Amoxicillin

Pharmacologic Category

Antibiotic, Penicillin

Dosing: Adult

Note: Amoxicillin 775 mg ER tablets (brand and generic) have been discontinued in the United States for >1 year.

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

Usual dosage range:

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

Extended release: 775 mg once daily.

Actinomycosis (off-label use):

Note: For initial therapy of mild infections or step-down therapy following parenteral treatment of severe infections.

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

Anthrax (alternative agent for penicillin-susceptible strains) (off-label use):

Note: Consult public health officials for event-specific recommendations. A high index of suspicion for emergent beta-lactam resistance during therapy is warranted (Wilson 2019).

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

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

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

Bronchiectasis (off-label use):

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

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

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

Helicobacter pylori eradication: Oral:

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

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

Sequential regimen (alternative regimen): Amoxicillin 1 g twice daily plus a standard-dose proton pump inhibitor twice daily for 5 to 7 days; followed by clarithromycin 500 mg twice daily, either metronidazole or tinidazole 500 mg twice daily, plus a standard-dose proton pump inhibitor twice daily for 5 to 7 days; some experts prefer the 10-day regimen due to the lack of data showing superiority of the 14-day sequential regimen in North America (ACG [Chey 2017]; Crowe 2020).

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

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

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

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

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

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

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

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

Otitis media, acute (alternative agent): Limited data: Oral: 500 mg every 8 hours or 875 mg every 12 hours (WHO 2001; manufacturer's labeling). Some experts use 1 g every 8 hours for patients at high risk of severe infection or resistant Streptococcus pneumoniae. Duration is 5 to 7 days for mild to moderate infection and 10 days for severe infection (Limb 2019).

Note: Some experts recommend amoxicillin/clavulanate over amoxicillin alone because of concern for decreased penicillin susceptibility in Streptococcus pneumoniae and other otopathogens (Limb 2019).

Periodontitis, severe (off-label use): Oral: 500 mg every 8 hours in combination with metronidazole for 7 to 14 days; used in addition to periodontal debridement (Caton 2018; Chow 2019; Silva-Senem 2013; Wilder 2020).

Pneumonia, community acquired, outpatient empiric therapy (patients without comorbidities or risk factors for antibiotic resistant pathogens):

Oral: 1 g 3 times daily (ATS/IDSA [Metlay 2019]); some experts prefer use of amoxicillin in combination with an antibiotic that targets atypical pathogens (File 2020). Duration is for a minimum of 5 days; patients should be clinically stable with normal vital signs before therapy is discontinued (ATS/IDSA [Metlay 2019]).

Prosthetic joint infection (off-label use):

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

Oral: 500 mg 3 times daily (IDSA [Osmon 2013]; Siqueria 2015); duration depends on patient-specific factors (Berbari 2019).

Rhinosinusitis, acute bacterial:

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

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

Skin and soft tissue infection:

Erysipelas, mild: Oral: 500 mg 3 times daily or 875 mg twice daily for 5 days, with extension to 14 days for slow response, severe infection, or immunosuppression (Spelman 2019; manufacturer's labeling).

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

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

Extended release: 775 mg once daily for 10 days.

Urinary tract infection:

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

Acute uncomplicated or simple cystitis (infection limited to the bladder and no signs/symptoms of upper tract or systemic infection) due to Enterococcus spp.: Oral: 500 mg every 8 hours or 875 mg every 12 hours for 5 days (Cole 2015; Hooton 2019a; Hooton 2019b; Murray 2019; Swaminathan 2010).

Asymptomatic group B Streptococcus bacteriuria (≥105 CFU per mL) in pregnancy: Oral: 500 mg every 8 hours or 875 mg every 12 hours for 4 to 7 days (ACOG 782 2019; Hooton 2019c; IDSA [Nicolle 2019]).

* See Dosage and Administration in AHFS Essentials for additional information.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment: Adult

Oral:

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

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

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

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

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

Extended-release:

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

CrCl <30 mL/minute: Not recommended

Hemodialysis: Not recommended.

Dosing: Hepatic Impairment: Adult

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

Dosing: Pediatric

Note: Unless otherwise specified, all pediatric dosing recommendations based on immediate-release product formulations (oral suspension, chewable tablet, tablet, and capsule). Amoxicillin 775 mg ER tablets (brand [Moxatag] and generic) have been discontinued in the US for >1 year.

General dosing, susceptible infection:

Mild to moderate infection:

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

Infants >3 months, Children, and Adolescents:

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

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

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

Anthrax:

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

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

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

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

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

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

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

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

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

Pneumonia, community-acquired: Infants ≥3 months, Children, and Adolescents:

Empiric therapy for presumed bacterial pneumonia: Oral: 90 mg/kg/day in divided doses every 12 hours; maximum daily dose: 4,000 mg/day (IDSA [Bradley 2011]).

Group A Streptococcus, mild infection or step-down therapy: Oral: 50 to 75 mg/kg/day in divided doses every 12 hours; maximum daily dose: 4,000 mg/day (IDSA [Bradley 2011]).

Haemophilus influenzae, mild infection or step-down therapy: Oral: 75 to 100 mg/kg/day in divided doses every 8 hours; maximum daily dose: 4,000 mg/day (IDSA [Bradley 2011]).

Streptococcus pneumonia, mild infection or step-down therapy (penicillin MIC ≤2 mcg/mL): Oral: 90 mg/kg/day in divided doses every 12 hours or 45 mg/kg/day in divided doses every 8 hours; maximum daily dose: 4,000 mg/day (IDSA [Bradley 2011]).

Streptococcus pneumonia, relatively resistant (penicillin MIC = 2 mcg/mL): Oral: 90 to 100 mg/kg/day in divided doses every 8 hours; dosing based on pharmacokinetic modeling; Monte Carlo simulations show that this dose provides optimal lung exposures to increase efficacy (Bradley 2010; IDSA [Bradley 2011]).

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

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

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

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

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

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

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

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

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

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

Dosing: Renal Impairment: Pediatric

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

Immediate release: Infants, Children, and Adolescents:

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

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

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

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

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

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

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

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

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

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

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

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

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

Dosing: Hepatic Impairment: Pediatric

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

Calculations

• Amoxicillin (Dental)
• Creatinine Clearance by Cockcroft-Gault
• Creatinine Clearance by Cockcroft-Gault (SI units)
• Creatinine Clearance by Cockcroft-Gault with IBW
• Creatinine Clearance by Cockcroft-Gault with IBW (SI units)
• Glomerular Filtration Rate by Abbreviated MDRD
• Glomerular Filtration Rate by Abbreviated MDRD (SI units)
• Glomerular Filtration Rate by MDRD
• Glomerular Filtration Rate by MDRD (IDMS-Traceable SCr)
• Glomerular Filtration Rate by MDRD (SI units)
• Glomerular Filtration Rate by Schwartz
• Glomerular Filtration Rate Estimate in African Americans by AASK Equation

Use: Labeled Indications

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

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

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

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

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

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

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

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

* See Uses in AHFS Essentials for additional information.

Use: Off-Label: Adult

ActinomycosisLevel of Evidence [C]

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

AnthraxLevel of Evidence [G]

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

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

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

BronchiectasisLevel of Evidence [C, G]

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

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

Endocarditis, prophylaxisLevel of Evidence [G]

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

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

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

Periodontitis, severeLevel of Evidence [B]

Data from a small, randomized, double-blind study support the use of amoxicillin, in combination with metronidazole as well as scaling and root planing, in the treatment of periodontitis Ref. In addition, clinical experience suggests the use of amoxicillin, in combination with metronidazole and scaling and root planing, in the treatment of severe periodontitis Ref.

Prosthetic joint infectionLevel of Evidence [G]

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

Level of Evidence Definitions

Level of Evidence Scale

Class and Related Monographs

Penicillins

Clinical Practice Guidelines

Acne:

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

Dyspepsia:

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

Helicobacter pylori Infection:

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

Infectious Endocarditis Prophylaxis:

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

Lyme Disease:

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

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

Opportunistic Infections:

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

Pharyngitis, Group A Streptococci:

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

Pneumonia, Community-Acquired:

ATS/IDSA, "Diagnosis and Treatment of Adults With Community-Acquired Pneumonia," 2019

Prosthetic Joint Infection:

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

Rhinosinusitis:

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

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

Sexually-Transmitted Disease:

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

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

Skin and Soft-tissue Infection:

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

Urinary Tract Infection:

IDSA/ESCMID, “International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases,” 2011

IDSA, “Infectious Diseases Society of America Guidelines for the Management of Asymptomatic Bacteriuria,” 2019

Administration: Oral

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

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

Bariatric surgery: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate. Switch to IR formulation.

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

Administration: Pediatric

Oral:

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

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

Dietary Considerations

Some products may contain phenylalanine.

Storage/Stability

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

Preparation for Administration: Adult

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

Preparation for Administration: Pediatric

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

Medication Patient Education with HCAHPS Considerations

What is this drug used for?

• It is used to treat bacterial infections.

• It may be given to you for other reasons. Talk with the doctor.

Frequently reported side effects of this drug

• Nausea

• Vomiting

• Headache

• Diarrhea

Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:

• Clostridioides (formerly Clostridium) difficile-associated diarrhea

• Stevens-Johnson syndrome/toxic epidermal necrolysis like red, swollen, blistered, or peeling skin (with or without fever); red or irritated eyes; or sores in mouth, throat, nose, or eyes.

• Vaginal pain, itching, and discharge

• Bruising

• Bleeding

• Chills

• Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Medication Safety Issues

Sound-alike/look-alike issues:

International issues:

Contraindications

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

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

Warnings/Precautions

Concerns related to adverse effects:

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

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

Disease-related concerns:

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

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

Concurrent drug therapy issues:

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

Dosage form specific issues:

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

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

* See Cautions in AHFS Essentials for additional information.

Geriatric Considerations

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

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

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

Warnings: Additional Pediatric Considerations

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

In a meta-analysis of pediatric acute otitis media trials, high-dose amoxicillin regimens were associated with a higher incidence of adverse effects compared to standard-dose; the incidence of diarrhea was 18.9% with high-dose amoxicillin/clavulanate, 13.8% with high-dose amoxicillin, and 8.7% with standard-dose amoxicillin; the incidence of generalized rash was 6.5% with high-dose amoxicillin, 4.9% with high-dose amoxicillin/clavulanate, and 2.9% with standard-dose amoxicillin; however, significant heterogeneity was observed (Hum 2019).

Pregnancy Risk Factor

B

Pregnancy Considerations

Amoxicillin crosses the placenta (Muller 2009).

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

Amoxicillin may be used for the management of Bacillus anthracis in pregnant women when penicillin susceptibility is documented (Meaney-Delman 2014). Amoxicillin is an alternative antibiotic for the treatment of chlamydial infections in pregnancy (CDC [Workowski 2015]). Amoxicillin can also be used in the management of preterm prelabor rupture of membranes (PROM) and in certain situations prior to vaginal delivery in women at high risk for endocarditis (ACOG 188 2019; ACOG 199 2018).

Breast-Feeding Considerations

Amoxicillin is present in breast milk (Kafetzis 1981).

The relative infant dose (RID) of amoxicillin is 0.15% to 0.54% when calculated using the highest average breast milk concentration located and compared to an infant therapeutic dose of 25 to 90 mg/kg/day.

In general, breastfeeding is considered acceptable when the RID is <10% (Anderson 2016; Ito 2000).

The RID of amoxicillin was calculated using a milk concentration of 0.9 mcg/mL, providing an estimated daily infant dose via breast milk of 0.135 mg/kg/day. This milk concentration was obtained following maternal administration of a single oral dose of amoxicillin 1,000 mg (Kafetzis 1981).

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

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

Lexicomp Pregnancy & Lactation, In-Depth

• Amoxicillin

Briggs' Drugs in Pregnancy & Lactation

• Amoxicillin

Adverse Reactions

1% to 10%:

Central nervous system: Headache (1%)

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

Genitourinary: Vulvovaginal infection (2%)

Frequency not defined:

Cardiovascular: Hypersensitivity angiitis

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

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

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

Genitourinary: Crystalluria

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

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

Hypersensitivity: Anaphylaxis

Immunologic: Serum sickness-like reaction

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

* See Cautions in AHFS Essentials for additional information.

Allergy and Idiosyncratic Reactions

• Penicillin Allergy

Metabolism/Transport Effects

None known.

Drug Interactions Open Interactions

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

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

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

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

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

Dichlorphenamide: Penicillins may enhance the hypokalemic effect of Dichlorphenamide. Risk C: Monitor therapy

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

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

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

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

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

Tetracyclines: May diminish the therapeutic effect of Penicillins. Risk C: Monitor therapy

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

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

Test Interactions

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

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

Monitoring Parameters

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

Advanced Practitioners Physical Assessment/Monitoring

Assess culture and sensitivity report and patient’s allergy history prior to starting therapy. Obtain CBC with differential, renal function tests (dosage adjustment may be needed), and liver function tests periodically with prolonged therapy. Screen patients for history of renal impairment, liver impairment, or active mononucleosis. Assess for signs of anaphylaxis during first dose. Assess for signs and symptoms of opportunistic infections. Assess other medication patient may be taking; alternative therapy or dosage adjustment may be needed. Test for Clostridioides (formerly Clostridium) difficile-associated diarrhea if patient develops diarrhea.

Nursing Physical Assessment/Monitoring

Check ordered labs and report any abnormalities. Monitor patients closely for signs and symptoms of hypersensitivity (shortness-of-breath, dyspnea, chest pain, complaints of difficulty swallowing or throat tightness, or change in vital signs). Monitor for severe or bloody diarrhea and send a specimen to the lab for Clostridioides (formerly Clostridium) difficile-associated diarrhea. Maintain adequate hydration unless fluid restriction is in place. Educate patients on proper administration (spacing doses evenly around the clock, timing of extended release medication with regard to meals, and mixing of suspension).

Product Availability

Amoxicillin 775 mg ER tablets (brand and generic) have been discontinued in the United States for >1 year.

Dosage Forms: US

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

Capsule, Oral:

Generic: 250 mg, 500 mg

Suspension Reconstituted, Oral:

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

Tablet, Oral:

Generic: 500 mg, 875 mg

Tablet Chewable, Oral:

Generic: 125 mg, 250 mg

Tablet Extended Release 24 Hour, Oral:

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

Generic: 775 mg [DSC]

Dosage Forms: Canada

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

Capsule, Oral:

Polymox: 250 mg, 500 mg

Generic: 250 mg, 500 mg

Suspension Reconstituted, Oral:

Moxilean 50: 50 mg/mL ([DSC])

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

Generic: 125 mg/5 mL (15 mL, 75 mL, 100 mL, 150 mL); 250 mg/5 mL (15 mL, 75 mL, 100 mL, 150 mL)

Tablet Chewable, Oral:

Generic: 125 mg, 250 mg

Anatomic Therapeutic Chemical (ATC) Classification

• J01CA04

Generic Available (US)

Yes

Pricing: US

Capsules (Amoxicillin Oral)

250 mg (per each): $0.13 - $0.25

500 mg (per each): $0.19 - $5.88

Chewable (Amoxicillin Oral)

125 mg (per each): $0.34

250 mg (per each): $0.67

Suspension (reconstituted) (Amoxicillin Oral)

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

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

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

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

Tablets (Amoxicillin Oral)

500 mg (per each): $0.50

875 mg (per each): $0.87

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

Mechanism of Action

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

Pharmacodynamics/Kinetics

Absorption: Oral:

Immediate-release: Rapid with or without food

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

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

Protein binding: ~20%

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

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

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

Dental Use

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

* See Uses in AHFS Essentials for additional information.

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

Prolonged use of penicillins may lead to development of oral candidiasis

Effects on Bleeding

No information available to require special precautions

Dental Usual Dosing

Oral:

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

Adults:

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

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

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

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

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

Related Information

• Oral Medications That Should Not Be Crushed or Altered
• Prevention of Infective Endocarditis

Index Terms

p-Hydroxyampicillin; Amoxicillin Trihydrate; Amoxil; Amoxycillin

FDA Approval Date

August 06, 1984

References

Ahlfors CE. Benzyl alcohol, kernicterus, and unbound bilirubin. J Pediatr. 2001;139(2):317-319.[PubMed 11487763]

American Academy of Pediatrics (AAP). In: Kimberlin DW, Brady MT, Jackson MA, Long SA, eds. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015.

American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin no. 188: prelabor rupture of membranes. Obstet Gynecol. 2018;131(1):e1-e14.[PubMed 29266075]

American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin no. 199: use of prophylactic antibiotics in labor and delivery. Obstet Gynecol. 2018;132(3):e103-e119.[PubMed 30134425]

American College of Obstetricians and Gynecologists (ACOG). Prevention of group B streptococcal early-onset disease in newborns: ACOG Committee Opinion, number 782. Obstet Gynecol. 2019;134(1):e19-e40. doi: 10.1097/AOG.0000000000003334.[PubMed 31241599]

American Dental Association (ADA); American Academy of Orthopedic Surgeons (AAOS). Antibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc. 2003;134(7):895-899.[PubMed 12892448]

Amoxicillin [prescribing information]. North Wales, PA: Teva Pharmaceuticals; January 2016.

Amoxil (amoxicillin) [prescribing information]. Bristol, TN: Dr Reddy’s Laboratories; December 2015.

Anderson PO, Sauberan JB. Modeling drug passage into human milk. Clin Pharmacol Ther. 2016;100(1):42-52.[PubMed 27060684]

Andrew MA, Easterling TR, Carr DB, et al. Amoxicillin pharmacokinetics in pregnant women: modeling and simulations of dosage strategies. Clin Pharmacol Ther. 2007;81(4):547-556.[PubMed 17329990]

Aronoff GR, Bennett WM, Berns JS, et al. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children. 5th ed. Philadelphia, PA: American College of Physicians; 2007:61, 153.

Baltimore RS, Gewitz M, Baddour LM, et al. Infective endocarditis in childhood: 2015 update: a scientific statement from the American Heart Association. Circulation. 2015;132(15):1487-1515.[PubMed 26373317]

Barker AF. Treatment of bronchiectasis in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed August 21, 2018.

Belarmino JM and Kogan BA. Management of neonatal hydronephrosis. Early Hum Dev. 2006;82(1):9-14.[PubMed 16427220]

Benyamini L, Merlob P, Stahl B, et al, "The Safety of Amoxicillin/Clavulanic Acid and Cefuroxime During Lactation," Ther Drug Monit, 2005, 27(4):499-502.[PubMed 16044108]

Berbari E, Baddour LM. Prosthetic joint infection: treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed May 2, 2019.

Boguniewicz M and Leung DY, “Hypersensitivity Reactions to Antibiotics Commonly Used in Children,” Pediatr Infect Dis J, 1995, 14(3):221-31.[PubMed 7761188]

Bonnefond S, Catroux M, Melenotte C, et al. Clinical features of actinomycosis: a retrospective, multicenter study of 28 cases of miscellaneous presentations. Medicine (Baltimore). 2016;95(24):e3923. doi: 10.1097/MD.0000000000003923.[PubMed 27311002]

Bradley JS, Byington CL, Shah SS, et al. “The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America”, Clin Infect Dis, 2011, 53(7):e25-76.[PubMed 21880587]

Bradley JS, Garonzik SM, Forrest A, Bhavnani SM. Pharmacokinetics, pharmacodynamics, and Monte Carlo simulation: selecting the best antimicrobial dose to treat an infection. Pediatr Infect Dis J. 2010;29(11):1043-1046. doi: 10.1097/INF.0b013e3181f42a53.[PubMed 20975453]

Bradley JS, Peacock G, Krug SE, et al; AAP Committee on Infectious Diseases and Disaster Preparedness Advisory Council. Pediatric anthrax clinical management. Pediatrics. 2014;133(5):e1411-e1436. doi: 10.1542/peds.2014-0563.[PubMed 24777226]

Bradley JS, Nelson JD, Kimberlin DK, et al, eds. Nelson's Pocket Book of Pediatric Antimicrobial Therapy. 21st ed. American Academy of Pediatrics; 2015.

Canafax DM, Yuan Z, Chonmaitree T, et al, “Amoxicillin Middle Ear Fluid Penetration and Pharmacokinetics in Children with Acute Otitis Media,” Pediatr Infect Dis J, 1998, 17(2):149-56.[PubMed 9493813 ]

Caton JG, Armitage G, Berglundh T, et al. A new classification scheme for periodontal and peri-implant diseases and conditions: introduction and key changes from the 1999 classification. J Periodontol. 2018;89(suppl 1):S1-S8. doi: 10.1002/JPER.18-0157.[PubMed 29926946]

CDC and Johns Hopkins Working Group on Civilian Biodefense, “Commentary on Non-Labeled Dosing of Oral Amoxicillin in Adults and Pediatrics for Post-Exposure Inhalational Anthrax,” December 10, 2001, http://www.fda.gov/cder/drugprepare/amox-anthrax.htm.

Centers for Disease Control (CDC). Neonatal deaths associated with use of benzyl alcohol—United States. MMWR Morb Mortal Wkly Rep. 1982;31(22):290-291. http://www.cdc.gov/mmwr/preview/mmwrhtml/00001109.htm[PubMed 6810084]

Centers for Disease Control and Prevention (CDC), "Sexually Transmitted Diseases Treatment Guidelines, 2015," MMWR Recomm Rep, 2015, 64(RR-3):1-140.[PubMed 21160459]

Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG clinical guideline: treatment of Helicobacter pylori infection [published correction appears in Am J Gastroenterol. 2018;113(7):1102]. Am J Gastroenterol. 2017;112(2):212-239. doi: 10.1038/ajg.2016.563.[PubMed 28071659]

Chow AW, Benninger MS, Brook I, et al; Infectious Diseases Society of America. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8):e72-e112.[PubMed 22438350]

Chow AW. Complications, diagnosis, and treatment of odontogenic infections. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed August 22, 2019.

Coignard-Biehler H, Lanternier F, Hot A, et al. Adherence to preventive measures after splenectomy in the hospital setting and in the community. J Infect Public Health. 2011;4(4):187-194. doi: 10.1016/j.jiph.2011.06.004.[PubMed 22000846]

Cole KA, Kenney RM, Perri MB, et al. Outcomes of aminopenicillin therapy for vancomycin-resistant enterococcal urinary tract infections. Antimicrob Agents Chemother. 2015;59(12):7362-7366.[PubMed 26369973]

Crowe SE. Treatment regimens for Helicobacter pylori. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed February 5, 2020.

Currie DC, Garbett ND, Chan KL, et al. Double-blind randomized study of prolonged higher-dose oral amoxycillin in purulent bronchiectasis. Q J Med. 1990;76(280):799-816.[PubMed 2217684]

DHHS Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Department of Health and Human Services. November 2013. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/oi_guidelines_pediatrics.pdf.

Fallone CA, Chiba N, van Zanten SV, et al. The Toronto consensus for the treatment of Helicobacter pylori infection in adults. Gastroenterology. 2016;151(1):51-69.e14.[PubMed 27102658]

File TM. Treatment of community-acquired pneumonia in adults in the outpatient setting. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed February 5, 2020.

Finegold SM, Gentry LO, Mogabgab W, Campbell SC, Skatrud J. Controlled comparative trial of bacampicillin and amoxicillin in therapy of bacterial infections of the lower respiratory tract. Rev Infect Dis. 1981;3(1):150-153.[PubMed 7012996]

Garbutt JM, Banister C, Spitznagel E, Piccirillo JF. Amoxicillin for acute rhinosinusitis: a randomized controlled trial. JAMA. 2012;307(7):685-692.[PubMed 22337680]

Gerber MA, Baltimore RS, Eaton CB, et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 2009;119(11):1541-1551. doi: 10.1161/CIRCULATIONAHA.109.191959.[PubMed 19246689]

Goldstein LH, Berlin M, Tsur L, Bortnik O, Binyamini L, Berkovitch M. The safety of macrolides during lactation. Breastfeed Med. 2009;4(4):197-200.[PubMed 19366316]

Greenbaum LA and Mesrobian HG. Vesicoureteral reflux. Pediatr Clin North Am. 2006;53(3):413-427.[PubMed 16716788]

Gupta K, Hooton TM, Naber KG, et al; Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-e120. doi: 10.1093/cid/ciq257.[PubMed 21292654]

Halperin JJ, Shapiro ED, Logigian E, et al. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2007;69(1):91-102.[PubMed 17522387]

Harris AM, Hicks LA, Qaseem A; High Value Care Task Force of the American College of Physicians and for the Centers for Disease Control and Prevention. Appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016;164(6):425-434.[PubMed 26785402]

Hendricks KA, Wright ME, Shadomy SV, et al; Workgroup on Anthrax Clinical Guidelines. Centers for Disease Control and Prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis. 2014;20(2). doi: 10.3201/eid2002.130687.[PubMed 24447897]

HHS Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. September 2015. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. Accessed October 8, 2015

Hooton TM, Gupta K. Acute simple cystitis in women. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed July 12, 2019a.

Hooton TM. Acute simple cystitis in men. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed July 12, 2019b.

Hooton TM, Gupta K. Urinary tract infections and asymptomatic bacteriuria in pregnancy. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 10, 2019c.

Hu L. Treatment of Lyme disease. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 9, 2019.

Hum SW, Shaikh KJ, Musa SS, Shaikh N. Adverse events of antibiotics used to treat acute otitis media in children: a systematic meta-analysis. J Pediatr. 2019;215:139-143.e7.[PubMed 31561959]

"Inactive" ingredients in pharmaceutical products: update (subject review). American Academy of Pediatrics (AAP) Committee on Drugs. Pediatrics. 1997;99(2):268-278.[PubMed 9024461]

Ito S, Blajchman A, Stephenson M, et al, "Prospective Follow-Up of Adverse Reactions in Breast-Fed Infants Exposed to Maternal Medication," Am J Obstet Gynecol, 1993, 168(5):1393-9.[PubMed 8498418]

Ito S. Drug therapy for breast-feeding women. N Engl J Med. 2000;343(2):118-126.[PubMed 10891521]

Jevsevar DS and Abt E, "The New AAOS-ADA Clinical Practice Guideline on Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures," J Am Acad Orthop Surg, 2013, 21(3):195-7.[PubMed 23457071]

Kafetzis DA, Siafas CA, Georgakopoulos PA, Papadatos CJ. Passage of cephalosporins and amoxicillin into the breast milk. Acta Paediatr Scand. 1981;70(3):285-288.[PubMed 7246123]

Koletzko S, Jones NL, Goodman KJ, et al. Evidence-based guidelines from ESPGHAN and NASPGHAN for Helicobacter pylori infection in children. J Pediatr Gastroenterol Nutr. 2011;53(2):230-243.[PubMed 21558964]

Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964-e999. doi: 10.1542/peds.2012-3488.

Limb CJ, Lustig LR, Durand ML. Acute otitis media in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed August 15, 2019.

Lin KJ, Mitchell AA, Yau WP, Louik C, Hernandez-Diaz S. Maternal exposure to amoxicillin and the risk of oral clefts. Epidemiology. 2012;23(5):699-705.[PubMed 22766750]

Lindbaek M, Hjortdahl P, Johnsen UL. Randomised, double blind, placebo controlled trial of penicillin V and amoxycillin in treatment of acute sinus infections in adults. BMJ. 1996;313(7053):325-329.[PubMed 8760738]

Martin MV. The use of oral amoxycillin for the treatment of actinomycosis. A clinical and in vitro study. Br Dent J. 1984;156(7):252-254.[PubMed 6584159]

Mattoo TK. Medical management of vesicoureteral reflux - quiz within the article. Don't overlook placebos. Pediatr Nephrol. 2007;22(8):1113-1120.[PubMed 17483966]

McIntosh K, "Community-Acquired Pneumonia in Children," N Engl J Med, 2002, 346(6):429-37.[PubMed 11832532]

Meaney-Delman D, Zotti ME, Creanga AA, et al; Workgroup on Anthrax in Pregnant and Postpartum Women. Special considerations for treatment of anthrax in pregnant and postpartum women. Emerg Infect Dis. 2014;20(2).[PubMed 24457117]

Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Resp Crit Care Med. 2019;200(7):e45-e67. doi:10.1164/rccm.201908-1581ST.[PubMed 31573350]

Moayyedi PM, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. ACG and CAG clinical guideline: management of dyspepsia. Am J Gastroenterol. 2017;112(7):988-1013. doi: 10.1038/ajg.2017.154.[PubMed 28631728]

Moghimi M, Salentijn E, Debets-Ossenkop Y, Karagozoglu KH, Forouzanfar T. Treatment of cervicofacial actinomycosis: a report of 19 cases and review of literature. Med Oral Patol Oral Cir Bucal. 2013;18(4):e627-e632.[PubMed 23722146]

Moxatag (amoxicillin) [prescribing information]. Locust Valley, NY: Fera Pharmaceuticals LLC; June 2015.

Muller AE, Oostvogel PM, DeJongh J, et al. Pharmacokinetics of amoxicillin in maternal, umbilical cord, and neonatal sera. Antimicrob Agents Chemother. 2009;53(4):1574-1580.[PubMed 19164154]

Murray BE. Treatment of enterococcal infections. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed June 20, 2019.

Nicolle LE, Gupta K, Bradley SF, et al. Clinical Practice Guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis. 2019;68(10):1611-1615. doi: 10.1093/cid/ciz021.[PubMed 31506700]

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

Novamoxin (amoxicillin) [product monograph]. Toronto, Ontario, Canada: Teva Canada Limited; March 2020.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Siqueira MB, Saleh A, Klika AK, et al. Chronic suppression of periprosthetic joint infections with oral antibiotics increases infection-free survivorship. J Bone Joint Surg Am. 2015;97(15):1220-1232. doi: 10.2106/JBJS.N.00999.[PubMed 26246256]

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

Spelman D, Baddour LM. Cellulitis and skin abscess in adults: treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed August 6, 2019.

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

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

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

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

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

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

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

Wilder RS, Moretti AJ. Overview of gingivitis and periodontitis in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.c. Accessed February 5, 2020.

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

Wilson KH. Treatment of anthrax. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed May 2, 2019.

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

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

World Health Organization (WHO). Breastfeeding and maternal medication, recommendations for drugs in the Eleventh WHO Model List of Essential Drugs. 2002. Available at http://www.who.int/maternal_child_adolescent/documents/55732/en/[PubMed 23215911]

Workowski KA, Bolan GA; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1-137.[PubMed 26042815]

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

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

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

Brand Names: International

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

Last Updated 4/29/20