DRUG STUDY

Generic Name:
amoxicillin

Brand Name:
Amoxil, Moxatag, Novamoxin, Trimox

Classification:
Broad-spectrum penicillin
Therapeutic: anti-infectives, antiulcer agents
Pharmacologic: aminopenicillins
Pharmacotherapeutic: Penicillin.
Clinical: Antibiotic.
Pregnancy Category B

Mechanism of Action:
Inhibits bacterial cell wall synthesis. Binds to bacterial cell walls, causing cell death.
Therapeutic Effects: To treat respiratory tract infection, urinary tract infection, otitis media, and
sinusitis

Doctor’s Order: (for actual practice)

Recommended Dosage, Route, and Frequency:

PO (Adults): 250– 500 mg q 8 hr or 500– 875 mg q 12 hr (not to exceed 2– 3 g/ day).
PO (Adults and Children 12 yr): Extended-release tablets (for Strep throat)—775 mg once daily
for 10 days.
PO (Children 3 mo): 25– 50 mg/kg/day in divided doses q 8 hr or 25– 50 mg/kg/ day individual
doses q 12 hr; Acute otitis media due to highly resistant strains of S. pneumoniae—80– 90
mg/kg/day divided q 12 hr; Postexposure inhalational anthrax prophylaxis—40 kg: 45 mg/kg/day
in divided doses q 8 hr; 40 k g: 500 mg q 8 hr.
PO (Infants 3 mo and neonates): 20– 30 mg/kg/day in divided doses q 12 hr.

Pharmacokinetics/Pharmacodynamics:
Absorption: Well absorbed from duodenum (75– 90%). More resistant to acid inactivation than
other penicillins
Distribution: PB: 20%. Diffuses readily into most body tissues and fluids. CSF penetration
increases when meninges are inflamed. Crosses placenta; enters breast milk in small amounts.
Metabolism: t ​½​: 1–1.3 hrs. Partially metabolized in the liver.
Excretion: In urine
PO
Onset: 30 min
Peak: 1–2 hr
Duration: 8–12 hr

Indications:
Treatment of: Skin and skin structure infections, Otitis media, Sinusitis, Respiratory infections,
Genitourinary infections. Endocarditis prophylaxis. Postexposure inhalational anthrax
prophylaxis. Management of ulcer disease due to Helicobacter pylori.

Contraindications:
● Hypersensitivity to amoxicillin/ penicillins (cross-sensitivity exists to cephalosporins and
other
● Allergic to penicillin, asthma, inflammatory bowel disease, pseudomembranous colitis,
ulcerative colitis
● Mononucleosis
● Hypersensitivity to cephalosporins
● Renal impairment

Side Effects:
● GI disturbances (mild diarrhea, nausea, vomiting)
● Headache
● Oral/vaginal candidiasis
● Generalized rash
● Urticaria
● Diarrhea
● Rash
● Stomatitis
● Seizures
● Pseudomembranous colitis
● Edema
● Insomnia
● Dysphagia

Adverse Reactions:
● Antibiotic-associated colitis
● Other superinfections (vaginitis, abdominal cramps, severe watery diarrhea, fever)
● Severe hypersensitivity reactions, including anaphylaxis, acute interstitial nephritis
● Blood dyscrasias
● Thrombocytopenia
● Neutropenia
● Hemolytic anemia
● Bone marrow depression
● Stevens-Johnson syndrome
● Respiratory distress
Drug-Drug Interactions:
● Probenecid ​↓ ​renal excretion and may ​↑ ​concentration, toxicity risk as well as blood
levels of amoxicillin— therapy may be combined for this purpose.
● May ​↑ ​effect of warfarin.
● May ​↓ ​effectiveness of oral contraceptives.
● Allopurinol may ​↑ ​frequency of rash
● Increase effect with aspirin, allopurinol, probenecid
● Increase bleeding with oral anticoagulants
● Increase effect of methotrexate
● Decrease effect with tetracycline, erythromycin

Drug-Food Interactions:
Decrease effect with acidic fruits or juices

Nursing Responsibilities with Rationale:

1. Obtain a history before initiating therapy. Persons with a negative history of penicillin
sensitivity may still have an allergic response.
Rationale: To determine previous use of and reactions to penicillins or cephalosporins as
patients who are hypersensitive to such are contraindicated from this medication.

2. Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC)
at beginning of and throughout therapy.
Rationale: To assess whether the patient is still indicated for the medication and to
evaluate whether desired outcomes or therapeutic effect has taken place with the
medication.

3. Observe for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema,
wheezing). Notify the health care professional immediately if these occur.
Rationale: To evaluate whether the patient is experiencing side effects with the
medication and whether there is a need for additional interventions.

4. Monitor bowel function.

Rationale: To assess whether the patient is experiencing diarrhea, abdominal cramping,
fever, and bloody stools as this should be reported to a health care professional
promptly as this is a sign of pseudomembranous colitis.

5. Administer the medication around the clock and may be given without regard to meals or
with meals.
Rationale: To follow compliance to the medication as well as to decrease gastrointestinal
side effects.

6. Instruct patients to take medication around the clock and to finish the drug completely as
directed, even if feeling better.
Rationale: To encourage the patient to be compliant in the medication regimen, maintain
the desired therapeutic dose and avoid achieving the toxic dose.
 7. Advise the patient to report the signs of superinfection (furry overgrowth on the tongue,
vaginal itching or discharge, loose or foul-smelling stools) and allergy.
Rationale: To evaluate whether the patient is experiencing adverse effects from the
medication and to become aware as to whether there is a need for additional
interventions.

8. Instruct female patients taking oral contraceptives to use an alternate or additional

non-hormonal method of contraception during therapy with amoxicillin and until the next
menstrual period.
Rationale: To avoid drug-to-drug interactions as taking in amoxicillin may decrease the
effectiveness of oral contraceptives.

9. Teach patients with a history of rheumatic heart disease or valve replacement the
importance of using antimicrobial prophylaxis before invasive medical or dental
procedures.
Rationale: To educate the patient as to the risks the medication may pose without the
use of such medications as this is for preventing infective endocarditis.

10. Teach parents or caregivers to calculate and measure doses accurately. Reinforce the
importance of using measuring devices supplied by pharmacies or with products, not
household items.
Rationale: To avoid achieving the toxic dose in order to achieve the therapeutic effect
and desired outcomes from the medication through proper compliance of the correct
dosage of the drug.

References:
Kee, J. L., Hayes, E. R., & McCuistion, L. E. (2014). ​Pharmacology: A patient-centered nursing
process approach.​ Elsevier Health Sciences.
Kizior, R. J., & Hodgson, B. B. (2018). ​Saunders nursing drug handbook 2019​. Saunders.
Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2015). ​Davis's drug guide for nurses​. Davis's
Drug Guide for Nurses.