Get Expert Advice for controlling your Severe Allergies

Amoxicillin

Pronunciation

Class: Aminopenicillins
Chemical Name: [2S - [2α,5α,6β(S*)]] - 6 - [[Amino(4 - hydroxyphenyl)acetyl]amino] - 3,3 - dimethyl - 7 - oxo - 4 - thia - 1 - azabicyclo[3.2.0]heptane - 2 - carboxylic acid trihydrate
CAS Number: 61336-70-7
Brands: Amoxil, Trimox, Prevpac

Introduction

Antibacterial; β-lactam antibiotic; an aminopenicillin.6 62

Uses for Amoxicillin

Otitis Media

Treatment of acute otitis media (AOM).1 140 176 177 190 192 199 200 209 210 211 244 AAP, AAFP, CDC, and others recommend amoxicillin as drug of first choice for initial treatment of AOM,190 200 202 204 205 210 244 unless patient has severe illness (moderate to severe otalgia or fever ≥39°C)244 or the infection is suspected of being caused by β-lactamase-producing Haemophilus influenzae or Moraxella catarrhalis, in which case the fixed combination of amoxicillin and clavulanate is recommended for initial treatment.190 200 202 204 205 210 244 Those who fail to respond to amoxicillin should be retreated with amoxicillin and clavulanate.244

Has been used for prevention of recurrent AOM.190 206 207 214 217 219 220 222 223 224 225 226 Such prophylaxis not generally recommended103 104 206 217 220 since it is minimally effective and may promote emergence of resistance.103 104 106 190 202 214 217 Use only in selected patients with >3 episodes within 6 months or >4 episodes within 12 months; drugs of choice are amoxicillin or sulfisoxazole.190 193

Has been used for management of otitis media with effusion (OME).193 206 208 219 221 227 Anti-infectives not usually recommended;111 115 206 208 219 221 245 they provide only limited benefit in enhancing resolution of effusion and may promote resistance.115 207 208 219 AAP, AAFP, and others recommend watchful waiting for 3 months from date of effusion onset or diagnosis in those 2 months to 12 years of age who are not at risk for speech, language, or learning problems; some suggest a short course of anti-infectives may be considered for possible short-term benefits when parent and/or caregiver expresses a strong aversion to impending surgery.245 If anti-infectives are used, amoxicillin or the fixed combination of amoxicillin and clavulanate recommended.219 221 227

Pharyngitis and Tonsillitis

Treatment of pharyngitis and tonsillitis caused by Streptococcus pyogenes (group A β-hemolytic streptococci).1 6 35 39 108 109 110 190 240 242

Slideshow: View Frightful (But Dead Serious) Drug Side Effects

AAP, IDSA, AHA, and others recommend oral penicillin V or IM penicillin G benzathine as treatments of choice;190 240 241 242 oral cephalosporins and oral macrolides are considered alternatives.190 240 241 242 Amoxicillin sometimes used instead of penicillin V, especially for young children.35 39 108 109 110 190 242

A second episode can be retreated with the same or other treatment of choice;190 242 other regimens (amoxicillin and clavulanate, clindamycin, penicillin G benzathine with or without rifampin) recommended for symptomatic patients with multiple, recurrent episodes.190 240 242

Consider that multiple, recurrent episodes of symptomatic pharyngitis within several months to years may indicate a streptococcal carrier experiencing repeated episodes of nonstreptococcal (e.g., viral) pharyngitis;240 242 treatment not usually recommended for streptococcal pharyngeal carriers.190 240 242

Respiratory Tract Infections

Treatment of lower respiratory tract infections caused by susceptible Streptococcus (α- or β-hemolytic strains only), S. pneumoniae, Staphylococcus, or H. influenzae.1 6 57 62 73 81

Skin and Skin Structure Infections

Treatment of skin and skin structure infections caused by susceptible Streptococcus (α- or β-hemolytic strains only), Staphylococcus, or Escherichia coli.1

Urinary Tract Infections (UTIs)

Treatment of UTIs caused by susceptible Enterococcus faecalis, Escherichia coli, or Proteus mirabilis.1 3 4 6 75 76 78 81 A drug of choice for treatment of uncomplicated UTIs caused by E. faecalis;81 consider high incidence of amoxicillin-resistant E. coli and other Enterobacteriaceae.6

Gonorrhea

Previously used for treatment of acute uncomplicated gonorrhea (anogenital and urethral) caused by susceptible Neisseria gonorrhoeae.1 6 94 184 No longer recommended for gonorrhea by CDC or other experts94 189 190 (high incidence of penicillin-resistant strains).

Typhoid Fever and other Salmonella Infections

Alternative for treatment of typhoid fever (enteric fever) caused by susceptible Salmonella typhi.6 57 64 66 68 81 190 Drugs of choice are fluoroquinolones and third generation cephalosporins (e.g., ceftriaxone, cefotaxime);81 190 consider that multidrug-resistant strains of S. typhi (strains resistant to ampicillin, amoxicillin, chloramphenicol, and/or co-trimoxazole) reported with increasing frequency.102 190

Treatment of chronic carriers of S. typhi; drugs of choice are fluoroquinolones (e.g., ciprofloxacin), ampicillin, or amoxicillin (with probenecid).6 62 63 65 67 81

Alternative for treatment of gastroenteritis caused by nontyphoidal Salmonella.190 Anti-infectives not indicated in otherwise healthy individuals with uncomplicated (noninvasive) gastroenteritis, but recommended if gastroenteritis is severe and in those at increased risk of invasive disease (e.g., <6 months or >50 years of age; hemoglobinopathies, severe atherosclerosis, valvular heart disease, prostheses, uremia, chronic GI disease, severe colitis; immunocompromised because of malignancy, immunosuppressive therapy, HIV infection).81 120 121 190 Drugs of choice are fluoroquinolones, third generation cephalosporins (cefotaxime, ceftriaxone), ampicillin, amoxicillin, co-trimoxazole, or chloramphenicol, depending on in vitro susceptibility.81 120 121 190

Helicobacter pylori Infection and Duodenal Ulcer Disease

Treatment of Helicobacter pylori infection and duodenal ulcer disease (active or 1-year history of duodenal ulcer);1 168 172 173 174 eradication of H. pylori has been shown to reduce the risk of duodenal ulcer recurrence.1 107 116 119 122 168 172 173

Used in a multidrug regimen that includes amoxicillin, clarithromycin, and either lansoprazole or omeprazole (triple therapy).1 81 107 168 169 172 173 174 175 Used with lansoprazole (dual therapy) in those allergic to or intolerant of clarithromycin or when clarithromycin resistance is suspected.1 168 169

Lyme Disease

Treatment of early localized or early disseminated Lyme disease associated with erythema migrans, in the absence of neurologic involvement or third-degree AV heart block.81 95 190 179 181 182 183 184 185 186 188 190 191 238

IDSA, AAP, and others consider amoxicillin a drug of choice for treatment of early localized or early disseminated Lyme disease when oral therapy is appropriate.81 95 179 181 182 185 186 190 232 238 May be used in those with mild Lyme carditis,95 179 181 182 185 186 232 238 Lyme arthritis (without associated neurologic disease),95 181 185 186 190 232 238 or isolated facial nerve palsy (without other neurologic involvement).95 190 238

Amoxicillin is the preferred oral agent for treatment in pregnant women and children <8 years of age who should not receive doxycycline.88 95 179 190 232 238

Chlamydial Infections

Treatment of uncomplicated urethritis and cervicitis caused by Chlamydia trachomatis in pregnant women.81 157 94 189 190 CDC and others recommend amoxicillin or a macrolide (azithromycin, erythromycin) as drugs of choice for treatment of urogenital chlamydial infections in these women.94 189 190

Prevention of Bacterial Endocarditis

Prevention of bacterial endocarditis in patients undergoing certain dental, oral, respiratory tract, or esophageal procedures who have cardiac conditions that put them at high or moderate risk.69 72 96 97 99 100 101 AHA recommends amoxicillin as drug of choice for such prophylaxis.96

Prevention of bacterial endocarditis in patients undergoing certain GU and GI (except esophageal) procedures who have cardiac conditions that put them at moderate-risk.96

An alternative for follow-up to an initial parenteral regimen for prevention of bacterial endocarditis in patients undergoing certain GU and GI (except esophageal procedures who have cardiac conditions that put them at high-risk.96

Consult most recent AHA recommendations for specific information on which cardiac conditions are associated with high or moderate risk of endocarditis and which procedures require prophylaxis.96

Prevention of S. pneumoniae Infections in Asplenic Individuals

Prevention of S. pneumoniae infections in children with anatomic or functional asplenia (e.g., congenital, resulting from sickle cell disease or surgery)190 or children with malignant neoplasms or thalassemia.190

Oral penicillin V usually drug of choice;74 190 some experts recommend amoxicillin.190

Children at increased risk for pneumococcal infections should receive pneumococcal 7-valent conjugate vaccine and pneumococcal 23-valent polysaccharide vaccine.190 243 Long-term anti-infective prophylaxis recommended for children with functional or anatomic asplenia regardless of vaccination status.74 190 243

Anthrax

An alternative for postexposure prophylaxis of anthrax following exposure to aerosolized Bacillus anthracis spores (inhalational anthrax).190 228 229 231 233 235 236 239 Ciprofloxacin or doxycycline are initial drugs of choice for postexposure prophylaxis following a suspected or confirmed bioterrorism-related anthrax exposure.190 231 235 If penicillin susceptibility is confirmed, consideration can be given to changing prophylaxis to a penicillin in infants and children and in pregnant or lactating women; amoxicillin usually recommended.190 231 233 236 239

An alternative for treatment of inhalational anthrax when a parenteral regimen is not available (e.g., when there are supply or logistic problems in a mass-casualty setting).231

An alternative for treatment of cutaneous anthrax.231 If cutaneous anthrax occurs in the context of biologic warfare or bioterrorism, initial drugs of choice are ciprofloxacin or doxycycline.231 If penicillin susceptibility is confirmed, consideration can be given to changing to a penicillin in infants and children or in pregnant or lactating women; amoxicillin usually is recommended.231 239

Amoxicillin Dosage and Administration

Administration

Oral Administration

Administer orally without regard to meals.1 4 10 22 29 38 40

Following reconstitution, the required amount of oral suspension should be placed directly on the child’s tongue for swallowing.1 Alternatively, the required amount of suspension can be added to infant formula, milk, fruit juice, water, ginger ale, or cold drinks and these fluids taken immediately and completely consumed.1

For most infections, continue therapy for at least 48–72 hours after patient becomes asymptomatic or evidence that the infection is eradicated is obtained.1 The drug should be given for at least 10 days for treatment of infections caused by S. pyogenes (group A β-hemolytic streptococci).1

Reconstitution

Reconstitute oral suspension at the time of dispensing.1 Tap bottle to thoroughly loosen powder and then add the amount of water specified on the bottle in 2 portions; agitate vigorously after each addition.1

Agitate suspension well prior to administration of each dose.1

Dosage

Available as the trihydrate;1 dosage expressed in terms of anhydrous amoxicillin.1

Pediatric Patients

Neonates and infants ≤12 weeks (3 months) of age can receive amoxicillin in a dosage up to 30 mg/kg daily given in divided doses every 12 hours.1

Pediatric dosage specified below is for those >3 months of age weighing <40 kg.1

Children weighing ≥40 kg should receive usual adult dosage.1

Otitis Media
Treatment of Acute Otitis Media (AOM)
Oral

80–90 mg/kg daily given in 2 or 3 divided doses recommended by AAP, AAFP, CDC, and others.190 200 201 205 215 244

Usual duration is 10 days;190 200 201 205 215 optimal duration is uncertain.244 AAP and AAFP recommend 10 days in those <6 years of age and in those with severe disease and state 5–7 days may be appropriate in those ≥6 years of age with mild to moderate AOM.244

Prevention of Recurrent AOM
Oral

20 mg/kg daily given in 1 or 2 divided doses has been used.214 220

Pharyngitis and Tonsillitis
Oral

45 mg/kg daily in 2 divided doses or 40 mg/kg daily in 3 divided doses for 10 days.1 39 108 109

50 mg/kg once daily35 or 750 mg once daily for 10 days.110

Follow-up throat cultures after treatment of pharyngitis and tonsillitis not indicated in asymptomatic patients,190 240 242 but recommended 2–7 days after treatment in those who remain symptomatic, develop recurring symptoms, or have a history of rheumatic fever and are at unusually high risk for recurrence.240 242

Ear, Nose, and Throat Infections
Oral

25 mg/kg daily in divided doses every 12 hours or 20 mg/kg daily in divided doses every 8 hours for mild to moderate infections per manufacturer.1

45 mg/kg daily in divided doses every 12 hours or 40 mg/kg in divided doses every 8 hours for severe infections per manufacturer.1

Respiratory Tract Infections
Oral

45 mg/kg daily in divided doses every 12 hours or 40 mg/kg daily in divided doses every 8 hours for mild, moderate, or severe lower respiratory tract infections.1

Skin and Skin Structure Infections
Oral

25 mg/kg daily in divided doses every 12 hours or 20 mg/kg daily in divided doses every 8 hours for mild to moderate infections.1

45 mg/kg daily in divided doses every 12 hours or 40 mg/kg daily in divided doses every 8 hours for severe infections or those caused by less susceptible bacteria.1

Urinary Tract Infections (UTIs)
Oral

25 mg/kg daily in divided doses every 12 hours or 20 mg/kg daily in divided doses every 8 hours for mild to moderate infections.1

45 mg/kg daily in divided doses every 12 hours or 40 mg/kg daily in divided doses every 8 hours for severe infections or those caused by less susceptible bacteria.1

Gonorrhea
Oral

Prepubertal children ≥2 years of age: 50 mg/kg as a single dose given with a single dose of probenecid (25 mg/kg).1

No longer recommended for gonorrhea by the CDC or other experts.94 189

Lyme Disease
Oral

25–50 mg/kg daily (up to 2 g daily) in 2–3 divided doses for 14–21 days for treatment of early localized or early disseminated Lyme disease.95 179 181 182 185 190 238

50 mg/kg daily in 3 divided doses for 14–28 days for mild Lyme carditis95 179 181 182 185 186 or for 28 days for Lyme arthritis (without associated neurologic disease).95 190 181 185 186 232 238

Prevention of Bacterial Endocarditis
Patients Undergoing Certain Dental, Oral, Respiratory Tract, or Esophageal Procedures
Oral

50 mg/kg given 1 hour prior to the procedure.96

Patients Undergoing Certain GU or GI (except Esophageal) Procedures
Oral

50 mg/kg as a single dose given 1 hour prior to the procedure for moderate-risk patients.96

For high-risk patients, give an initial IM or IV dose of ampicillin with IM or IV gentamicin within 30 minutes of starting the procedure followed by 25 mg/kg of amoxicillin 6 hours later.96

Prevention of S. pneumoniae Infections in Asplenic Individuals
Oral

20 mg/kg daily in children with anatomic or functional asplenia.190

In infants with sickle cell anemia, initiate prophylaxis as soon as diagnosis is established (preferably by 2 months of age);190 74 continue until approximately 5 years of age.190 74 243 Appropriate duration in children with asplenia from other causes unknown;190 some experts recommend that asplenic children at high risk receive prophylaxis throughout childhood and into adulthood.190

Anthrax
Postexposure Prophylaxis
Oral

80 mg/kg daily (maximum 1.5 g daily) given in divided doses every 8 hours for 60 days for postexposure prophylaxis following exposure to B. anthracis spores (inhalational anthrax).190 231 233 239

500 mg every 8 hours for 60 days in those weighing ≥20 kg.231

Use only if penicillin susceptibility is confirmed.190 228

Inhalational Anthrax
Oral

80 mg/kg daily (maximum 1.5 g daily) given in divided doses every 8 hours for 60 days for treatment of inhalational anthrax in a mass-casualty setting.231

500 mg every 8 hours for 60 days for those weighing ≥20 kg.231

Cutaneous Anthrax
Oral

80 mg/kg daily (maximum 1.5 g daily) given in divided doses every 8 hours for treatment of uncomplicated cutaneous anthrax.234 231

Treat for 60 days if cutaneous anthrax occurred as the result of exposure to aerosolized anthrax spores;231 234 7–10 days may be adequate if it occurred as the result of natural or endemic exposure to anthrax.231 234

Adults

Pharyngitis and Tonsillitis
Oral

500 mg 3 times daily39 or 750 mg once daily for 10 days.35 110

Follow-up throat cultures after treatment of pharyngitis and tonsillitis not indicated in asymptomatic patients,190 240 242 but recommended 2–7 days after treatment in those who remain symptomatic, develop recurring symptoms, or have a history of rheumatic fever and are at unusually high risk for recurrence.240 242

Ear, Nose, and Throat Infections
Oral

500 mg every 12 hours or 250 mg every 8 hours for mild to moderate infections per manufacturer.1

875 mg every 12 hours or 500 mg every 8 hours for severe infections or those caused by less susceptible bacteria per manufacturer.1

Respiratory Tract Infections
Oral

875 mg every 12 hours or 500 mg every 8 hours for mild, moderate, or severe lower respiratory tract infections.1

Skin and Skin Structure Infections
Oral

500 mg every 12 hours or 250 mg every 8 hours for mild to moderate infections.1

875 mg every 12 hours or 500 mg every 8 hours for severe infections or those caused by less susceptible bacteria.1

Urinary Tract Infections (UTIs)
Oral

500 mg every 12 hours or 250 mg every 8 hours for mild to moderate infections.1

875 mg every 12 hours or 500 mg every 8 hours for severe infections or those caused by less susceptible bacteria.1

Gonorrhea
Oral

3 g as a single dose.1

No longer recommended for gonorrhea by the CDC or other experts.94 189

Typhoid Fever
Oral

100 mg/kg daily or 1–1.5 g every 6 hours for 14 days.6

Helicobacter pylori Infection and Duodenal Ulcer Disease
Oral

1 g 2 times daily for 10 or 14 days given in conjunction with clarithromycin and either lansoprazole or omeprazole (triple therapy).1 168 172 173 174

1 g 3 times daily for 14 days given in conjunction with lansoprazole (dual therapy).1 168

Lyme Disease
Oral

500 mg 3 times daily for 14–21 days for treatment of early localized or early disseminated Lyme disease.95 238

500 mg 3 times daily for 14–28 days for mild Lyme carditis95 179 181 182 185 186 or for 28 days for Lyme arthritis (without associated neurologic disease).95 190 181 185 186 232 238

Chlamydial Infections
Oral

500 mg 3 times daily for 7 days for treatment of chlamydial infections in pregnant women.94 189 190

Repeat testing (preferably by culture) recommended 3 weeks after completion of treatment.94

Prevention of Bacterial Endocarditis
Patients Undergoing Certain Dental, Oral, Respiratory Tract, or Esophageal Procedures
Oral

2 g given 1 hour prior to the procedure.96

Patients Undergoing Certain GU or GI (except Esophageal) Procedures
Oral

2 g given 1 hour prior to the procedure in moderate-risk patients.96

For high-risk patients, give an initial IM or IV dose of ampicillin with IM or IV gentamicin within 30 minutes of starting the procedure followed by 1 g of amoxicillin 6 hours later.96

Anthrax
Postexposure Prophylaxis
Oral

500 mg every 8 hours for 60 days for postexposure prophylaxis following exposure to B. anthracis spores; use only if penicillin susceptibility confirmed.231 233 236

Inhalational Anthrax
Oral

500 mg every 8 hours for 60 days for treatment of inhalational anthrax.231

Cutaneous Anthrax
Oral

500 mg every 8 hours for treatment of inhalational anthrax.231

Treat for 60 days if cutaneous anthrax occurred as the result of exposure to aerosolized anthrax spores;231 234 7–10 days may be adequate if it occurred as the result of natural or endemic exposure to anthrax.231 234

Prescribing Limits

Pediatric Patients

Neonates and Infants ≤12 weeks (3 Months) of Age
Oral

Maximum 30 mg/kg daily in divided doses every 12 hours.1

Prevention of Bacterial Endocarditis
Oral

Dosage should not exceed adult dosage for prevention of bacterial endocarditis.96

Special Populations

Renal Impairment

Dosage adjustment necessary in severe renal impairment.1 6 41 82 83

Do not use 875-mg tablets in those with severe renal impairment and GFR <30 mL/minute.1

Dosage recommendations not available for pediatric patients with renal impairment.1

Dosage for Adults with Renal Impairment

GFR (mL/min)

Daily Dosage

10–30

250 or 500 mg every 12 hours depending on infection severity1

<10

250 or 500 mg every 24 hours depending on infection severity1

Hemodialysis Patients

250 or 500 mg every 24 hours depending on infection severity; with an additional dose both during and at the end of dialysis1

Cautions for Amoxicillin

Contraindications

  • Known hypersensitivity to any penicillin.1

Warnings/Precautions

Warnings

Superinfection/Clostridium difficile-associated Colitis

Possible emergence and overgrowth of nonsusceptible bacteria or fungi.1 21 Discontinue and institute appropriate therapy if superinfection occurs.1

Treatment with anti-infectives may permit overgrowth of clostridia.1 Consider Clostridium difficile-associated diarrhea and colitis (antibiotic-associated pseudomembranous colitis) if diarrhea develops and manage accordingly.1 194 195 196 197 198

Some mild cases of C. difficile-associated diarrhea and colitis may respond to discontinuance alone.1 194 195 196 197 198 Manage moderate to severe cases with fluid, electrolyte, and protein supplementation; appropriate anti-infective therapy (e.g., oral metronidazole or vancomycin) recommended if colitis is severe.1 194 195 196 197 198

Sensitivity Reactions

Hypersensitivity Reactions

Serious and occasionally fatal hypersensitivity reactions, including anaphylaxis, reported with penicillins.1 6 51 53 55

Prior to initiation of therapy, make careful inquiry regarding previous hypersensitivity reactions to penicillins, cephalosporins, or other drugs.1 Partial cross-allergenicity occurs among penicillins and other β-lactam antibiotics including cephalosporins and cephamycins.1 6

If a severe hypersensitivity reaction occurs, discontinue immediately and institute appropriate therapy as indicated (e.g., epinephrine, corticosteroids, maintenance of an adequate airway and oxygen).1

General Precautions

Selection and Use of Anti-infectives

To reduce development of drug-resistant bacteria and maintain effectiveness of amoxicillin and other antibacterials, use only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.1

When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing.1 In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy.1

Hepatic Effects

Moderate increases in serum AST and/or ALT reported.1

Hepatic dysfunction, including cholestatic jaundice, hepatic cholestasis, and acute cytolytic hepatitis reported.1

Assess hepatic function periodically during prolonged therapy.1

Renal Effects

Assess renal function periodically during prolonged therapy.1

Hematologic Effects

Adverse hematologic effects (e.g., anemia, hemolytic anemia, leukopenia, agranulocytosis, thrombocytopenia, thrombocytopenic purpura) reported with penicillins.1 Usually reversible when drug discontinued; may be a hypersensitivity reaction.1

Assess hematologic function periodically during prolonged therapy.1

Mononucleosis

Possible increased risk of rash in patients with mononucleosis; use in these patients not recommended.4 29 54 60

Phenylketonuria

200- and 400-mg chewable tablets contain aspartame (NutraSweet), which is metabolized in the GI tract to provide 1.82 or 3.64 mg of phenylalanine, respectively.1 3

Oral suspensions do not contain aspartame and can be used in individuals with phenylketonuria (i.e., homozygous genetic deficiency of phenylalanine hydroxylase) and other individuals who must restrict their intake of phenylalanine.1

Use of Fixed Combination

When used in fixed combination with other agents, consider the cautions, precautions, and contraindications associated with the concomitant agents.

Specific Populations

Pregnancy

Category B.

Recommended as an alternative for various indications in pregnant women (e.g., treatment of chlamydial infections,94 189 190 treatment of Lyme disease,88 95 181 182 190 191 postexposure prophylaxis or treatment of anthrax).231

Lactation

Distributed into milk; use with caution.1 4 6 26 49

Use in a breast-feeding woman may result in sensitization of infants.1

Recommended as an alternative for postexposure prophylaxis or treatment of anthrax in women who are breast-feeding.239

Pediatric Use

Renal clearance of amoxicillin may be delayed in neonates and young infants because of incompletely developed renal function.20 27 32 62 128

Neonates and infants ≤12 weeks (3 months) of age should receive no more than 30 mg/kg daily given in divided doses every 12 hours.1

Tooth discoloration (brown, yellow, gray) reported rarely, most frequently in pediatric patients.1 Brushing or dental cleaning reduces or eliminates discoloration in most cases.1

Geriatric Use

Renal clearance may be decreased.

Hepatic Impairment

Assess hepatic function periodically during prolonged therapy.1

Renal Impairment

Assess renal function periodically during prolonged therapy.1

Dosage adjustments necessary in severe renal impairment.1 41 82 83

Common Adverse Effects

Adverse GI effects (e.g., nausea, vomiting, diarrhea), hypersensitivity reactions (e.g., rash).1 4 52 142

Interactions for Amoxicillin

Specific Drugs and Laboratory Tests

Drug

Interaction

Comments

Allopurinol

Possible increased incidence of rash;59 61 84 reported with ampicillin but no data regarding amoxicillin59 61 84

Unclear whether potentiation of rash is caused by allopurinol or hyperuricemia present in these patients59 61 84

Chloramphenicol

In vitro evidence of antagonism1

Clinical importance unclear1

Clavulanic acid

In vitro and in vivo synergistic bactericidal effect13 14 15 16 84 85 86 87 127

Used to therapeutic advantage in infections caused by β-lactamase-producing bacteria;84 commercially available in fixed combination with clavulanate potassium84

Macrolides

In vitro evidence of antagonism1

Clinical importance unclear1

Methotrexate

Possible decreased renal clearance of methotrexate;171 possible increased methotrexate concentrations and hematologic and GI toxicity171

Monitor closely if used concomitantly171

Probenecid

Decreased renal tubular secretion of amoxicillin;1 23 24 34 increased and prolonged amoxicillin concentrations may occur1 23 24 34

Sulfonamides

In vitro evidence of antagonism1

Clinical importance unclear1

Tests for glucose

Possible false-positive reactions in urine glucose tests using Clinitest, Benedict’s solution, or Fehling’s solution;1 reported with ampicillin but no data regarding amoxicillin1

Use glucose tests based on enzymatic glucose oxidase reactions (e.g., Clinistix, Tes-Tape)1

Tetracyclines

In vitro evidence of antagonism1

Clinical importance unclear1

Amoxicillin Pharmacokinetics

Absorption

Bioavailability

74–92% of an oral dose absorbed from GI tract.4 17 28 44 62

Peak serum concentrations usually attained within 1–2 hours.1 6 23 36 40 47

A 400-mg chewable tablet is bioequivalent to 5 mL of the oral suspension containing 400 mg/5 mL.1

Food

Food has minimal or no effect on bioavailability of oral amoxicillin.4 6 10 22 29 38 40 62

Special Populations

Oral absorption delayed in neonates compared with older children and adults;20 27 peak concentrations attained within 3–4.5 hours in neonates.20 27

Distribution

Extent

Readily distributed into most tissues and fluids1 following oral administration, including lungs,6 48 bronchial secretions,19 maxillary sinus secretions,4 bile,6 48 pleural fluid,6 sputum,4 6 30 and middle ear fluid.4 56 203

Only low concentrations attained in CSF.6 33 37

Crosses the placenta4 6 and is distributed into human milk.4 6 49

Plasma Protein Binding

17–20%.1 6 9 29 45 62

Elimination

Metabolism

Probably metabolized to some extent in the liver.6 28 36 42

Elimination Route

Eliminated principally in urine by both glomerular filtration and tubular secretion.6

Approximately 50–80% of amoxicillin dose excreted unchanged in urine.1 6

Half-life

1–1.4 hours.1 17 21 29 36 43 46 50

Special Populations

Serum concentrations increased and half-life prolonged in patients with renal impairment.17 25 31 41 50 62

Renal clearance may be delayed in neonates and young infants because of incompletely developed renal function.20 27 32 128

Stability

Storage

Oral

Capsules

≤20°C.1

For Suspension

250 mg/5 mL: ≤20°C.1 Following reconstitution, refrigerate (preferable but not required) and discard after 14 days.1

200 or 400 mg/5 mL: ≤25°C.1 Following reconstitution, refrigerate (preferable but not required) and discard after 14 days.1

Tablets

200- and 400-mg chewable tablets and 500- or 875-mg film-coated tablets: ≤25°C.1

Actions and Spectrum

  • A β-lactam antibacterial classified as an aminopenicillin.6 62 The p-hydroxyl analog of ampicillin.62

  • Usually bactericidal.1 6 7

  • Gram-positive aerobes: Active in vitro and in clinical infections against Staphylococcus (β-lactamase-negative strains only), Streptococcus pneumoniae, other Streptococcus (α- and β-hemolytic strains only), and Enterococcus faecalis.1 6 62

  • Gram-negative aerobes: Active in vitro and in clinical infections against H. influenzae, N. gonorrhoeae, E. coli, Corynebacterium diphtheriae,1 2 Listeria monocytogenes,1 2 Proteus mirabilis, Salmonella, and Shigella.1 4 6 8 10 62

  • Other organisms: Active in vitro and in clinical infections caused by H. pylori.1 6 Also active against Borrelia burgdorferi.6

  • Generally has same spectrum and level of activity as ampicillin,4 5 6 9 10 11 but more active than ampicillin against enterococci and Salmonella and less active against Shigella and Enterobacter.4 6 10 11 18

  • Resistance reported in gram-positive and gram-negative bacteria that produce β-lactamases, including β-lactamase-producing S. aureus and E. faecalis.5 6 8 9 10 11 12 79 129 130 131 132 133 134 135 136

  • Complete cross-resistance generally occurs between amoxicillin and ampicillin.4 5 6 9 10

Advice to Patients

  • Advise patients that antibacterials (including amoxicillin) should only be used to treat bacterial infections and not used to treat viral infections (e.g., the common cold).1

  • Importance of completing the entire prescribed course of treatment, even if feeling better after a few days.1

  • Advise patients that skipping doses or not completing the full course of therapy may decrease effectiveness and increase the likelihood that bacteria will develop resistance and will not be treatable with amoxicillin or other antibacterials in the future.1

  • Advise individuals with phenylketonuria and other individuals who must restrict their intake of phenylalanine that 200- and 400-mg chewable tablets contain aspartame (NutraSweet),1 which is metabolized in the GI tract to phenylalanine.89 90 91 92 93

  • Importance of discontinuing therapy and informing clinician if an allergic reaction occurs.1

  • Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs.1

  • Importance of women informing clinicians if they are or plan to become pregnant or to breast-feed.1

  • Importance of advising patients of other important precautionary information.1 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Amoxicillin (Trihydrate)

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules

250 mg (of amoxicillin)*

Trimox

Sandoz

500 mg (of amoxicillin)*

Amoxil

GlaxoSmithKline

Trimox

Sandoz

For suspension

125 mg (of amoxicillin) per 5 mL*

Trimox

Sandoz

200 mg (of amoxicillin) per 5 mL*

Amoxil

GlaxoSmithKline

250 mg (of amoxicillin) per 5 mL*

Amoxil

GlaxoSmithKline

Trimox

Sandoz

50 mg (of amoxicillin) per mL

Amoxil Pediatric Drops

GlaxoSmithKline

Trimox Pediatric Drops

Sandoz

400 mg (of amoxicillin) per 5 mL*

Amoxil

GlaxoSmithKline

Tablets, chewable

125 mg (of amoxicillin)*

Amoxicillin Chewable Tablets

Teva

Amoxil

GlaxoSmithKline

200 mg (of amoxicillin)

Amoxil (with aspartame)

GlaxoSmithKline

250 mg (of amoxicillin)*

Amoxil (scored)

GlaxoSmithKline

400 mg (of amoxicillin)

Amoxil (with aspartame)

GlaxoSmithKline

Tablets, film-coated

500 mg (of amoxicillin)*

Amoxicillin Tablets

Teva

Amoxil

GlaxoSmithKline

875 mg (of amoxicillin)*

Amoxicillin Tablets (scored)

Teva

Amoxil (scored)

GlaxoSmithKline

Amoxicillin (Trihydrate) Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Kit

4 Capsules, Amoxicillin (trihydrate) 500 mg (of amoxicillin) (Trimox)

2 Capsules, delayed-release (containing enteric-coated granules) Lansoprazole 30 mg (Prevacid)

2 Tablets, film-coated, Clarithromycin 500 mg (Biaxin) Filmtab (with povidone and propylene glycol)

Prevpac

TAP Pharmaceuticals

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Amoxicillin 125MG Chewable Tablets (TEVA PHARMACEUTICALS USA): 21/$15.32 or 42/$18.58

Amoxicillin 250MG Capsules (TEVA PHARMACEUTICALS USA): 90/$17.99 or 180/$25.97

Amoxicillin 250MG Chewable Tablets (TEVA PHARMACEUTICALS USA): 30/$17.51 or 90/$29.53

Amoxicillin 250MG/5ML Suspension (SANDOZ): 100/$13.99 or 200/$17.97

Amoxicillin 250MG/5ML Suspension (TEVA PHARMACEUTICALS USA): 150/$14.99 or 300/$18.97

Amoxicillin 400MG Chewable Tablets (RANBAXY PHARMACEUTICALS): 30/$25.99 or 60/$40.97

Amoxicillin 400MG/5ML Suspension (TEVA PHARMACEUTICALS USA): 100/$16.99 or 200/$24.98

Amoxicillin 500MG Capsules (SANDOZ): 30/$15.99 or 60/$20.97

Amoxicillin 500MG Tablets (TEVA PHARMACEUTICALS USA): 100/$49.99 or 300/$125.97

Amoxicillin 875MG Tablets (AUROBINDO PHARMA): 30/$26.99 or 90/$70.97

Biaxin 250MG Tablets (ABBOTT): 60/$361.00 or 180/$1,025.97

Biaxin 500MG Tablets (ABBOTT): 20/$129.98 or 60/$369.98

Clarithromycin 250MG Tablets (SANDOZ): 30/$148.99 or 90/$426.99

Clarithromycin 500MG Tablets (TEVA PHARMACEUTICALS USA): 30/$125.99 or 90/$355.96

Lansoprazole 15MG Delayed-release Capsules (SANDOZ): 30/$105.99 or 90/$263.97

Lansoprazole 30MG Delayed-release Capsules (SANDOZ): 30/$99.99 or 90/$245.97

Prevacid 15MG Delayed-release Capsules (TAKEDA PHARMACEUTICALS): 30/$213.98 or 90/$617.99

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions May 1, 2008. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

1. GlaxoSmithKline. Amoxil (amoxicillin) capsules, chewable tablets, and powder for oral suspension prescribing information. Research Triangle Park, NC; 2004 Jun.

2. Hou JP, Poole JW. β-Lactam antibiotics: their physiochemical properties and biological activities in relation to structure. J Pharm Sci. 1971; 60:503-27. [PubMed 4336386]

3. Wilkowske CJ. The penicillins. Mayo Clin Proc. 1977; 52:616-24. [PubMed 242733]

4. Brogden RN, Speight TM, Avery GS. Amoxycillin: a review of its antibacterial and pharmacokinetic properties and therapeutic use. Drugs. 1975; 9:88-140. [PubMed 1126306]

5. Brogden RN, Heel RC, Speight TM et al. Amoxycillin injectable: a review of its antibacterial spectrum, pharmacokinetics and therapeutic use. Drugs. 1979; 18:169-84. [PubMed 387371]

6. Kucers A, Crowe S, Grayson ML et al, eds. The use of antibiotics. A clinical review of antibacterial, antifungal, and antiviral drugs. 5th ed. Jordan Hill, Oxford: Butterworth-Heinemann; 1997: 134-42.

7. Rolinson GN, Macdonald AC, Wilson DA. Bactericidal action of β-lactam antibiotics on Escherichia coli with particular reference to ampicillin and amoxycillin. J Antimicrob Chemother. 1977; 3:541-53. [PubMed 340439]

8. Lorian V, ed. Antibiotics in laboratory medicine. Baltimore: Williams & Wilkins; 1980:298-341, 418-73, 607-722.

9. Sutherland R, Croydon EA, Rolinson GN. Amoxycillin: a new semi-synthetic penicillin. Br Med J. 1972; 3:13-6. [PubMed 4402672]

10. Rolinson GN. Laboratory evaluation of amoxicillin. J Infect Dis. 1974; 129(Suppl):S139-45. [PubMed 4601188]

11. Neu HC. Antimicrobial activity and human pharmacology of amoxicillin. J Infect Dis. 1974; 129(Suppl):S123-31.

12. Rocco V, Overturf G. Chloramphenicol inhibition of the bactericidal effect of ampicillin against Haemophilus influenzae. Antimicrob Agents Chemother. 1982; 21:349-51. [IDIS 146670] [PubMed 6978674]

13. Wise R, Andrews JM, Bedford KA. In vitro study of clavulanic acid in combination with penicillin, amoxycillin, and carbenicillin. Antimicrob Agents Chemother. 1978; 13:389-93. [PubMed 122520]

14. Hunter PA, Coleman K, Fisher J et al. In vitro synergistic properties of clavulanic acid, with ampicillin, amoxycillin and ticarcillin. J Antimicrob Chemother. 1980; 6:455-70. [PubMed 6968746]

15. Matsuura M, Nakazawa H, Hashimoto T et al. Combined antibacterial activity of amoxicillin with clavulanic acid against ampicillin-resistant strains. Antimicrob Agents Chemother. 1980; 17:908-11. [IDIS 116380] [PubMed 6967713]

16. Brogden RN, Carmine A, Heel RC et al. Amoxycillin/clavulanic acid: a review of its antibacterial activity, pharmacokinetics and therapeutic use. Drugs. 1981; 22:337-62. [IDIS 166620] [PubMed 7037354]

17. Barza M, Weinstein L. Pharmacokinetics of the penicillins in man. Clin Pharmacokinet. 1976; 1:297-308. [PubMed 797501]

18. Ullmann U, Wurst W. Antibacterial active components in human urine after administration of penicillins. Infection. 1979; 7:187-9. [PubMed 511336]

19. Bergogne-Berezin E, Morel C, Benard Y et al. Pharmacokinetic study of β-lactam antibiotics in bronchial secretions. Scand J Infect Dis. 1978; 14(Suppl):267-72.

20. Morselli PL, Franco-Morselli R, Bossi L. Clinical pharmacokinetics in newborns and infants: age-related differences and therapeutic implications. Clin Pharmacokinet. 1980; 5:485-527. [IDIS 128387] [PubMed 7002417]

21. Selwyn S. Applied pharmacology, adverse effects and drug interactions. In: Selwyn S, ed. The beta-lactam antibiotics: penicillins and cephalosporins in perspective. London: Hodder and Stoughton; 1980:91-126.

22. Melander A. Influence of food on the bioavailability of drugs. Clin Pharmacokinet. 1978:3:337-51.

23. Barbhaiya R, Thin RN, Turner P et al. Clinical pharmacological studies of amoxycillin: effect of probenecid. Br J Vener Dis. 1979; 55:211-3. [PubMed 466384]

24. Gibaldi M, Schwartz MA. Apparent effect of probenecid on the distribution of penicillins in man. Clin Pharmacol Ther. 1968; 9:345-9. [PubMed 5649987]

25. Giusti DL. A review of the clinical use of antimicrobial agents in patients with renal and hepatic insufficiency: the penicillins. Drug Intell Clin Pharm. 1973; 7:62-74.

26. Anderson PO. Drugs and breast feeding—a review. Drug Intell Clin Pharm. 1977; 11:208-23.

27. Cohen MD, Raeburn JA, Devine J et al. Pharmacology of some oral penicillins in the newborn infant. Arch Dis Child. 1975; 50:230-4. [PubMed 1147656]

28. Cole M, Kening MD, Hewitt VA. Metabolism of penicillins to penicilloic acids and 6-aminopenicillanic acid in man and its significance in assessing penicillin absorption. Antimicrob Agents Chemother. 1973; 3:463-8. [PubMed 4364176]

29. Brogden RN, Speight TM, Avery GS. Amoxycillin: a preliminary report of its pharmacokinetic properties and therapeutic efficacy. Drugs. 1974; 7:326-36. [PubMed 4604079]

30. Davies B, Maesen F. Serum and sputum antibiotic levels after ampicillin, amoxycillin and bacampicillin in chronic bronchitis patients. Infection. 1979; 7(Suppl 5):S465-8.

31. Francke EL, Appel GB, Neu HC. Kinetics of intravenous amoxicillin in patients on long-term dialysis. Clin Pharmacol Ther. 1979; 26:31-5. [PubMed 445959]

32. Rudoy RC, Goto N, Pettit D et al. Pharmacokinetics of intravenous amoxicillin in pediatric patients. Antimicrob Agents Chemother. 1979; 15:628-9. [IDIS 123121] [PubMed 464594]

33. Strausbaugh LJ, Girgis NI, Mikhail IA et al. Penetration of amoxicillin into cerebrospinal fluid. Antimicrob Agents Chemother. 1978; 14:899-902. [IDIS 119374] [PubMed 742877]

34. Craft JC, Feldman WE, Nelson JD. Clinicopharmacological evaluation of amoxicillin and probenecid against bacterial meningitis. Antimicrob Agents Chemother. 1979; 16:346-52. [IDIS 108665] [PubMed 507789]

35. Shvartzman P, Tabenkin H, Rosentzqaig A et al. Treatment of streptococcal pharyngitis with amoxycillin once a day. BMJ. 1993; 306:1170-2. [PubMed 8499823]

36. Arancibia A, Guttmann J, Gonzalez G et al. Absorption and disposition kinetics of amoxicillin in normal human subjects. Antimicrob Agents Chemother. 1980; 17:199-202. [IDIS 111694] [PubMed 7387142]

37. Clumeck N, Thys JP, Vanhoof R et al. Amoxicillin entry into human cerebrospinal fluid: comparison with ampicillin. Antimicrob Agents Chemother. 1978; 14:531-2. [PubMed 102244]

38. Eshelman FN, Spyker DA. Pharmacokinetics of amoxicillin and ampicillin: crossover study of the effect of food. Antimicrob Agents Chemother. 1978; 14:539-43. [PubMed 363052]

39. Hayes CS, Williamson H. Management of group A beta-hemolytic streptococcal pharyngitis. Am Fam Physician. 2001; 63:1557-64. [PubMed 11327431]

40. Welling PG, Huang H, Kock PA et al. Bioavailability of ampicillin and amoxicillin in fasted and nonfasted subject. J Pharm Sci. 1977; 66:549-52. [PubMed 323461]

41. Oe PL, Simonian S, Verhoef J. Pharmacokinetics of the new penicillins. Chemotherapy. 1973; 19:279-88. [PubMed 4787741]

42. Graber H, Perenyi T, Arr M et al. On human biotransformation of some penicillins. Int J Clin Pharmacol. 1976; 14:284-9.

43. Gordon RC, Regamey C, Kirby WM. Comparative clinical pharmacology of amoxicillin and ampicillin administered orally. Antimicrob Agents Chemother. 1972; 1:504-7. [PubMed 4680813]

44. Zarowny D, Ogilvie R, Tamblyn D et al. Pharmacokinetics of amoxicillin. Clin Pharmacol Ther. 1974; 16:1045-51. [PubMed 4433471]

45. Tan JS, Bannister T, Phair JP. Levels of amoxicillin and ampicillin in human serum and interstitial fluid. J Infect Dis. 1974; 129(Suppl):S146-8. [PubMed 4601189]

46. Kirby WM, Gordon RC, Regamey C. The pharmacology of orally administered amoxicillin and ampicillin. J Infect Dis. 1974; 129(Suppl):S154-5.

47. Lode H, Janisch P, Kupper G et al. Comparative clinical pharmacology of three ampicillins and amoxicillin administered orally. J Infect Dis. 1974; 129(Suppl):S156-70. [PubMed 4834960]

48. Kiss IJ, Farago E, Schnitzler J et al. Amoxycillin levels in human serum, bile, gallbladder, lung, and liver tissue. Int J Clin Pharmacol Ther Toxicol. 1981; 19:69-74. [PubMed 7216553]

49. Kafetzis DA, Siafas CA, Georgakopoulos PA et al. Passage of cephalosporins and amoxicillin into the breast milk. Acta Paediatr Scand. 1981; 70:285-8. [PubMed 7246123]

50. Arancibia A, Droguett MT, Fuentes G et al. Pharmacokinetics of amoxicillin in subjects with normal and impaired renal function. Int J Clin Pharmacol Ther Toxicol. 1982; 20:447-53. [PubMed 7141752]

51. Idsoe O, Guthe T, Willcox RR et al. Nature and extent of penicillin side-reactions, with particular reference to fatalities from anaphylactic shock. Bull World Health Organ. 1968; 38:159-88. [PubMed 5302296]

52. Nordbring F. Review of side-effects of aminopenicillins. Infection. 1979; 7(Suppl 5):S503-6. [PubMed 511364]

53. Erffmeyer JE. Adverse reactions to penicillin. Ann Allergy. 1981; 47:288-300. [PubMed 6171185]

54. Copeman PW, Scrivener R. Amoxycillin rash. Br Med J. 1977; 1:1354. [PubMed 861632]

55. Isbister JP. Penicillin allergy: a review of the immunological and clinical aspects. Med J Aust. 1971; 1:1067-74. [PubMed 4398272]

56. Klimek JJ, Nightingale C, Lehmann WB et al. Comparison of concentrations of amoxicillin and ampicillin in serum and middle ear fluid of children with chronic otitis media. J Infect Dis. 1977; 135:999-1002. [PubMed 864293]

57. Neu HC. Amoxicillin. Ann Intern Med. 1979; 90:356-60. [PubMed 34342]

59. Jick H, Porter JB. Potentiation of ampicillin skin reactions by allopurinol or hyperuricemia. J Clin Pharmacol. 1981; 21:456-8. [IDIS 141506] [PubMed 6458626]

60. Mulroy R. Amoxycillin rash in infectious mononucleosis. Br Med J. 1973; 1:554. [PubMed 4266345]

61. Jick H, Slone D, Shapiro S et al. Excess of ampicillin rashes associated with allopurinol or hyperuricemia. N Engl J Med. 1972; 286:505-7. [PubMed 4258181]

62. Chambers HF. Penicillins. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 5th ed. New York: Churchill Livingstone; 2000: 261-74.

63. Nolan CM, White PC. Treatment of typhoid carriers with amoxicillin: correlates of successful therapy. JAMA. 1978; 239:2352-4. [IDIS 115632] [PubMed 642172]

64. Howard JB, Aquirre X, Palombo G. Amoxicillin versus ampicillin for treatment of typhoid fever in children. Curr Ther Res Clin Exp. 1980; 28:491-7.

65. Munnich D, Bekesi S. Curing of typhoid carriers by cholecystectomy combined with amoxycillin plus probenecid treatment. Chemotherapy. 1979; 25:362-6. [IDIS 104814] [PubMed 520079]

66. Abengowe CU. Comparative clinical trial of amoxycillin and chloramphenicol in the treatment of typhoid in adults. J Int Med Res. 1979; 7:247-51. [PubMed 378735]

67. Munnich D, Bekesi S, Lakatos M et al. Treatment of typhoid carriers with amoxycillin and in combination with probenecid. Chemotherapy. 1974; 20:29-38. [PubMed 4846500]

68. Scragg JN. Further experience with amoxycillin in typhoid fever in children. Br Med J. 1976; 2:1031-3. [PubMed 990748]

69. Shanson DC, Cannon P, Wilks M. Amoxycillin compared with penicillin V for prophylaxis of dental bacteraemia. J Antimicrob Chemother. 1978; 4:431-6. [PubMed 99423]

72. Shanson DC, Ashford RF, Singh J. High-dose oral amoxycillin for preventing endocarditis. Br Med J. 1980; 280:446. [IDIS 123606] [PubMed 7370526]

73. Mackay AD. Amoxycillin versus ampicillin in treatment of exacerbations of chronic bronchitis. Br J Dis Chest. 1980; 74:379-83. [PubMed 7011353]

74. Committee on Infectious Diseases. Policy statement: recommendations for prevention of pneumococcal infections, including the use of pneumococcal conjugate vaccine (Prevnar), pneumococcal polysaccharide vaccine, and antibiotic prophylaxis. Pediatrics. 2000; 106:362-6. [IDIS 451984] [PubMed 10920169]

75. Ronald AR, Jagdis FA, Harding GK et al. Amoxicillin therapy of acute urinary infections in adults. Antimicrob Agents Chemother. 1977; 11:780-4. [PubMed 327919]

76. Savard-Fenton M, Fenton BW, Reller LB et al. Single-dose amoxicillin therapy with follow-up urine culture: effective initial management for acute uncomplicated urinary tract infections. Am J Med. 1982; 73:808-13. [IDIS 162549] [PubMed 6924538]

78. Souney P, Polk BF. Single-dose antimicrobial therapy for urinary tract infections in women. Rev Infect Dis. 1982; 4:29-34. [IDIS 149916] [PubMed 6918057]

79. Mayo JB, McCarthy LR. Antimicrobial susceptibility of Haemophilus parainfluenzae. Antimicrob Agents Chemother. 1977; 11:844-7. [PubMed 587028]

81. Anon. The choice of antibacterial drugs. Med Lett Drugs Ther. 2001; 43:69-78. [PubMed 11518876]

82. Appel GB, Neu HC. The nephrotoxicity of antimicrobial agents (first of three parts). N Engl J Med. 1977; 296:663-70. [PubMed 402574]

83. Bennett WM, Aronoff GR, Morrison G et al. Drug prescribing in renal failure: dosing guidelines for adults. Am J Kidney Dis. 1983; 3:155-93. [PubMed 6356890]

84. SmithKline Beecham. Augmentin (amoxicillin and clavulanate potassium) chewable tablets and powder for oral suspension prescribing information. Research Triangle Park, NC; 2003 Jan.

85. Yogev R, Melick C, Kabat WJ. In vitro and in vivo synergism between amoxicillin and clavulanic acid against ampicillin-resistant Haemophilus influenzae type b. Antimicrob Agents Chemother. 1981; 19:993-6. [IDIS 133226] [PubMed 6973952]

86. Weber DJ, Tolkoff-Rubin NE, Rubin RH. Amoxicillin and potassium clavulanate: an antibiotic combination: mechanisms of action, pharmacokinetics, antimicrobial spectrum, clinical efficacy and adverse effects. Pharmacotherapy. 1984; 4:122-36. [IDIS 393570] [PubMed 6739312]

87. Fuglesang JE, Bergan T. Antibacterial activity and kill kinetics of amoxicillin-clavulanic acid combinations against Escherichia coli and Klebsiella aerogenes. Infection. 1983; 11:329-35. [PubMed 6365790]

88. Markowitz LE, Steere AC, Benach JL et al. Lyme disease during pregnancy. JAMA. 1986; 255:3394-6. [PubMed 2423719]

89. American Medical Association Council on Scientific Affairs. Aspartame: review of safety issues. JAMA. 1985; 254:400-2. [IDIS 202002] [PubMed 2861297]

90. Gossel TA. A review of aspartame: characteristics, safety and uses. US Pharm. 1984; 9:26, 28-30.

91. Food and Drug Administration. Aspartame as an inactive ingredient in human drug products; labeling requirements. Proposed rule. (21 CFR Part 201) Fed Regist. 1983; 48:54993-5. (IDIS 178728)

92. Food and Drug Administration. Food additives permitted for direct addition to food for human consumption: aspartame. Final rule. (21 CFR Part 172) Fed Regist. 1983; 48:31376-82. (IDIS 172957)

93. Anon. Aspartame and other sweeteners. Med Lett Drugs Ther. 1982; 24:1-2. [PubMed 7054648]

94. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002. MMWR Morb Mortal Wkly Rep. 2002; 51(No. RR-6):1-78.

95. Anon. Treatment of Lyme disease. Med Lett Drugs Ther. 2000; 42:37-9. [PubMed 10825919]

96. Dajani AS, Taubert KA, Wilson W et al. Prevention of bacterial endocarditis: recommendations by the American Heart Association. JAMA. 1997; 277:1794-801. [IDIS 385878] [PubMed 9178793]

97. Petersen EA. Prevention of bacterial endocarditis. Arch Intern Med. 1990; 150:2447-8. [IDIS 276844] [PubMed 2244761]

99. American Heart Association, American Dental Association Council on Dental Therapeutics. Preventing bacterial endocarditis: a statement for the dental professional. J Am Dent Assoc. 1991; 122:87-92.

100. Kaye D, Abrutyn E. Prevention of bacterial endocarditis: 1991. Ann Intern Med. 1991; 114:803-4. [IDIS 280195] [PubMed 2012361]

101. Cawson RA. Antibiotic prophylaxis for dental treatment: for hearts but not for prosthetic joints. BMJ. 1992; 304:933-4. [IDIS 294728] [PubMed 1581713]

102. Zenilman JM. Typhoid fever. JAMA. 1997; 278:847-50. [IDIS 391174] [PubMed 9293994]

103. Klein JO. Protecting the therapeutic advantage of antimicrobial agents used for otitis media. Pediatr Infect Dis J. 1998; 17:571-5. [IDIS 408841] [PubMed 9655563]

104. Paradise JL. Managing otitis media: a time for change. Pediatrics. 1995; 96:712-5. [IDIS 355408] [PubMed 7567336]

106. Hirschmann JV. Methods for decreasing antibiotic use in otitis media. Lancet. 1998; 352:672. [PubMed 9728980]

107. Chiba N, Rao BV, Rademaker JW et al. Meta-analysis of the efficacy of antibiotic therapy in eradicating Helicobacter pylori. Am J Gastroenterol. 1992; 87:1716-27. [IDIS 307322] [PubMed 1449132]

108. Esposito S, Marchisio P, Bosis S et al. Comparative efficacy and safety of 5-day cefaclor and 10-day amoxycillin treatment of group A streptococcal pharyngitis in children. Int J Antimicrob Agents. 2002; 20:28-33. [PubMed 12127708]

109. Aquilar A, Tinoco JC, Macias M et al. Clincial and bacteriologic efficacy of amoxycillin b.d. (45 mg/kg/day) versus amoxycillin t.d.s (40 mg/kg/day) in children with group A beta-hemolytic streptococcal tonsillopharyngitis. J Chemother. 2000; 12:396-405. [PubMed 11128559]

110. Feder HM, Gerber MA, Randolph MF et al. Once-daily therapy for streptococcal pharyngitis with amoxicillin. Pediatrics. 1999; 103:47-51. [PubMed 9917438]

111. Berman S, Roark R, Luckey D. Theoretical cost effectiveness of management options for children with persisting middle ear effusions. Pediatrics. 1994; 93:353-63. [IDIS 326488] [PubMed 8115191]

112. Bayerdörffer E, Mannes GA, Sommer A et al. Long-term follow-up after eradication of Helicobacter pylori with a combination of omeprazole and amoxycillin. Scand J Gastroenterol Suppl. 1993; 196:19-25. [PubMed 8341987]

113. Unge P, Ekstrom P. Effects of combination therapy with omeprazole and an antibiotic on H. pylori and duodenal ulcer disease. Scand J Gastroenterol Suppl. 1993; 196:17-8.

115. Hsu GS, Levine SC, Giebink GS. Management of otitis media using agency for health care policy and research guidelines. Otolaryngol Head Neck Surg. 1998; 118:437-43. [PubMed 9560092]

116. Bell GD, Powell U. Eradication of Helicobacter pylori and its effect in peptic ulcer disease. Scand J Gastroenterol Suppl. 1993; 196:7-11. [PubMed 8341990]

117. Adamek RJ, Wegener M, Opferkuch W et al. Successful Helicobacter pylori eradication: a systemic effect of antibiotics? Am J Gastroenterol. 1993; 88:792-3. Letter.

118. Bianchi Porro G, Parente F, Lazzaroni M. Short and long term outcome of Helicobacter pylori positive resistant duodenal ulcers treated with colloidal bismuth subcitrate plus antibiotics or sucralfate alone. Gut. 1993; 34:466-9. [IDIS 312865] [PubMed 8491391]

119. George LL, Borody TJ, Andrews P et al. Cure of duodenal ulcer after eradication of H. pylori. Med J Aust. 1990; 153:145-9. [IDIS 273364] [PubMed 1974027]

120. Centers for Disease Control and Prevention. Diagnosis and management of foodborne illnesses: a primer for physicians. MMWR Morb Mortal Wkly Rep. 2001; 50(No. RR-2):1-69. [PubMed 11215787]

121. Guerrant RL, Gilder TV, Steiner TS et al. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. 2001; 32:331-50. [IDIS 466024] [PubMed 11170940]

122. Graham DY, Lew GM, Klein PD et al. Effect of treatment of Helicobacter pylori infection on the long-term recurrence of gastric or duodenal ulcer. A randomized, controlled study. Ann Intern Med. 1992; 116:705-8. [IDIS 295138] [PubMed 1558340]

123. Axon AT. Helicobacter pylori therapy: effect on peptic ulcer disease. J Gastroenterol Hepatol. 1991; 6:131-7. [PubMed 1912418]

124. Benson JM, Nahata MC. Sulbactam/ampicillin, a new beta-lactamase inhibitor/beta-lactam antibiotic combination. DICP. 1988; 22:534-41.

125. Campoli-Richards DM, Brogden RN. Sulbactam/ampicillin: a review of its antibacterial activity, pharmacokinetic properties, and therapeutic use. Drugs. 1987; 33:577-609. [IDIS 232439] [PubMed 3038500]

126. Chamberland S, L’Ecuyer J, Lessard C et al. Antibiotic susceptibility profiles of 941 gram-negative bacteria isolated from septicemic patients throughout Canada. Clin Infect Dis. 1992; 15:615-28. [IDIS 302941] [PubMed 1420674]

127. Wexler HM, Molitoris E, Finegold SM. Effect of β-lactamase inhibitors on the activities of various β-lactam agents against anaerobic bacteria. Antimicrob Agents Chemother. 1991; 1219-24.

128. Driessen OM, Sorgedrager N, Michel MF et al. Variability and predictability of the plasma concentration of ampicillin and kanamycin in new-born infants. Eur J Clin Pharmacol. 1979; 15:133-7. [IDIS 112304] [PubMed 436921]

129. Spera RV, Farber BF. Multiply-resistant Enterococcus faecium: the nosocomial pathogen of the 1990s. JAMA. 1993; 268:2563-4.

130. Klare I, Rodloff AC, Wagner J et al. Overproduction of a penicillin-binding protein is not the only mechanism of penicillin resistance in Enterococcus faecium. Antimicrob Agents Chemother. 1992; 36:783-7. [PubMed 1503440]

131. Handwerger S, Perlman DC, Altarae D et al. Concomitant high-level vancomycin and penicillin resistance in clinical isolates of Enterococci. Clin Infect Dis. 1992; 14: 655-61.

132. Rhinehart E, Smith NE, Wennersten C et al. Rapid dissemination of β-lactamase-producing, aminoglycoside-resistant, Enterococcus faecalis among patients and staff on an infant-toddler surgical ward. N Engl J Med. 1990; 323:1814-8. [PubMed 2123301]

133. Murray BE. New aspects of antimicrobial resistance and the resulting therapeutic dilemmas. J Infect Dis. 1991; 163:1185-94.

134. Coudron PE, Markowitz SM, Wong ES. Isolation of a β-lactamase-producing, aminoglycoside-resistant strain of Enterococcus faecium. Antimicrob Agents Chemother. 1992; 36:1125-6. [PubMed 1510404]

135. Markowitz SM, Wells VD, Williams DS et al. Antimicrobial susceptibility and molecular epidemiology of β-lactamase-producing, aminoglycoside-resistant isolates of Enterococcus faecalis. Antimicrob Agents Chemother. 1991; 35:1075-80. [PubMed 1929246]

136. Chirurgi V, Oster SE, Goldberg AA et al. Nosocomial acquisition of β-lactamase-negative, ampicillin-resistant Enterococcus. Arch Intern Med. 1992; 152:1457-61. [PubMed 1627025]

137. Rosioru C, Glassman MS, Halata MS et al. Esophagitis and Helicobacter pylori in children: incidence and therapeutic implications. Am J Gastroenterol. 1993; 88:510-3. [IDIS 313344] [PubMed 8470630]

138. Oderda G, Forni M, Dell’Olio D et al. Cure of peptic ulcer associated with eradication of Helicobacter pylori. Lancet. 1990; 335:1599.

140. Anon. Drugs for treatment of acute otitis media in children. Med Lett Drug Ther. 1994; 36:19-21.

141. Pichichero ME. Assessing the treatment of alternatives for acute otitis media. Pediatr Infect Dis J. 1994; 13:S27-34.

142. Bigby M, Jick S, Jick H et al. Drug-induced cutaneous reactions: a report from the Boston Collaborative Drug Surveillance Program on 15,438 consecutive inpatients, 1975 to 1982. JAMA. 1986; 256:3358-63. [PubMed 2946876]

143. Marshall BJ. Helicobacter pylori. Am J Gastroenterol. 1994; 89:S116-28.

144. Labenz J, Gyenes E, Rühl GH et al. Amoxicillin plus omeprazole versus triple therapy for eradication of Helicobacter pylori in duodenal ulcer disease: a prospective, randomized, and controlled study. Gut. 1993; 34:1167-70. [IDIS 320468] [PubMed 8406147]

145. Labenz J, Gyenes E, Rühl GH et al. Omeprazole plus amoxicillin: efficacy of various treatment regimens to eradicate Helicobacter pylori. Am J Gastroenterol. 1993; 88:491-5. [IDIS 313342] [PubMed 8470626]

146. Bell GD, Powell KU, Burridge SM et al. Helicobacter pylori eradication: efficacy and side effect profile of a combination of omeprazole, amoxycillin and metronidazole compared with four alternative regimens. Q J Med. 1993; 86:743-50. [IDIS 322332] [PubMed 8265776]

147. Labenz J, Rühl GH, Bertrams J et al. Medium- and high-dose omeprazole plus amoxicillin for eradication of Helicobacter pylori in duodenal ulcer disease. Dig Dis Sci. 1994; 39:1483-7. [IDIS 333050] [PubMed 8026260]

148. Labenz J, Börsch G. Highly significant change of the clinical course of relapsing and complicated peptic ulcer disease after cure of Helicobacter pylori infection. Am J Gastroenterol. 1994; 89:1785-8. [IDIS 336721] [PubMed 7942667]

149. Wang WM, Chen CY, Jan CM et al. Long-term follow-up and serological study after triple therapy of Helicobacter pylori-associated duodenal ulcer. Am J Gastroenterol. 1994; 89:1793-6. [IDIS 336723] [PubMed 7942669]

150. Savarino V, Mela GS, Zentilin P et al. Acid inhibition and amoxicillin activity against Helicobacter pylori. Am J Gastroenterol. 1993; 88:1975-6. [IDIS 321725] [PubMed 8237959]

151. Anon. Drugs for treatment of peptic ulcer. Med Lett Drugs Ther. 1994; 36:65-7. [PubMed 7912812]

152. Freston JW. Emerging strategies for managing peptic ulcer disease. Scand J Gastroenterol. 1994; 29(Suppl 201):49-54.

153. Axon ATR. The role of acid inhibition in the treatment of Helicobacter pylori infection. Scand J Gastroenterol. 1994; 29(Suppl 201):16-23.

154. Labenz J, Rühl GH, Bertrams J et al. Medium- or high-dose omeprazole plus amoxicillin eradicates Helicobacter pylori in gastric ulcer disease. Am J Gastroenterol. 1994; 89:726-30. [IDIS 329264] [PubMed 8172146]

155. Aujard Y, Boucot I, Brahimi N et al. Comparative efficacy and safety of four-day cefuroxime axetil and ten-day penicillin treatment of group A beta-hemolytic streptococcal pharyngitis in children. Pediatr Infect Dis J. 1995; 14:295-300. [IDIS 345876] [PubMed 7603811]

156. Klass PE, Klein JO. Therapy of bacterial sepsis, meningitis and otitis media in infants and children: 1992 poll of directors of programs in pediatric infectious diseases. Pediatr Infect Dis J. 1992; 11:702-5. [PubMed 1448307]

157. Alary M, Joly JR, Moutquin JM et al. Randomised comparison of amoxycillin and erythromycin in treatment of genital chlamydial infection in pregnancy. Lancet. 1994; 344:1461-5. [IDIS 339301] [PubMed 7968119]

158. Walsh JH, Peterson WL. The treatment of Helicobacter pylori infection in the management of peptic ulcer disease. N Engl J Med. 1995; 333:984-91. [IDIS 354448] [PubMed 7666920]

159. Hackelsberger A, Malfertheiner P. A risk-benefit assessment of drugs used in the eradication of Helicobacter pylori infection. Drug Saf. 1996; 15:30-52. [PubMed 8862962]

160. Rauws EAJ, van der Hulst RWM. Current guidelines for the eradication of Helicobacter pylori in peptic ulcer disease. Drugs. 1995; 6:984-90.

161. Soll AH. Medical treatment of peptic ulcer disease. JAMA. 1996; 275:622-9. [IDIS 361115] [PubMed 8594244]

162. van der Hulst RWM, Keller JJ, Rauws EAJ et al. Treatment of Helicobacter pylori infection: a review of the world literature. Helicobacter. 1996; 1:6-19. [PubMed 9398908]

163. Lind T, Veldhuyzen van Zanten S, Unge P et al. Eradication of Helicobacter pylori using one-week triple therapies combining omeprazole with two antimicrobials: the MACH I study. Helicobacter. 1996; 1:138-44. [PubMed 9398894]

164. Markham A, McTavish D. Clarithromycin and omeprazole: as Helicobacter pylori eradication therapy in patients with H. pylori-associated gastric disorders. Drugs. 1996; 51:161-78. [PubMed 8741237]

165. Bourke B, Jones N, Sherman P. Helicobacter pylori infection and peptic ulcer disease in children. Pediatr Infect Dis J. 1996; 15:1-13. [IDIS 359418] [PubMed 8684868]

166. Rowland M, Drumm B. Helicobacter pylori infection and peptic ulcer disease in children. Curr Opin Pediatr. 1995; 7:553-9. [PubMed 8541956]

167. Bujanover Y, Reif S, Yahav J. Helicobacter pylori and peptic disease in the pediatric patient. Pediatr Clin North Am. 1996; 43:213-34. [PubMed 8596681]

168. TAP Pharmaceuticals. Prevacid (lansoprazole) prescribing information. Lake Forest, IL: 2003 Nov.

169. Langtry HD, Wilde MI. Lansoprazole: an update of its pharmacological properties and clinical efficacy in the management of acid-related disorders. Drugs. 1997; 54:473-500. [PubMed 9279507]

171. Lederle. Methotrexate sodium tablets, methotrexate sodium for injection, methotrexate LPF sodium injection, and methotrexate sodium injection prescribing information. Pearl River, NY; 2001 Aug 28.

172. TAP Pharmaceuticals. PrevPac (lansoprazole 30-mg capsules, amoxicillin 500-mg capsules, and clarithromycin 500-mg tablets) prescribing information. Lake Forest, IL; 2002 Oct.

173. AstraZeneca. Prilosec (omeprazole) delayed release capsules prescribing information. Wilmington,DE; 2002 Jul.

174. Abbott Laboratories. Biaxin (clarithromycin) Filmtab tablets, XL Filmtab extended-release tablets, and granules for oral suspension) prescribing information. North Chicago, IL; 2003 May.

175. Salcedo JA, Al-Kawas F. Treatment of Helicobacter pylori infection. Arch Intern Med. 1998; 158:842-51. [IDIS 405335] [PubMed 9570169]

176. Klein JO. Selection of oral antimicrobial agents for otitis media and pharyngitis. Infect Dis Clin Pract. 1995; 4(Suppl 2):S88-94.

177. Pichichero ME, Cohen R. Shortened course of antibiotic therapy for acute otitis media, sinusitis and tonsillopharyngitis. Pediatr Infect Dis J. 1997; 16:680-95. [IDIS 390075] [PubMed 9239773]

179. Nocton JJ, Steere AC. Lyme disease. Adv Intern Med. 1995; 40:69-117.

181. Nadelman RB, Wormser GP. Erythema migrans and early Lyme disease. Am J Med. 1995; 98(4A):15-23S.

182. Steere AC. Musculoskeletal manifestations of Lyme disease. Am J Med. 1995; 98(4A):44S-48S. [PubMed 7726191]

183. Rees DHE, Axford JS. Lyme arthritis. Ann Rheum Dis. 1994; 53:553-6. [IDIS 336257] [PubMed 7979590]

184. Spach DH, Liles WC, Campbell GL et al. Tick-borne diseases in the United States. N Engl J Med. 1993; 329:936-47.

185. Sigal LH. Early disseminated Lyme disease: cardiac manifestations. Am J Med. 1995; 98(4A):25S-28S. [PubMed 7726189]

186. Sigal LH. Management of Lyme disease refractory to antibiotic therapy. Rheum Dis Clin North Am. 1995; 21:217-30.

187. Shapiro ED. Lyme disease in children. Am J Med. 1995; 98(4A):69S-73S. [PubMed 7726195]

188. Nadelman RB, Wormser GP. Lyme borreliosis. Lancet. 1998; 352:557-65. [IDIS 415637] [PubMed 9716075]

189. Anon. Drugs for sexually transmitted infections. Med Lett Treat Guid. 2004; 2:67-74.

190. Committee on Infectious Diseases, American Academy of Pediatrics. Red book: 2003 report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003:80-1,196-9,407-11,541-7,573-84,773.

191. Rahn DW, Felz MW. Lyme disease update. Current approach to early, disseminated, and late disease. Postgrad Med. 1998; 103:51-4, 57-9, 63-4. [IDIS 405540] [PubMed 9590986]

192. McCracken GH. Treatment of acute otitis media in an era of increasing microbial resistance. Pediatr Infect Dis J. 1998; 17:576-9. [IDIS 408842] [PubMed 9655564]

193. Klein JO. Otitis Media. Clin Infect Dis J. 1994; 19:823-33.

194. Johnson S, Gerding DN. Clostridium difficile-associated diarrhea. Clin Infect Dis. 1998; 26:1027-36. [IDIS 407733] [PubMed 9597221]

195. Gerding DN, Johnson S, Peterson LR et al for the Society for Healthcare Epidemiology of American. Position paper on Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol. 1995; 16:459-77. [PubMed 7594392]

196. Fekety R for the American College of Gastroenterology Practice Parameters Committee. Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. Am J Gastroenterol. 1997; 92:739-50 (IDIS 386628) [IDIS 386628] [PubMed 9149180]

197. American Society of Health-System Pharmacists Commission on Therapeutics. ASHP therapeutic position statement on the preferential use of metronidazole for the treatment of Clostridium difficile-associated disease. Am J Health-Syst Pharm. 1998; 55:1407-11. [IDIS 407213] [PubMed 9659970]

198. Wilcox MH. Treatment of Clostridium difficile infection. J Antimicrob Chemother. 1998; 41(Suppl C):41-6. [IDIS 407246] [PubMed 9630373]

199. Bauchner H, Adams W, Barnett E et al. Therapy for acute otitis media: preference of parents for oral or parenteral antibiotics. Arch Pediatr Adolesc Med. 1996; 150:396-9. [IDIS 366035] [PubMed 8634735]

200. Dowell SF, Butler JC, Giebink GS et al. Acute otitis media: management and surveillance in an era of pneumococcal resistance—a report from the drug-resistant Streptococcal pneumoniae Therapeutic Working Group. Pediatr Infect Dis J. 1999; 18:1-9. [IDIS 421864] [PubMed 9951971]

201. Klein JO. Current recommendations on the therapy of otitis media. Pediatr Infect Dis J. 1998; 17:1058-9. [IDIS 417358] [PubMed 9849999]

202. Klein JO. Clinical implications of antibiotic resistance for management of acute otitis media. Pediatr Infect Dis J. 1998; 17:1084-9. [IDIS 417362] [PubMed 9850003]

203. Blumer JL. Pharmacokinetics and pharmacodynamics of new and old antimicrobial agents for acute otitis media. Pediatr Infect Dis J. 1998; 17:1070-5. [IDIS 417361] [PubMed 9850001]

204. Jacobs MR. Antibiotic-resistant Streptococcus pneumoniae in acute otitis media: overview and update. Pediatr Infect Dis J. 1998; 17:947-52. [IDIS 416572] [PubMed 9802651]

205. Poole MD. Implications of drug-resistant Streptococcus pneumoniae for otitis media. Pediatr Infect Dis J. 1998; 17:953-6. [IDIS 416573] [PubMed 9802652]

206. Dowell SF, Marcy SM, Phillips WR et al. Otitis media—principles of judicious use of antimicrobial agents. Pediatrics. 1998; 101:165-71.

207. Williams RL, Chalmers TC, Stange KC et al. Use of antibiotics in preventing recurrent acute otitis media and in treating otitis media with effusion: a meta-analytic attempt to resolve the brouhaha. JAMA. 1993; 270:1344-51. [IDIS 319598] [PubMed 8141875]

208. Stool SE, Berg AO, Berman S et al for the Otitis Media Guideline Panel. Otitis media with effusion in young children. Clinical Practice Guideline. Number 12. AHCPR Publication No. 94-0622. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Resources. July 1994.

209. Berman S. Otitis media in children. N Engl J Med. 1995; 332:1560-5. [IDIS 348227] [PubMed 7739711]

210. Bluestone CD. Current therapy for otitis media and criteria for evaluation of new antimicrobial agents. Clin Infect Dis. 1992; 14(Suppl 2):S197-203. [IDIS 297197] [PubMed 1617038]

211. White LL, Holimon TD, Tepedino JT et al. Antimicrobials prescribed for otitis media in a pediatric Medicaid population. Am J Health-Syst Pharm. 1996; 53:2963-9. [IDIS 376955] [PubMed 8974159]

212. Block SL, Harrison CJ, Hedrick JA et al. Penicillin-resistant Streptococcus pneumoniae in acute otitis media: risk factors, susceptibility patterns and antimicrobial management. Pediatr Infect Dis J. 1995; 14:751-9. [IDIS 354053] [PubMed 8559623]

213. Oh PI, Maerov P, Pritchard D et al. A cost-utility analysis of second-line antibiotics in the treatment of acute otitis media in children. Clin Ther. 1996; 18:160-82. [IDIS 362007] [PubMed 8851461]

214. Perry BP, Zieno SA, Yonkers AJ. Outcome-oriented managed care comparing efficacies of cefaclor and amoxicillin in acute and recurrent acute otitis media. Ear Nose Throat J. 1995; 74:840-4. [PubMed 8556984]

215. Cohen R, Navel M, Grunberg J et al. One dose ceftriaxone vs. ten days of amoxicillin/clavulanate therapy for acute otitis media: clinical efficacy and change in nasopharyngeal flora. Pediatr Infect Dis J. 1999; 18:403-9. [IDIS 428911] [PubMed 10353511]

216. Ball P. Therapy for pneumococcal infection at the millennium: doubts and certainties. Am J Med. 1999; 107(Suppl 1A):77S-85S. [IDIS 432333] [PubMed 10451013]

217. Adderson EE. Preventing otitis media: medical approaches. Pediatr Ann. 1998; 27:101-7. [PubMed 9523298]

218. Hoppe HL, Johnson CE. Otitis media: focus on antimicrobial resistance and new treatment options. Am J Health-Syst Pharm. 1998; 55:1881-97. [IDIS 411525] [PubMed 9784768]

219. Bluestone CD. Ear and mastoid infections. In: Gorbach SL, Bartlett JG, Blacklow NR, eds. Infectious Diseases. Philadelphia, PA: WB Saunders; 1998:530-9.

220. Roark R, Berman S. Continuous twice daily or once daily amoxicillin prophylaxis compared with placebo for children with recurrent acute otitis media. Pediatr Infect Dis J. 1997; 16:376-81. [IDIS 385372] [PubMed 9109139]

221. Thomsen J, Sederberg-Olsen J, Balle V et al. Antibiotic treatment of children with secretory otitis media: amoxicillin-clavulanate is superior to penicillin V in a double-blind randomized study. Arch Otolaryngol Head Neck Sur. 1997; 123:695-9.

222. Mandel EM, Casselbrant ML, Rockette HE et al. Efficacy of antimicrobial prophylaxis for recurrent middle ear effusion. Pediatr Infect Dis J. 1996; 15:1074-82. [IDIS 378157] [PubMed 8970215]

223. Marchisio P, Principi N, Sala E et al. Comparative study of once-weekly azithromycin and once-daily amoxicillin treatments in prevention of recurrent acute otitis media in children. Antimicrob Agents Chemother. 1996; 40:2732-6. [IDIS 376323] [PubMed 9124831]

224. Casselbrant ML, Kaleida PH, Rockette HE et al. Efficacy of antimicrobial prophylaxis and of tympanostomy tube insertion for prevention of recurrent acute otitis media: results of a randomized clinical trial. Pediatr Infect Dis J. 1992; 11:278-86. [PubMed 1565551]

225. Berman S, Nuss R, Roark R et al. Effectiveness of continuous vs. intermittent amoxicillin to prevent episodes of otitis media. Pediatr Infect Dis J. 1992; 11:63-7. [PubMed 1741200]

226. Heikkinen T, Ruuskanen O, Ziegler T et al. Short-term use of amoxicillin-clavulanate during upper respiratory tract infection for prevention of acute otitis media. J Pediatr. 1995; 126:313-6. [IDIS 342675] [PubMed 7844685]

227. Mandel EM, Rockette HE, Paradise JL et al. Comparative efficacy of erythromycin-sulfisoxazole, cefaclor, amoxicillin or placebo for otitis media with effusion in children. Pediatr Infect Dis J. 1991; 10:899-906. [PubMed 1766705]

228. Centers for Disease Control and Prevention. Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2000; 49(No. RR-15):1-22. [IDIS 439515] [PubMed 10993565]

229. Dixon TC, Meselson M, Guillemin J et al. Anthrax. N Engl J Med. 1999; 341:815-26. [IDIS 432452] [PubMed 10477781]

230. Turnball PCB. Guidelines for surveillance and control of anthrax in human and animals. 3rd ed. Geneva, Switzerland: World Health Organization, Department of Communicable Diseases Surveillance and Response. Publication No. WHO/EMC/ZSI./98.6. 1998. From WHO website

231. Inglesby TV, O’Toole T, Henderson DA et al for the Working Group on Civilian Biodefense. Anthrax as a biological weapon 2002: updated recommendations for management. JAMA. 2002; 287:2236-52. [IDIS 480001] [PubMed 11980524]

232. Steere AC. Lyme disease. N Engl J Med. 2001; 345:115-25. [IDIS 467351] [PubMed 11450660]

233. Centers for Disease Control and Prevention. Update: Investigation of anthrax associated with intentional exposure and interim public health guidelines, October 2001. MMWR Morb Mortal Wkly Rep. 2001; 50:889-93. [IDIS 471389] [PubMed 11686472]

234. Centers for Disease Control and Prevention. Update: Investigation of bioterrorism-related anthrax and interim guidelines for exposure management and antimicrobial therapy, October 2001. MMWR Morb Mortal Wkly Rep. 2001; 50:909-19. [IDIS 471910] [PubMed 11699843]

235. US Army Medical Research Institute of Infectious Disease. USAMRIID’s medical management of biologic casualties handbook. 4th ed. USAMRIID: Fort Detrick, MD; 2001 Feb.

236. Centers for Disease Control and Prevention. Updated recommendations for antimicrobial prophylaxis among asymptomatic pregnant women after exposure to Bacillus anthracis. 2001; 50:960.

237. Swartz MN. Recognition and management of anthrax—an update. N Engl J Med. 2001; 345:1621-6. [IDIS 476730] [PubMed 11704686]

238. Wormser GP, Nadelman RB, Dattwyler R et al. Infectious Diseases Society of America. Practice guidelines for the treatment of Lyme disease. Clin Infect Dis. 2000; 31(Suppl 1):S1-14. [PubMed 10982743]

239. Centers for Disease Control and Prevention. Notice to readers: update: interim recommendations for antimicrobial prophylaxis for children and breastfeeding mothers and treatment of children with anthrax. MMWR Morb Mortal Wkly Rep. 2001; 50:1014-6. [PubMed 11724160]

240. Dajani A, Taubert K, Ferrieri P et al and the Committee on Rheumatic Fever et al. Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever: a statement for health professionals. Pediatrics. 1995; 96:758-64. [IDIS 355409] [PubMed 7567345]

241. Cooper RJ, Hoffman JR, Bartlett JG et al. Principles of appropriate antibiotic use for acute pharyngitis in adults: background. Ann Intern Med. 2001; 134:509-17. [IDIS 460578] [PubMed 11255530]

242. Bisno AL, Gerber MA, Gwaltney JM et al. Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Clin Infect Dis. 2002; 35:113-25. [IDIS 484228] [PubMed 12087516]

243. Centers for Disease Control and Prevention. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2000; 49(No. RR-9):1-55. [IDIS 439515] [PubMed 10993565]

244. American Academy of Pediatrics and American Academy of Family Physicians Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics. 2004; 113:1451-65. [PubMed 15121972]

245. American Academy of Pediatrics, American Academy of Family Physicians, American Academy of Otolaryngology-Head and Neck Surgery et al. Otitis media with effusion. Pediatrics. 2004; 113:1412-29. [PubMed 15121966]

Hide
(web4)