis

Effects on Bleeding

No information available to require special precautions

Dental Usual Dosing

Oral:

Children >3 months and <40 kg: Prophylaxis against infective endocarditis: 50 mg/kg 30-60 minutes before procedure. Note: American Heart Association (AHA) guidelines now recommend prophylaxis only in patients undergoing invasive procedures and in whom underlying cardiac conditions may predispose to a higher risk of adverse outcomes should infection occur.

Adults:

Periodontitis (aggressive) (in combination with metronidazole) associated with presence of Actinobacillus actinomycetemcomitans (AA): 500 mg every 8 hours for 10 days used in addition to scaling and root planing (Varela 2011). In aggressive periodontitis, greatest benefit is seen after 3 months of therapy. No benefit was seen after 6 months of therapy (Varela 2011).

Prophylaxis against infective endocarditis: 2 g 30-60 minutes before procedure. Note: American Heart Association (AHA) guidelines now recommend prophylaxis only in patients undergoing invasive procedures and in whom underlying cardiac conditions may predispose to a higher risk of adverse outcomes should infection occur.

Orofacial infection: 250-500 mg every 8 hours or 500-875 mg twice daily

Prophylaxis in total joint replacement patients undergoing dental procedures which produce bacteremia: 2 g 1 hour prior to procedure

Note: In general, patients with prosthetic joint implants do not require prophylactic antibiotics prior to dental procedures. In planning an invasive oral procedure, dental consultation with the patient’s orthopedic surgeon may be advised to review the risks of infection.

Index Terms

p-Hydroxyampicillin; Amoxicillin Trihydrate; Amoxil; Amoxycillin

FDA Approval Date
August 06, 1984
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Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(23):2440-2492.[PubMed 24589852]

Novamoxin (amoxicillin) [product monograph]. Toronto, Ontario, Canada: Teva Canada Limited; January 2018.

Osmon DR, Berbari EF, Berendt AR, et al; Infectious Diseases Society of America. Diagnosis and management of prosthetic joint infection: clinical practice guideline by the Infectious Diseases Society of America. Clin Infect Dis. 2013;56(1):e1-e25.[PubMed 23223583]

Paulo CO, Jordão S, Correia-Pinto J, Ferreira F, Neves I. Actinomycosis, a lurking threat: a report of 11 cases and literature review. Rev Soc Bras Med Trop. 2018;51(1):7-13. doi: 10.1590/0037-8682-0215-2017.[PubMed 29513846]

Parry MF, “The Penicillins,” Med Clin North Am, 1987, 71(6):1093-112.[PubMed 3320613]

Pasternack MS. Prevention of sepsis in the asplenic patient. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 30, 2018.

Patel ZM, Hwang PH. Uncomplicated acute sinusitis and rhinosinusitis in adults: treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 30, 2018.

Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J. 2017;50(3):pii:1700629. doi: 10.1183/13993003.00629-2017.[PubMed 28889110]

Price VE, Blanchette VS, Ford-Jones EL. The prevention and management of infections in children with asplenia or hyposplenia. Infect Dis Clin North Am. 2007;21(3):697-710.[PubMed 17826619]

Prigogine T, Glupczynski Y, Carpiaux JP, Blogie M, Yourassowsky E, Schmerber JS. Enoxacin in acute exacerbations of chronic bronchitis: a comparison with amoxycillin. J Antimicrob Chemother. 1988;21(suppl B):131-136.[PubMed 3129390]

Puhó EH, Szunyogh M, Métneki J, Czeizel AE. Drug treatment during pregnancy and isolated orofacial clefts in hungary. Cleft Palate Craniofac J. 2007;44(2):194-202.[PubMed 17328645]

Puopolo KM, Madoff LC, Baker CJ. Group B streptococcal infection in pregnant women. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 31, 2018.

Rabelo CC, Feres M, Gonçalves C, et al. Systemic antibiotics in the treatment of aggressive periodontitis. A systematic review and a Bayesian network meta-analysis. J Clin Periodontol. 2015;42(7):647-657. doi: 10.1111/jcpe.12427.[PubMed 26087839]

Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015;152(2)(suppl):S1-S39. doi: 10.1177/0194599815572097.[PubMed 25832968]

Schliamser SE, Cars O, Norrby SR. Neurotoxicity of beta-lactam antibiotics: predisposing factors and pathogenesis. J Antimicrob Chemother. 1991;27(4):405-425.[PubMed 1856121]

Sharkaway AA, Chow AW. Cervicofacial actinomycosis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 30, 2018.

Shikino K, Ikusaka M, Takada T. Cervicofacial actinomycosis. J Gen Intern Med. 2015;30(2):263. doi: 10.1007/s11606-014-3001-z.[PubMed 25280832]

Shulman ST, Bisno AL, Clegg HW, et al; Infectious Diseases Society of America. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America [published correction appears in Clin Infect Dis. 2014;58(10):1496]. Clin Infect Dis. 2012;55(10):e86-e102.[PubMed 22965026]

Silva-Senem MX, Heller D, Varela VM, Torres MC, Feres-Filho EJ, Colombo AP. Clinical and microbiological effects of systemic antimicrobials combined to an anti-infective mechanical debridement for the management of aggressive periodontitis: a 12-month randomized controlled trial. J Clin Periodontol. 2013;40(3):242-251. doi: 10.1111/jcpe.12052.[PubMed 23297772]

Sollecito TP, Abt E, Lockhart PB, et al. The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: Evidence-based clinical practice guideline for dental practitioners–a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 2015; 146(1):11-16.[PubMed 25569493]

Spelman D, Baddour LM. Cellulitis and skin abscess in adults: treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed August 20, 2018.

Stevens DL, Bisno AL, Chambers HF, et al; Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):e10-e52. doi: 10.1093/cid/ciu444.[PubMed 24973422]

Swaminathan S, Alangaden GJ. Treatment of resistant enterococcal urinary tract infections. Curr Infect Dis Rep. 2010;12(6):455-464.[PubMed 21308555]

Tu YH, Stiles ML, Allen LV Jr, et al, “Stability of Amoxicillin Trihydrate-Potassium Clavulanate in Original Containers and Unit Dose Oral Syringes,” Am J Hosp Pharm, 1988, 45(5):1092-9.[PubMed 3400652 ]

Valour F, Sénéchal A, Dupieux C, et al. Actinomycosis: etiology, clinical features, diagnosis, treatment, and management. Infect Drug Resist. 2014;7:183-197. doi: 10.2147/IDR.S39601.[PubMed 25045274]

Varela VM, Heller D, Silva-Senem MX, et al, “Systemic Antimicrobials Adjunctive to a Repeated Mechanical and Antiseptic Therapy for Aggressive Periodontitis: A 6-Month Randomized Controlled Trial,” J Periodontol, 2011, 82(8):1121-30.[PubMed 21235333]

Wald ER, Applegate KE, Bordley C, et al. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013;132(1):e262-e280.[PubMed 23796742]

Warady BA, Bakkaloglu S, Newland J, et al. Consensus guidelines for the prevention and treatment of catheter-related infections and peritonitis in pediatric patients receiving peritoneal dialysis: 2012 update. Perit Dial Int. 2012;32(Suppl 2):S32-S86.[PubMed 22851742]

Wilder RS, Moretti AJ. Gingivitis and periodontitis in adults: classification and dental treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed September 11, 2018.

Wilson W, Taubert KA, Gewitz M, et al; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee; American Heart Association Council on Cardiovascular Disease in the Young; American Heart Association Council on Clinical Cardiology; American Heart Association Council on Cardiovascular Surgery and Anesthesia; Quality of Care and Outcomes Research Interdisciplinary Working Group. 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 [published correction appears in Circulation. 2007;116(15):e376-e377]. Circulation. 2007;116(15):1736-1754.[PubMed 17446442]

Wilson KH. Treatment of anthrax. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 25, 2018.

World Health Organization, “Mastitis: Causes and Management, Publication Number WHO/FCH/CAH/00.13,” World Health Organization: Geneva, 2000.

World Health Organization (WHO). WHO Model Prescribing Information: Drugs Used in Bacterial Infections. Geneva, Switzerland: World Health Organization; 2001. http://apps.who.int/medicinedocs/pdf/s5406e/s5406e.pdf. Accessed November 6, 2018.

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Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43(9):1089-1134.[PubMed 17029130]

Wright AJ, “The Penicillins,” Mayo Clin Proc, 1999, 74(3):290-307.[PubMed 10090000]

Wynn RL, “Amoxicillin Update,” Gen Dent, 1991, 39(5):322,4,6.[PubMed 1812049]

Brand Names: International

A.M. Mox (TH); Abiolex (CL); Acilina (PY); Acimox (MX); Adbiotin (CO); Alemox (EG); Alfamox (IT); Almacin (HR); Almorsan (AR); Alphamox (AU); Amicil (MX); Amimox (SE); Amitron (ES); Amixen (AR); Amixozan (DK); Ammimox (TH); Amobay (MX); Amobiotic (CL); Amoclan (JO, SA); Amodex (FR); Amoksilav (TR); Amolin (JP); Amorion (FI); Amosin (RU); Amotaks (PL); Amoval (PE, PY); Amox (IT); Amoxa (SG); Amoxal (CO, VE); Amoxapen (ET, HK, MT); Amoxar (DK); Amoxcillin (TH); Amoxen (ZW); Amoxi-SAAR (DE); Amoxibay (CO); Amoxibel (JO); Amoxibeta (DE); Amoxicap (HK, PK, ZA); Amoxicid (EG); Amoxicilina (CO, EC); Amoxiclin (PE); Amoxidal (AR, UY); Amoxidin (AE); Amoxidin 7 (PE); Amoxidrex (LB); Amoxifur (MX); Amoxiga (CO, VE); Amoxigran (HK); Amoxil (AE, AU, BH, BR, EC, EG, ET, GB, GR, ID, IE, JO, KW, LT, MT, MX, NZ, PE, PT, QA, SA, UA, ZA); Amoxilan (AT, VE); Amoxilin (CN); Amoximex (LB); Amoxin (FI, IS); Amoxipen (AE, PE, VN); Amoxipenil (CL); Amoxisol (MX); Amoxistad (AT); Amoxitab (HK); Amoxivan (IN); Amoxivet (MX); Amoxsan (ID); Amoxy (CN); Amoxy Care Forte (IL); Amoxydar (AE, JO, QA, SA); Ampin (PK); Amyn (LK); Anamox (PY); Apimox (BD); Aproxal (GR, JO); Aramox (EG); Aroxin (SG); Atak (BR); Atoksilin (TR); Avlomox (BD); Bactox (LV); Bactox Ge (FR); Balmox (ZW); Beamoxy (MY); Berlimox (ID); Betamox (MY); Betmox (IN); Brumox (PH); Bufamoxy (ID); Cilamox (AU); Cipamox (PK, PT); Clamoxyl (BE, CH, ES, FR, LU, PT); Clonamox (HU, IE); Coamox (TH); Danoxilin (ID); Devamox (TR); Dimopen (MX); Duomox (BG, CZ, HU, PL, RO); Duzimicin (BR); Dymoxin (TH); E-Mox (AE, ET, QA, SA); Ecobol (RU); Edamox (HK); Elmox (PK); Ethimox (ID); Fabamox (PY, UY); Fisamox (AU); Flemoxin (AE, BE, DK, KW, PT, QA, RU, UA); Foxolin (KR); Geramox (IE); Gexcil (PH); Gimalxina (MX); Glomox (AE, LB, QA, SA); Gramox (RU, UA); Grinsul (AR); Grunamox (EC); Hiconcil (LT, LV, PL, VN); Hikoncil (UA); Hymox (AE, JO, KW, QA, SA); Hypher (CN); Ibiamox (NZ, TH); Ikamoxyl (ID); Imacillin (DK, NO, SE); Imadrax (DK); Imox (ET, ZW); InfectoMox (DE); J Mox (BD); Julphamox (AE, JO, KW, LB, QA, SA); Jutamox (DE); Kemox (IN); Kymoxin (KR); Lamoxy (IN); Largopen (ET); Linmox (VE); Loxyl (BD); Magnimox (PE); Manmox (TH); Max (IN); Maxamox (AU); Medomox (ZW); Meixil (TH); Mexylin (ID); Miloxy (ZW); Mopen (IT); Morgenxil (ES); Mox (IN); Moxatid (BD); Moxi (LK); Moxicor (LK); Moxifar (UY); Moxilen (HK, JO, LB, LV, MT, MY, RO, SG, VN); Moxilin (BD); Moxiram (JO); Moxol (LK); Moxtam (UY); Moxxo (TH); Moxylin (EC); Moxypen (IL, ZA); Moxyvit (IL); Mymox (LV); Neomox (AE, BH, KW, SA); Nobactam (AR); Novamox (CL); Novamoxin (KW); Novax (ID); Numoxylin (LK); Ocylin (BR); Opimox (ID); Opimox Forte (ID); Optamox (CL); Oramox (IE); Ospamox (AE, AT, BG, BH, CZ, EE, HR, HU, ID, JO, KW, LB, LT, LV, MY, NZ, PL, PT, QA, RU, SA, SI, SK, UA, VE); Pamocil (IT, MT); Pamoxin (KR); Pasetocin (JP); Penamox (AE, BH, ET, JO, KW, LB, QA, SA); Penbiosyn (PH); Pinamox (IE); Pondnoxcill (TH); Pyramox (TH); Ranmoxy (AU, NZ, ZA); Ranoxyl (AE, TH, ZW); Remox (SA); Remoxil (TR); Ri Ao (CN); Rivamox (ET); Sanet (PY); Sapox (BD); Sawacillin (JP); Sia-mox (TH); Sinot (UY); Sintopen (IT); Solpenox (ID); Strimox (SG, ZW); Taimox (PH); Telmox (AR); Teramoxyl (PH); Trifamox (AR); Trimoxal (VE); Ultramox (JO, KW); Unimox (SG); Velamox (BR, PE); Widecillin (ID, JP); Winpen (LV); Yomax (ZA); Zai Lin (CN); Zeemox (PK); Zerrsox (PH); Zimox (IT); Zymoxyl (PH)

Amoxicillin (Patient Education – Adult Medication)
You must carefully read the “Consumer Information Use and Disclaimer” below in order to understand and correctly use this information
Pronunciation

(a moks i SIL in)

Brand Names: US

Moxatag [DSC]

Brand Names: Canada

Novamoxin; Pro-Amox-250; Pro-Amox-500

What is this drug used for?
  • It is used to treat bacterial infections.
  • It may be given to you for other reasons. Talk with the doctor.
What do I need to tell my doctor BEFORE I take this drug?
  • If you have an allergy to amoxicillin, any penicillin, or any other part of this drug.
  • If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
  • If you have mono.
  • This is not a list of all drugs or health problems that interact with this drug.
  • Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this drug with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.
What are some things I need to know or do while I take this drug?
  • All products:
  • Tell all of your health care providers that you take this drug. This includes your doctors, nurses, pharmacists, and dentists.
  • Very bad and sometimes deadly allergic side effects have rarely happened. Talk with your doctor.
  • Have your blood work checked if you are on this drug for a long time. Talk with your doctor.
  • This drug may affect certain lab tests. Tell all of your health care providers and lab workers that you take this drug.
  • If you are taking warfarin, talk with your doctor. You may need to have your blood work checked more closely while you are taking it with this drug.
  • If you have high blood sugar (diabetes), do not use Clinitest®. Use some other urine glucose testing like Clinistix® or Tes-Tape®.
  • Do not use longer than you have been told. A second infection may happen.
  • Birth control pills and other hormone-based birth control may not work as well to prevent pregnancy. Use some other kind of birth control also like a condom when taking this drug.
  • Tell your doctor if you are pregnant, plan on getting pregnant, or are breast-feeding. You will need to talk about the benefits and risks to you and the baby.
  • Chewable tablet:
  • If you have phenylketonuria (PKU), talk with your doctor. Some products have phenylalanine.
What are some side effects that I need to call my doctor about right away?
  • WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:
  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Any unexplained bruising or bleeding.
  • Fever or chills.
  • Vaginal itching or discharge.
  • It is common to have diarrhea when taking antibiotics. Rarely, a severe form of diarrhea called C diff–associated diarrhea (CDAD) may happen. Sometimes, this has led to a deadly bowel problem (colitis). CDAD may happen while you are taking an antibiotic or within a few months after you stop taking it. Call your doctor right away if you have stomach pain or cramps, very loose or watery stools, or bloody stools. Do not try to treat diarrhea without first checking with your doctor.
  • A very bad skin reaction (Stevens-Johnson syndrome/toxic epidermal necrolysis) may happen. It can cause very bad health problems that may not go away, and sometimes death. Get medical help right away if you have signs like red, swollen, blistered, or peeling skin (with or without fever); red or irritated eyes; or sores in your mouth, throat, nose, or eyes.
What are some other side effects of this drug?
  • All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:
  • Upset stomach or throwing up.
  • Diarrhea.
  • Headache.
  • These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.
  • You may report side effects to your national health agency.
How is this drug best taken?
  • Use this drug as ordered by your doctor. Read all information given to you. Follow all instructions closely.
  • Extended-release tablets:
  • Take this drug within 1 hour after meals.
  • Swallow whole. Do not chew, break, or crush.
  • All other products:
  • Take with or without food. Take with food if it causes an upset stomach.
  • Chewable tablet:
  • Chew well before swallowing.
  • Liquid (suspension):
  • Shake well before use.
  • Measure liquid doses carefully. Use the measuring device that comes with this drug. If there is none, ask the pharmacist for a device to measure this drug.
  • May be mixed with formula, milk, water, or other cold drinks. Drink right away after mixing.
  • All products:
  • To gain the most benefit, do not miss doses.
  • Take this drug at the same time of day.
  • Keep using this drug as you have been told by your doctor or other health care provider, even if you feel well.
What do I do if I miss a dose?
  • Take a missed dose as soon as you think about it.
  • If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
  • Do not take 2 doses at the same time or extra doses.
How do I store and/or throw out this drug?
  • Liquid (suspension):
  • Store liquid (suspension) at room temperature or in a refrigerator. Do not freeze. Throw away any part not used after 2 weeks.
  • All other products:
  • Store at room temperature.
  • Store in a dry place. Do not store in a bathroom.
  • All products:
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.
General drug facts
  • If your symptoms or health problems do not get better or if they become worse, call your doctor.
  • Do not share your drugs with others and do not take anyone else’s drugs.
  • Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
  • Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.
  • Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your doctor, nurse, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.
Amoxicillin (Patient Education – Pediatric Medication)
You must carefully read the “Consumer Information Use and Disclaimer” below in order to understand and correctly use this information
Pronunciation

(a moks i SIL in)

Brand Names: US

Moxatag [DSC]

Brand Names: Canada

Novamoxin; Pro-Amox-250; Pro-Amox-500

What is this drug used for?
  • It is used to treat bacterial infections.
  • It may be given to your child for other reasons. Talk with the doctor.
What do I need to tell the doctor BEFORE my child takes this drug?
  • If your child has an allergy to this drug or any part of this drug.
  • If your child is allergic to any drugs like this one or any other drugs, foods, or other substances. Tell the doctor about the allergy and what signs your child had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
  • If your child has mono.
  • This is not a list of all drugs or health problems that interact with this drug.
  • Tell the doctor and pharmacist about all of your child’s drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for your child to take this drug with all of his/her drugs and health problems. Do not start, stop, or change the dose of any drug your child takes without checking with the doctor.
What are some things I need to know or do while my child takes this drug?
  • All products:
  • Tell all of your child’s health care providers that your child is taking this drug. This includes your child’s doctors, nurses, pharmacists, and dentists.
  • Very bad and sometimes deadly allergic side effects have rarely happened. Talk with your child’s doctor.
  • Have your child’s blood work checked if he/she is on this drug for a long time. Talk with your child’s doctor.
  • This drug may affect certain lab tests. Tell all of your child’s health care providers and lab workers that your child takes this drug.
  • If your child is taking warfarin, talk with the doctor. Your child may need to have blood work checked more closely while taking it with this drug.
  • If your child has high blood sugar (diabetes), do not use Clinitest®. Use some other urine glucose testing like Clinistix® or Tes-Tape®.
  • Do not give to your child longer than you have been told. A second infection may happen.
  • If your child is or may be sexually active:
  • Birth control pills and other hormone-based birth control may not work as well to prevent pregnancy. Be sure your child uses some other kind of birth control also, like a condom, when taking this drug.
  • If your child is pregnant or breast-feeding a baby:
  • Talk with the doctor if your child is pregnant, becomes pregnant, or is breast-feeding a baby. You will need to talk about the benefits and risks to your child and the baby.
  • Chewable tablet:
  • If your child has phenylketonuria (PKU), talk with your child’s doctor. Some products have phenylalanine.
What are some side effects that I need to call my child’s doctor about right away?
  • WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your child’s doctor or get medical help right away if your child has any of the following signs or symptoms that may be related to a very bad side effect:
  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Any unexplained bruising or bleeding.
  • Fever or chills.
  • Vaginal itching or discharge.
  • It is common to have diarrhea when taking antibiotics. Rarely, a severe form of diarrhea called C diff-associated diarrhea (CDAD) may happen. Sometimes, this has led to a deadly bowel problem (colitis). CDAD may happen while your child is taking an antibiotic or within a few months after he/she stops taking it. Call your child’s doctor right away if your child has stomach pain or cramps, very loose or watery stools, or bloody stools. Do not try to treat diarrhea without first checking with the doctor.
  • A very bad skin reaction (Stevens-Johnson syndrome/toxic epidermal necrolysis) may happen. It can cause very bad health problems that may not go away, and sometimes death. Get medical help right away if your child has signs like red, swollen, blistered, or peeling skin (with or without fever); red or irritated eyes; or sores in the mouth, throat, nose, or eyes.
What are some other side effects of this drug?
  • All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your child’s doctor or get medical help if any of these side effects or any other side effects bother your child or do not go away:
  • Upset stomach or throwing up.
  • Diarrhea.
  • Headache.
  • These are not all of the side effects that may occur. If you have questions about side effects, call your child’s doctor. Call your child’s doctor for medical advice about side effects.
  • You may report side effects to your national health agency.
How is this drug best given?
  • Give this drug as ordered by your child’s doctor. Read all information given to you. Follow all instructions closely.
  • Extended-release tablets:
  • Give this drug within 1 hour after meals.
  • Have your child swallow whole. Do not let your child chew, break, or crush.
  • All other products:
  • Give this drug with or without food. Give with food if it causes an upset stomach.
  • Chewable tablet:
  • Have your child chew well before swallowing.
  • Liquid (suspension):
  • Shake well before use.
  • Measure liquid doses carefully. Use the measuring device that comes with this drug. If there is none, ask the pharmacist for a device to measure this drug.
  • This drug may be mixed with formula, milk, water, or other cold drinks. Have your child drink right away after mixing.
  • All products:
  • To gain the most benefit, do not miss giving your child doses.
  • Give this drug at the same time of day.
  • Keep giving this drug to your child as you have been told by your child’s doctor or other health care provider, even if your child feels well.
What do I do if my child misses a dose?
  • Give a missed dose as soon as you think about it.
  • If it is close to the time for your child’s next dose, skip the missed dose and go back to your child’s normal time.
  • Do not give 2 doses at the same time or extra doses.
How do I store and/or throw out this drug?
  • Liquid (suspension):
  • Store liquid (suspension) at room temperature or in a refrigerator. Do not freeze. Throw away any part not used after 2 weeks.
  • All other products:
  • Store at room temperature.
  • Store in a dry place. Do not store in a bathroom.
  • All products:
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.
General drug facts
  • If your child’s symptoms or health problems do not get better or if they become worse, call your child’s doctor.
  • Do not share your child’s drug with others and do not give anyone else’s drug to your child.
  • Keep a list of all your child’s drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your child’s doctor.
  • Talk with your child’s doctor before giving your child any new drug, including prescription or OTC, natural products, or vitamins.
  • Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your child’s doctor, nurse, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.