Amoxicillin Dosage

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Usual Adult Dose for Actinomycosis

500 mg orally 3 times a day or 875 mg orally twice a day for six months
Initial treatment of actinomycosis should include high dose parenteral penicillin G or ampicillin for 4 to 6 weeks, followed by appropriate oral therapy.

Usual Adult Dose for Anthrax Prophylaxis

500 mg orally every 8 hours

Oral amoxicillin is not considered first-line treatment for anthrax prophylaxis; it may, however, be used to complete a 60-day prophylactic course after 10 to 14 days of ciprofloxacin or doxycycline in pregnant or lactating patients or in patients with contraindications to the other two agents. The total duration of antimicrobial therapy is 60 days.

Usual Adult Dose for Cutaneous Bacillus anthracis

Treatment for confirmed cases of cutaneous Bacillus anthracis infection: 500 mg orally three times a day

Oral amoxicillin is not considered first-line treatment for the treatment of cutaneous anthrax; it may, however, be used to complete the treatment course once clinical response to ciprofloxacin or doxycycline has been observed or if the patient has contraindications to the other two agents. The total duration of antimicrobial therapy is 60 days.

Usual Adult Dose for Bacterial Endocarditis Prophylaxis

2 g orally given one hour prior to the procedure

Amoxicillin is considered the standard agent for prophylaxis against bacterial endocarditis in at-risk individuals undergoing certain dental, oral, respiratory tract or esophageal procedures.

Amoxicillin is not appropriate as endocarditis prophylaxis for patients identified as high-risk, including those with prosthetic heart valves, prior endocarditis, and those who have had surgically constructed systemic shunts or conduits. These patients should receive appropriate parenteral antimicrobial therapy.

Usual Adult Dose for Chlamydia Infection

500 mg orally 3 times a day for 7 days in pregnant patients as an alternative to erythromycin in macrolide-sensitive individuals

Amoxicillin does not have reliable activity against Chlamydia trachomatis.

Usual Adult Dose for Cystitis

250 to 500 mg orally 3 times a day for 3 to 7 days; alternatively, 500 to 875 mg orally twice a day may be administered

Usual Adult Dose for Urinary Tract Infection

250 to 500 mg orally 3 times a day for 3 to 7 days; alternatively, 500 to 875 mg orally twice a day may be administered

Usual Adult Dose for Helicobacter pylori Infection

1 g orally 2 to 3 times a day for 14 days
Amoxicillin is used in combination with metronidazole and bismuth subsalicylate or with clarithromycin and a proton-pump inhibitor such as omeprazole or lansoprazole.

Usual Adult Dose for Lyme Disease - Arthritis

500 mg orally 3 times a day for 14 to 30 days
Early Lyme disease is often treated with an oral antibiotic such as doxycycline, cefuroxime or azithromycin, all of which are active against Borrelia burgdorferi. If amoxicillin is used, clinicians may wish to add probenecid, although the benefit of this addition is uncertain.

Up to 15% of patients with Lyme disease experience the Jarisch-Herxheimer reaction (increased fever, increased flushing rash, and increased pain) during the first 24 hours of therapy. This reaction is self-limiting, does not necessarily reflect true allergy to amoxicillin, and may be reduced in intensity by premedication with aspirin and/or prednisone.

Usual Adult Dose for Lyme Disease - Carditis

500 mg orally 3 times a day for 14 to 30 days
Early Lyme disease is often treated with an oral antibiotic such as doxycycline, cefuroxime or azithromycin, all of which are active against Borrelia burgdorferi. If amoxicillin is used, clinicians may wish to add probenecid, although the benefit of this addition is uncertain.

Up to 15% of patients with Lyme disease experience the Jarisch-Herxheimer reaction (increased fever, increased flushing rash, and increased pain) during the first 24 hours of therapy. This reaction is self-limiting, does not necessarily reflect true allergy to amoxicillin, and may be reduced in intensity by premedication with aspirin and/or prednisone.

Usual Adult Dose for Lyme Disease - Erythema Chronicum Migrans

500 mg orally 3 times a day for 14 to 30 days
Early Lyme disease is often treated with an oral antibiotic such as doxycycline, cefuroxime or azithromycin, all of which are active against Borrelia burgdorferi. If amoxicillin is used, clinicians may wish to add probenecid, although the benefit of this addition is uncertain.

Up to 15% of patients with Lyme disease experience the Jarisch-Herxheimer reaction (increased fever, increased flushing rash, and increased pain) during the first 24 hours of therapy. This reaction is self-limiting, does not necessarily reflect true allergy to amoxicillin, and may be reduced in intensity by premedication with aspirin and/or prednisone.

Usual Adult Dose for Lyme Disease - Neurologic

500 mg orally 3 times a day for 14 to 30 days
Early Lyme disease is often treated with an oral antibiotic such as doxycycline, cefuroxime or azithromycin, all of which are active against Borrelia burgdorferi. If amoxicillin is used, clinicians may wish to add probenecid, although the benefit of this addition is uncertain.

Up to 15% of patients with Lyme disease experience the Jarisch-Herxheimer reaction (increased fever, increased flushing rash, and increased pain) during the first 24 hours of therapy. This reaction is self-limiting, does not necessarily reflect true allergy to amoxicillin, and may be reduced in intensity by premedication with aspirin and/or prednisone.

Usual Adult Dose for Otitis Media

250 to 500 mg orally 3 times a day for 10 to 14 days; alternatively, 500 to 875 mg orally twice a day may be administered

Usual Adult Dose for Pneumonia

500 mg orally 3 times a day or 875 mg orally twice a day may be administered for 7 to 10 days if pneumococcal pneumonia is suspected
Only mild pneumonia due to pneumococcus should be treated with amoxicillin.

Usual Adult Dose for Sinusitis

250 to 500 mg orally 3 times a day for 10 to 14 days; alternatively, 500 to 875 mg orally twice a day may be administered
Longer courses of therapy, up to 3 or 4 weeks, may be required in refractory or recurrent cases.

Usual Adult Dose for Skin or Soft Tissue Infection

250 to 500 mg orally 3 times a day for 7 to 10 days; alternatively, 500 to 875 mg orally twice a day may be administered

Usual Adult Dose for Upper Respiratory Tract Infection

250 to 500 mg orally 3 times a day for 7 to 10 days; alternatively, 500 to 875 mg orally twice a day may be administered

Usual Adult Dose for Bronchitis

250 to 500 mg orally 3 times a day for 7 to 10 days; alternatively, 500 to 875 mg orally twice a day may be administered

Usual Adult Dose for Tonsillitis/Pharyngitis

Immediate-release: 250 to 500 mg orally 3 times a day for 7 to 10 days; alternatively, 500 to 875 mg orally twice a day may be administered
Extended-release: 775 mg orally once a day within 1 hour after a meal for 10 days; for infections secondary to Streptococcus pyogenes

Usual Adult Dose for Bacterial Infection

250 to 500 mg orally 3 times a day for 7 to 21 days; alternatively, 500 to 875 mg orally twice a day may be administered

Usual Pediatric Dose for Bacterial Endocarditis Prophylaxis

50 mg/kg orally as a single dose 1 hour prior to procedure

Amoxicillin is not appropriate as endocarditis prophylaxis for patients identified as high-risk, including those with prosthetic heart valves, prior endocarditis, and those who have had surgically constructed systemic shunts or conduits. These patients should receive appropriate parenteral antimicrobial therapy.

Usual Pediatric Dose for Anthrax Prophylaxis

80 mg/kg/day divided into equal doses administered orally every 8 hours
Maximum dose: 500 mg/dose

Oral amoxicillin is not considered first-line treatment for anthrax prophylaxis; it may, however, be used to complete a 60-day prophylactic course after 10 to 14 days of ciprofloxacin or doxycycline in pediatric patients. The total duration of antimicrobial therapy is 60 days.

Usual Pediatric Dose for Cutaneous Bacillus anthracis

Treatment for confirmed cases of cutaneous Bacillus anthracis infection: 80 mg/kg/day divided into equal doses administered orally every 8 hours
Maximum dose: 500 mg/dose

Oral amoxicillin is not considered first-line treatment for the treatment of cutaneous anthrax; it may, however, be used to complete the treatment course once clinical response to ciprofloxacin or doxycycline has been observed. The total duration of antimicrobial therapy is 60 days.

Usual Pediatric Dose for Otitis Media

4 weeks to 3 months: 20 to 30 mg/kg/day in divided doses every 12 hours
4 months to 12 years: 20 to 50 mg/kg/day in divided doses every 8 to 12 hours; acute otitis media due to highly resistant strains of Streptococcus pneumonia may require doses of 80 to 90 mg/kg/day orally divided into 2 equal doses 12 hours apart

Usual Pediatric Dose for Skin or Soft Tissue Infection

4 weeks to 3 months: 20 to 30 mg/kg/day in divided doses every 12 hours
4 months to 12 years: 20 to 50 mg/kg/day in divided doses every 8 to 12 hours; acute otitis media due to highly resistant strains of Streptococcus pneumonia may require doses of 80 to 90 mg/kg/day orally divided into 2 equal doses 12 hours apart

Usual Pediatric Dose for Urinary Tract Infection

4 weeks to 3 months: 20 to 30 mg/kg/day in divided doses every 12 hours
4 months to 12 years: 20 to 50 mg/kg/day in divided doses every 8 to 12 hours; acute otitis media due to highly resistant strains of Streptococcus pneumonia may require doses of 80 to 90 mg/kg/day orally divided into 2 equal doses 12 hours apart

Usual Pediatric Dose for Pneumonia

40 to 50 mg/kg/day orally in divided doses every 8 hours

Usual Pediatric Dose for Tonsillitis/Pharyngitis

4 weeks to 3 months: 20 to 30 mg/kg/day in divided doses every 12 hours
4 months to 12 years: 20 to 50 mg/kg/day in divided doses every 8 to 12 hour

12 years or older:
Immediate-release: 250 to 500 mg orally 3 times a day for 7 to 10 days; alternatively, 500 to 875 mg orally twice a day may be administered
Extended-release: 775 mg orally once a day within 1 hour after a meal for 10 days; for infections secondary to S pyogenes

Renal Dose Adjustments

CrCl 10 to 30 mL/min: 250 to 500 mg orally every 12 hours
CrCl 9 mL/min or less: 250 to 500 mg orally every 24 hours

The 875 mg tablets and the 775 mg extended-release tablets should not be given to patients with CrCl less than 30 mL/min.

Liver Dose Adjustments

Data not available

Precautions

The drug should be discontinued immediately at the first appearance of a skin rash or other signs of hypersensitivity.

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following amoxicillin therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Dose reductions are recommended in patients with severe renal impairment. It may be advisable to monitor renal function in elderly patients.

Periodic monitoring of renal, hepatic, and hematologic function is recommended in all patients during prolonged therapy.

Patients with phenylketonuria should be aware that amoxicillin chewable tablets contain phenylalanine (1.82 mg/200 mg tablet and 3.64 mg/400 mg tablet). The 200 and 400 mg tablets for oral suspension contain 5.6 mg phenylalanine per tablet.

The immediate-release formulations should not be substituted for the extended-release tablets.

Amoxicillin is not effective for the treatment of syphilis, although it may mask or delay its symptoms when used to treat gonorrhea. All gonorrhea patients should undergo serologic testing for syphilis at the time of diagnosis and 3 months after treatment.

The safety and efficacy of the extended-release tablets have not been established in patients less than 12 years of age.

Dialysis

Adults, conventional hemodialysis: 250 to 500 mg every 24 hours with supplemental doses during and after a hemodialysis session

The 775 mg extended-release tablets are not recommended for patients on hemodialysis.

Other Comments

At least 10 days of therapy is recommended for infections caused by S pyogenes to prevent acute rheumatic fever.

Immediate-release amoxicillin may be given without regard to meals. The extended-release tablets should be taken within 1 hour of finishing a meal at about the same time each day.

The oral suspension may be mixed with formula, milk, fruit juice, ginger ale, or cold drinks, and should be taken immediately after mixing.

The suspension should be discarded 14 days after reconstitution.

The tablets for oral suspension should not be chewed or swallowed whole. The dispersible tablets for oral suspension should be mixed with 2 teaspoonfuls of water, the patient should drink the entire mixture, then a small amount of water should be used to rinse the container, and the patient should drink this also. The extended-release tablets should not be chewed or crushed.

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