AMOXICILLIN

Drugs in Pregnancy and Lactation.
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Name: AMOXICILLIN
Class: Antibiotic (Penicillin)
Risk Factor:    BM

Fetal Risk Summary

Amoxicillin is a penicillin antibiotic similar to ampicillin (see also Ampicillin). No reports linking its use to congenital defects have been located.

Reproduction studies have been conducted in mice and rats at doses up to 10 times the human dose (1). No effect on fertility or fetal harm was observed at this dose.

The Collaborative Perinatal Project monitored 50,282 mother-child pairs, 3,546 of which had 1st trimester exposure to penicillin derivatives (2, pp. 297– 313). For use anytime during pregnancy, 7,171 exposures were recorded (2, p. 435). In neither group was evidence found to suggest a relationship to large categories of major or minor malformations or to individual defects. Amoxicillin has been used as a single 3-g dose to treat bacteriuria in pregnancy without causing fetal harm (3,4).

In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 8,538 newborns had been exposed to amoxicillin during the 1st trimester (F. Rosa, personal communication, FDA, 1993). A total of 317 (3.7%) major birth defects were observed (363 expected). Specific data were available for six defect categories, including (observed/expected) 76/85 cardiovascular defects, 16/14 oral clefts, 6/7 spina bifida, 17/24 polydactyly, 9/16 limb reduction defects, and 22/22 hypospadias. These data do not support an association between the drug and the defects.

Amoxicillin depresses both plasma-bound and urinary excreted estriol (see also Ampicillin) (5). Urinary estriol was formerly used to assess the condition of the fetoplacental unit, but this is now done by measuring plasma unconjugated estriol, which is not usually affected by amoxicillin.

Breast Feeding Summary

Amoxicillin is excreted into breast milk in low concentrations. Following a 1-g oral dose given to six mothers, peak milk levels occurred at 4-5 hours, averaging 0.9 µg/mL (range 0.68–1.3 µg/mL) (6). Mean milk:plasma ratios at 1, 2, and 3 hours were 0.014, 0.013, and 0.043, respectively. Although no adverse effects have been observed, three potential problems exist for the nursing infant: modification of bowel flora, direct effects on the infant (e.g., allergy or sensitization), and interference with the interpretation of culture results if a fever workup is required. The American Academy of Pediatrics considers amoxicillin to be compatible with breast feeding (7).



References

  1. Product information. Amoxil. SmithKline Beecham Pharmaceuticals, 2000.
  2. Heinonen OP, Slone D, Shapiro S. Birth Defects and Drugs in Pregnancy. Littleton, MA:Publishing Sciences Group, 1977.
  3. Masterton RG, Evans DC, Strike PW. Single-dose amoxicillin in the treatment of bacteriuria in pregnancy and the puerperium-a controlled clinical trial. Br J Obstet Gynaecol 1985;92:498–505.
  4. Jakobi P, Neiger R, Merzbach D, Paldi E. Single-dose antimicrobial therapy in the treatment of asymptomatic bacteriuria in pregnancy. Am J Obstet Gynecol 1987;156:1148–52.
  5. Van Look PFA, Top-Huisman M, Gnodde HP. Effect of ampicillin or amoxicillin administration on plasma and urinary estrogen levels during normal pregnancy. Eur J Obstet Gynaecol Reprod Biol 1981;12:225–33.
  6. Kafetzis D, Siafas C, Georgakopoulos P, Papadatos C. Passage of cephalosporins and amoxicillin into the breast milk. Acta Paediatr Scand 1981;70:285–8.
  7. Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:137–50.

Index

Q&A about Amoxicillin

jwsmiles...
Amoxicillin?
My doctor put me on Amoxicillin for a toe infection I've had this medicine before. Last night I started getting huge cold sores on my bottom lip and now today I have five more for a total of 11. Does anyone know if this could be a side effect of this medicine? Should I contact my doctor?
Giggles
Antibiotics kill the good bacteria in your body as well as the bad. This may be a side effect, defiantly ask your doc.

You can eat yogurt , which has live cultures, or take acidophilus pills to add back the good bacteria.
Stephen J
What's the difference between flucloxacillin and amoxicillin?
What's the difference between flucloxacillin and amoxicillin in terms of treatment? What are these drugs used for? Which one is better to use?
Indiana Frenchman
Flucloxacillin is often used for the treatment of serious infections due to sensitive staphylococci. The pharmacokinetic (PK)-pharmacodynamic (PD) breakpoint of flucloxacillin has not been determined by the use of population PK. Targets based on the duration of non-protein-bound concentrations above the MIC (fT>MIC) best correlate with clinical cure rates for beta-lactams

check web page for full study results
SIAN G
Is it okay to take amoxicillin capsules 500mg with Sudafed Decongestants?
I got a chest infection combined with a blocked up nose. I have been prescribed Amoxicillin Capsules for my chest but I still have a blocked nose....Can I take these together? As I would like to be able to breath through my nose!
Rita S
This would be a very good question for your pharmacist. You have not mentioned any other medical conditions, but often Sudafed cannot be taken with other conditions. As for the nasal congestion, maybe a vaporizer would help. Any time you can treat a symptom without additional medication, you will be better off. Good Luck and I hope you feel better soon.
MissyMay
What kind of effect does Amoxicillin have on birth conrtol?
I am on ortho tri cyclen lo and recently had to take amoxicillin. I had sex a few times while on both medications. I know that a back up method is suggested, so I used the withdrawal method (i know not quite as good as condoms). Do you think I will be ok and not pregnant?
doggiemo...
Uh, is that really a chance you're willing to take? For goodness sakes, if you can't wait until you're off the antibiotics, then use a condom. It's not forever!
pooter
What are the side effects for dog amoxicillin?
We just adopted a dog a few days ago. The former owner said the dog just came down with kennel cough two days prior and gave us a bottle of medication (amoxicillin) for the dog. Since she has been on the meds, she has not pooped yet and has peed only on a few occasions over a two day period. Could this be a side effect of the meds? The owner told us the 1 1/2 year old is housebroken but maybe not, i dont know what to do/.
krissy p
The dog is most likely dehydrated or just frightened by the change of owners, when my friend moved to a new house her dog wouldn't go for days.
Nanoka
What do amoxicillin pills do for you after getting your wisdom teeth removed?
So I was given amoxicillin pills to take 3 times a day until they run out after getting my wisdom teeth removed. I know they're antibiotics, but what are they supposed to be preventing/treating? What sort of infection? Dry socket which I hear is a deep bone infection or just a general infection of the gum?
Marilyn B
Besides preventing an infection from starting at the site of your tooth extraction, it's to keep the nasty bacteria in your mouth from traveling to your heart and other organs and starting up a new infection there. People with heart conditions are ALWAYS put on antibiotics--sometimes even prior to--major, invasive dental work.
writingm...
How long does it usually take for amoxicillin to kick in?
I have strep throat and started taking amoxicillin for it yesterday. I am wondering when I will start to feel better. Thanks!
mdGreg C
I Think you Would Feel Better In At Least 24 Hrs., Amoxicillin is a Beta-Lactam, I Would Expect Almost Immediate Killing (Bacteriocidal) of Bacteria.
Kitty
If someone is allergic to amoxicillin, would it be safe for them to take penicillin?
I am just wondering. Lots of people in my family are allergic to amoxicillin, would penicillin affect them the same? Sorry if anything is spelled wrong.
Louiegir...
this is a VERY interesting question. all drugs are different, some in the tiniest ways. it does not really matter if two or more drugs are within the same family because their molecular structures are just a touch different. so you do not know until you try. for example, organic vitamins are better than not organic because of the enzyme activity around the organic molecules. the same goes with penicillin. ampicillin is the "copy" of penicillin, and for me, i can take penicillin, but not ampicillin. doctors did not understand these things or even believe them in the past because they were taught that a molecular copy of a drug is exactly the same as the organic type, which is not correct. ampicillin is different too than amoxicillin. people that are allergic to all drugs in that family might do okay with sulpha antibiotics. you can ask your doctor to tell you what allergic reactions you should watch out for. but often, it's a good idea to talk to your pharmacist--they seem to know even more about the molecular structures of drugs in the same families but of a different name.

one thing is for certain: if we take antibiotics without having real reason for them (such as trying to cure a viral cold, not a bacterial cold INFECTION), or if we do not take them as prescribed (unless you have a reaction, in which case you call your doctor immediately to get a different one), we run a great risk of coming down with infections that should be, but are not, sensitive to any antibiotic. in that case, you just might die.
melani42...
Is it safe to take amoxicillin doses 6 hours apart when it says every 12?
At the er today doctor said to give the my 2 yr old amoxicillin when we got home and then before she went tp bed. We gave it to her at 5 and she will go to sleep soon. It says every 12 hours and this will only be 6!
Ski owl
follow the doctors orders. just skip the dose give it to her in the morning when she gets up, then start the 12 hour.

don't mess around with antibiotics you don't want her illness to become resistant to them
Dia
What is the difference between amoxicillin and azithromycin?
I caught strep throat about 2 weeks ago, and I was prescribed amoxicillin. I went back for a checkup on Wednesday because even though I was done with my medication, I still felt sick. I had some blood drawn and the clinic called and said I had gotten strep again. The new prescription I got is azithromycin. What is the difference between these two medications?
Ms.D.
You probably never got over the first bout of strep and the amoxicillian is a derivative of penicillin, zithromycin is a different antibiotic, some people have had the penicillin too many times and it doesn't work anymore. zithromycin is one that is taken for 1 time and stays in the system until 5 days on its own.