Amoxil

Amoxil is an antibiotic of the group of semi-synthetic penicillins with a broad spectrum of action. It is a 4-hydroxyl analog of ampicillin. It has a bactericidal effect. This antibiotic is active against aerobic gram-positive bacteria: Staphylococcus spp. (with the exception of strains producing penicillinase), Streptococcus spp .; aerobic gram-negative bacteria: Neisseria gonorrhoeae, Neisseria meningitidis, Escherichia coli, Shigella spp., Salmonella spp., Klebsiella spp.

Microorganisms that produce penicillinase are resistant to amoxicillin. In combination with metronidazole, it is active against Helicobacter pylori. Amoxicillin inhibits the development of Helicobacter pylori resistance to metronidazole.

There is cross-resistance between amoxicillin and ampicillin.

The spectrum of antibacterial action expands with the simultaneous use of amoxicillin and a beta-lactamase inhibitor clavulanic acid. This combination increases the activity of amoxicillin against Bacteroides spp., Legionella spp., Nocardia spp., Pseudomonas (Burkholderia) pseudomallei. However, Pseudomonas aeruginosa, Serratia marcescens and many other gram-negative bacteria remain resistant.

Indications of the active substances

For use as monotherapy and in combination with clavulanic acid: infectious and inflammatory diseases caused by sensitive microorganisms, incl. bronchitis, pneumonia, tonsillitis, pyelonephritis, urethritis, gastrointestinal tract infections, gynecological infections, infectious diseases of the skin and soft tissues, listeriosis, leptospirosis, gonorrhea.

For use in combination with metronidazole: chronic gastritis in the acute phase, gastric ulcer and duodenal ulcer in the acute phase, associated with Helicobacter pylori.

Dosage

Individual dosage mode. For oral administration, a single dose for adults and children over 10 years of age (weighing over 40 kg) is 250-500 mg. A severe disease course – up to 1 g. For children aged 5-10 years, a single dose is 250 mg; at the age of 2 to 5 years – 125 mg. The interval between doses is 8 hours. For children weighing under 40 kg, the daily dose, depending on the indications and the clinical situation, may be 20-100 mg/kg in 2-3 doses.

In the treatment of acute uncomplicated gonorrhea – 3 g once (in combination with probenecid). In patients with impaired renal function with CC 10-40 ml / min, the interval between doses should be increased to 12 hours; with CC less than 10 ml / min, the interval between doses should be 24 hours.

Side effects

  • Allergic reactions: urticaria, erythema, Quincke’s edema, rhinitis, conjunctivitis; rarely – fever, joint pain, eosinophilia; in isolated cases – anaphylactic shock.
  • Effects associated with chemotherapeutic action: development of superinfections is possible (especially in patients with chronic diseases or reduced body resistance).
  • In the case of long-lasting use in high doses: dizziness, ataxia, confusion, depression, peripheral neuropathy, convulsions.
  • When used in combination with metronidazole: nausea, vomiting, anorexia, diarrhea, constipation, epigastric pain, glossitis, stomatitis; rarely – hepatitis, pseudomembranous colitis, allergic reactions (urticaria, angioedema), interstitial nephritis, hematopoietic disorders.
  • When used in combination with clavulanic acid: cholestatic jaundice, hepatitis; rarely – erythema multiforme, toxic epidermal necrolysis, exfoliative dermatitis.

Contraindications

  • Infectious mononucleosis, lymphocytic leukemia, severe gastrointestinal infections accompanied by diarrhea or vomiting, respiratory viral infections, allergic diathesis, bronchial asthma, hay fever, hypersensitivity to penicillins and/or cephalosporins.
  • For use in combination with metronidazole: diseases of the nervous system; hematopoietic disorders, lymphocytic leukemia, infectious mononucleosis; hypersensitivity to nitroimidazole derivatives.
  • For use in combination with clavulanic acid: a history of liver dysfunction and jaundice associated with taking amoxicillin in combination with clavulanic acid.

Application during pregnancy and lactation

Amoxicillin penetrates the placental barrier and is excreted in small amounts in breast milk. If it is necessary to use Amoxicillin during pregnancy, the expected benefits of therapy for the mother and the potential risk to the fetus should be carefully weighed.

Use Amoxicillin with caution during lactation.

Application in children

Application in children is possible according to the dosage regimen. Amoxicillin in combination with metronidazole is not recommended for use in patients under 18 years of age.

Drug interactions

Amoxil may decrease the effectiveness of oral contraceptives. With the simultaneous use of amoxicillin with bactericidal antibiotics (including aminoglycosides, cephalosporins, cycloserine, vancomycin, rifampicin), synergism is manifested; with bacteriostatic antibiotics (including macrolides, chloramphenicol, lincosamides, tetracyclines, sulfonamides) – antagonism may be found.

Amoxil enhances the effect of indirect anticoagulants by suppressing the intestinal microflora, reduces the synthesis of vitamin K and the prothrombin index.

Amoxil reduces the effect of drugs, in the process of metabolism of which p-aminobenzoic acid is formed.

Probenecid, diuretics, allopurinol, phenylbutazone, NSAIDs reduce the tubular secretion of amoxicillin, which may be accompanied by an increase in its concentration in the blood plasma.

Antacids, glucosamine, laxatives, aminoglycosides slow down and reduce the effect of Amoxil, and ascorbic acid increases the absorption of amoxicillin.

With the combined use of amoxicillin and clavulanic acid, the pharmacokinetics of both components does not change.