II. Preparations: Amoxicillin and Ampicillin

  1. Ampicillin
    1. Child: 50-200 mg/kg/day IV divided qid
  2. Amoxicillin
    1. Maximum dose: Maximum dose: 3-4 grams/day
    2. Adult: 875 to 1000 mg orally twice daily
    3. Child
      1. Low dose: 45 mg/kg/day divided twice daily
      2. High dose: 90 mg/kg/day divided twice daily

III. Preparations: Added Beta-lactamase resistance

  1. Ampicillin Sulbactam (Unasyn)
    1. Adult: 1.5-3 grams IV every 6 hours
  2. Amoxicillin Clavulanate (Augmentin)
    1. Adult: 875 mg PO bid
    2. Child: 45 mg/kg/day divided PO bid

IV. Mechanism

  1. Same as for Natural Penicillins
  2. Penetrates outer membrane of some Gram Negatives
  3. Clavulanic acid and sulbactam bind Beta-lactamases

V. Pharmacokinetics

  1. Keep Augmentin suspension refrigerated
  2. Clavulanate suspension breaks down at room Temperature
    1. Turns brown with breakdown
    2. Loses 90% of potency after 2 days at room Temperature

VI. Pathophysiology: Bacterial Resistance Mechanisms Overcome

  1. Beta-lactamase Production
  2. Alteration of Penicillin binding protein

VIII. Adverse effects

  1. Similar to Natural Penicillins
  2. Maculopapular rash
    1. Onset 5-7 days after initiating medication
    2. Typically not IgE mediated (non-allergic)
      1. No immediate allergy (e.g. Urticaria), systemic symptoms or mucous membrane involvement
    3. Typically safe to use Amoxicillin in future if non-allergic rash alone
      1. Consider IgE Skin Testing if unclear rash etiology
    4. References
      1. Orman and Hayes in Herbert (2017) EM:Rap 17(7): 7-8
  3. Diarrhea (modifications can decrease stools to 12%)
    1. Dose exactly by kilogram for children
    2. Avoid food before dose
    3. Consider eating yogurt with each dose

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Cost: Medications

Amoxicillin (on 6/18/2017 at Walmart.com)
Amoxicillin 125mg/5ml susp (100ml) #1 bottle for $4.00 $4.00 each
Amoxicillin 125mg/5ml susp (100ml) #3 bottles for $10.00 $3.33 each
Amoxicillin 125mg/5ml susp (150ml) #1 bottle for $4.00 $4.00 each
Amoxicillin 125mg/5ml susp (150ml) #3 bottles for $10.00 $3.33 each
Amoxicillin 125mg/5ml susp (80ml) #1 bottle for $4.00 $4.00 each
Amoxicillin 125mg/5ml susp (80ml) #3 bottles for $10.00 $3.33 each
Amoxicillin 200mg/5ml susp (100ml) #1 bottle for $4.00 $4.00 each
Amoxicillin 200mg/5ml susp (100ml) #3 bottles for $10.00 $3.33 each
Amoxicillin 200mg/5ml susp (50ml) #1 bottle for $4.00 $4.00 each
Amoxicillin 200mg/5ml susp (50ml) #3 bottles for $10.00 $3.33 each
Amoxicillin 200mg/5ml susp (75ml) #1 bottle for $4.00 $4.00 each
Amoxicillin 200mg/5ml susp (75ml) #3 bottles for $10.00 $3.33 each
Amoxicillin 250mg #30 capsules for $4.00 $0.13 each
Amoxicillin 250mg #90 capsules for $10.00 $0.11 each
Amoxicillin 250mg/5ml susp (100ml) #1 bottle for $4.00 $4.00 each
Amoxicillin 250mg/5ml susp (100ml) #3 bottles for $10.00 $3.33 each
Amoxicillin 250mg/5ml susp (80ml) #1 bottle for $4.00 $4.00 each
Amoxicillin 250mg/5ml susp (80ml) #3 bottles for $10.00 $3.33 each
Amoxicillin 400mg/5ml susp (100ml) #1 bottle for $4.00 $4.00 each
Amoxicillin 400mg/5ml susp (100ml) #3 bottles for $10.00 $3.33 each
Amoxicillin 400mg/5ml susp (50ml) #1 bottle for $4.00 $4.00 each
Amoxicillin 400mg/5ml susp (50ml) #3 bottles for $10.00 $3.33 each
Amoxicillin 400mg/5ml susp (75ml) #1 bottle for $4.00 $4.00 each
Amoxicillin 400mg/5ml susp (75ml) #3 bottles for $10.00 $3.33 each
Amoxicillin 500mg #30 capsules for $4.00 $0.13 each
Amoxicillin 500mg #90 capsules for $10.00 $0.11 each
ampicillin (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
AMPICILLIN 250 MG CAPSULE Generic $0.08 each
AMPICILLIN 500 MG CAPSULE Generic $0.13 each
amoxicillin (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
AMOXICILLIN 125 MG/5 ML SUSP Generic $0.02 per ml
AMOXICILLIN 200 MG/5 ML SUSP Generic $0.03 per ml
AMOXICILLIN 250 MG CAPSULE Generic $0.08 each
AMOXICILLIN 250 MG TAB CHEW Generic $0.30 each
AMOXICILLIN 250 MG/5 ML SUSP Generic $0.02 per ml
AMOXICILLIN 400 MG/5 ML SUSP Generic $0.02 per ml
AMOXICILLIN 500 MG CAPSULE Generic $0.07 each
AMOXICILLIN 500 MG TABLET Generic $0.24 each
AMOXICILLIN 875 MG TABLET Generic $0.14 each

Ontology: Amoxicillin (C0002645)

Definition (CHV) a kind of antibiotics
Definition (CHV) a kind of antibiotics
Definition (NCI_NCI-GLOSS) A drug used to treat some bacterial infections. Amoxicillin is a form of penicillin that is made in the laboratory. It kills certain types of bacteria. It is a type of antibiotic.
Definition (NCI) A broad-spectrum, semisynthetic aminopenicillin antibiotic with bactericidal activity. Amoxicillin binds to and inactivates penicillin-binding protein (PBP) 1A located on the inner membrane of the bacterial cell wall. Inactivation of PBPs interferes with the cross-linkage of peptidoglycan chains necessary for bacterial cell wall strength and rigidity. This interrupts bacterial cell wall synthesis and results in the weakening of the bacterial cell wall and causes cell lysis.
Definition (MSH) A broad-spectrum semisynthetic antibiotic similar to AMPICILLIN except that its resistance to gastric acid permits higher serum levels with oral administration.
Definition (PDQ) A broad-spectrum, semisynthetic aminopenicillin antibiotic with bactericidal activity. Amoxicillin binds to and inactivates penicillin-binding protein (PBP) 1A located on the inner membrane of the bacterial cell wall. Inactivation of PBPs interferes with the cross-linkage of peptidoglycan chains necessary for bacterial cell wall strength and rigidity. This interrupts bacterial cell wall synthesis and results in the weakening of the bacterial cell wall and causes cell lysis. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42310&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42310&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C237" NCI Thesaurus)
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH D000658
SnomedCT 323707004, 323699003, 27658006, 372687004
LNC LP15265-9, MTHU006036
English Amoxycillin, Hydroxyampicillin, Amoxycillin [generic addn], amoxicillin, Amoxycillin [2], Amoxycillin [generic additions], AMOX, amoxicillin (medication), AMOXICILLIN, Amoxicillin [Chemical/Ingredient], amoxycillin, Amoxicilline, Amoxicillin [generic additions], Amoxycillin [2] (product), Amoxicillin [2], Amoxycillin [generic additions] (product), p-Hydroxyampicillin, Amoxycillin product, Amoxicillin (product), Amoxicillin (substance), Amoxycillin [2] (substance), Amoxycillin [generic additions] (substance), Amoxicillin, Amoxicillin product
Swedish Amoxicillin
Czech amoxicilin
Finnish Amoksisilliini
Russian GIDROKSIAMPITSILLIN, AMOKSITSILLIN, АМОКСИЦИЛЛИН, ГИДРОКСИАМПИЦИЛЛИН
Japanese アミノヒドロキシベンジルペニシリン, アモキシシリン, ヒドロキシアンピシリン
Croatian AMOKSICILIN
Polish Amoksycylina
Spanish amoxicilina (2) (producto), amoxicilina (2), amoxicilina (agregados genéricos) (producto), amoxicilina (agregados genéricos), amoxicilina (sustancia), amoxicilina, p-hidroxiampicilina, Amoxicilina, Hidroxiampicilina
French Amoxicilline
German Amoxicillin, Hydroxyampicillin
Italian Amoxicillina
Portuguese Amoxicilina, Hidroxiampicilina

Ontology: Ampicillin (C0002680)

Definition (NCI) A broad-spectrum, semi-synthetic, beta-lactam penicillin antibiotic with bactericidal activity. Ampicillin binds to and inactivates penicillin-binding proteins (PBP) located on the inner membrane of the bacterial cell wall. Inactivation of PBPs interferes with the cross-linkage of peptidoglycan chains necessary for bacterial cell wall strength and rigidity. This interrupts bacterial cell wall synthesis and results in the weakening of the bacterial cell wall and causes cell lysis. Ampicillin is stable against hydrolysis by a variety of beta-lactamases, therefore, can be used in wide range of gram-positive and -negative infections.
Definition (MSH) Semi-synthetic derivative of penicillin that functions as an orally active broad-spectrum antibiotic.
Definition (CSP) semi-synthetic derivative of penicillin that functions as an orally active broad-spectrum antibiotic.
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH D000667
SnomedCT 31087008, 387170002
LNC LP15762-5, MTHU007962
English Aminobenzyl Penicillin, Aminobenzylpenicillin, Penicillin, Aminobenzyl, 4-Thia-1-azabicyclo(3.2.0)heptane-2-carboxylic acid, 6-((aminophenylacetyl)amino)-3,3-dimethyl-7-oxo-, (2S-(2alpha,5alpha,6beta(S*)))-, (2S,5R,6R)-6-((R)-2-Amino-2-phenylacetamido)-3,3-dimethyl-7-oxo-4-thia-1-azabicyclo(3.2.0)heptane-2-carboxylic Acid, ampicillin (medication), ampicillin, Ampicillin [Chemical/Ingredient], aminobenzylpenicillin, ampicillins, Ampicillin, AMPICILLIN, Ampicillin (product), Ampicillin (substance)
Swedish Ampicillin
Czech ampicilin
Finnish Ampisilliini
German Aminobenzylpenizillin, Ampicillin, Penizillin, Aminobenzyl-
Russian PENITSILLIN, AMINOBENZIL, AMPITSILLIN, АМПИЦИЛЛИН, ПЕНИЦИЛЛИН, АМИНОБЕНЗИЛ
Japanese アミノベンジルペニシリン, アンピシリン, ペニシリン-アミノベンジル
Croatian AMPICILIN
Polish Penicylina aminobenzylowa, Ampicylina
Spanish Aminobencilpenicilina, aminobenzilpenicilina, ampicilina (producto), ampicilina (sustancia), ampicilina, Ampicilina, Aminobencil Penicilina
French Ampicilline
Italian Ampicillina
Portuguese Aminobenzilpenicilina, Ampicilina

Ontology: Unasyn (C0147814)

Concepts Organic Chemical (T109) , Antibiotic (T195)
MSH C035444
English Unasyn, Unasyn ADD-Vantage, unasyn

Ontology: Augmentin (C0591132)

Concepts Organic Chemical (T109) , Antibiotic (T195)
MSH D019980
French Augmentin
German Augmentin
English augmentin, Augmentin