What Are the Pros and Cons of Amoxicillin for Babies?

Amoxicillin is a semi-synthetic broad-spectrum penicillin, which has a strong bactericidal effect and a strong ability to penetrate cell walls. For the treatment of typhoid fever, other salmonella infections and typhoid carriers, urinary tract infections caused by sensitive bacteria and pneumococcus, penicillinase-free Staphylococcus aureus, hemolytic streptococcus, and influenza bacteria And soft tissue infections.

Amoxicillin-flucloxacillin

(Amoxicillin-flucloxacillin)

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Amoxicillin,

This product is white or off-white crystalline powder; slightly bitter. This product is slightly soluble in water.

Take this product accurately weighed, add water to dissolve and dilute to a solution containing 1mg per 1ml, measured according to law, the specific rotation is +290 degrees to +310 degrees.

Amoxicillin is a semi-synthetic broad-spectrum penicillin drug.

For the treatment of typhoid fever, other salmonella infections and typhoid carriers, urinary tract infections caused by sensitive bacteria and pneumococcus, penicillinase-free Staphylococcus aureus, hemolytic streptococcus, and influenza bacteria And soft tissue infections.

The incidence of adverse reactions in clinical application of amoxicillin is about 5-6%, and about 2% of patients discontinued due to the reaction. The main adverse reactions are:

1. Symptoms of allergic reactions can be drug fever,

1. In order to prevent the occurrence of severe allergic reactions, amoxicillin must inquire about past medical history in detail, including the history of medication, whether it has been used with penicillin, and whether there are symptoms that are easily overlooked by the patient, such as chest tightness, itching, and facial numbness , Fever, etc., and whether there are individuals or families with allergic diseases.

2. Penicillin G skin test is required for intramuscular injection or intravenous administration of amoxicillin. Those who respond positively to skin test cannot use this drug.

3. In the medication, if an allergic reaction occurs, you must rescue it in place. Immediately intramuscularly inject 0.5-1 mL of 0.1% epinephrine into the patient, and if necessary, dilute with 5% glucose injection or sodium chloride injection for intravenous injection. Those with no improvement in clinical manifestations will repeat the procedure after half an hour; those with cardiac arrest can be injected intracardially with epinephrine, while intravenously injecting large doses of adrenocorticoids, and supplementing blood volume. Those with persistently elevated blood pressure may be given vasoactive drugs such as dopamine. At the same time, antihistamines can be considered to reduce urticaria. Those who have difficulty breathing should be given oxygen inhalation or artificial respiration. Those with obvious edema of the throat should be tracheotomy in time.

4. Amoxicillin oral preparations are only used for mild to moderate infections. It should be taken after meals to reduce gastrointestinal reactions.

5. Amoxicillin is very soluble in water, and the -lactam ring in the aqueous solution is easy to crack, and the hydrolysis rate will accelerate with the increase of temperature. Therefore, the injection solution should be prepared fresh, and it should not be stored for a long time after preparation.

6. Amoxicillin and aminoglycoside drugs (such as gentamicin, kanamycin), ciprofloxacin, pefloxacin and other drugs are contraindicated, and should not be placed in the same container when combined.

7. Severe persistent diarrhea (possibly pseudomembranous colitis) during or after treatment must be discontinued.

8. Treatment of overdose: supportive and symptomatic treatment can be taken when overdose.

9. Because its absorption in the gastrointestinal tract is not affected by food, it can be taken on an empty stomach or after a meal, and can be taken with food such as milk.

10. Patients with infectious mononucleosis should not use this medicine.

Oral: 1-4g / d for adults, divided into 3-4 times; children: 50-100mg / kg / d.

Intramuscular injection: 0.5-1g / time, 3-4 times a day.

Intravenous infusion: 0.5-1g / time, 3-4 times a day.

Patients with severe renal insufficiency should prolong the interval between medications; those with a glomerular filtration rate of 10-15 ml / min will be given once every 8-12 hours; those with less than 10 ml / min will be given once every 12-16 hours.

[Medication for pregnant and lactating women]

Animal reproduction tests showed that amoxicillin at 10 times the human dose did not damage fertility and fetuses in rats and mice. However, there is not enough controlled studies in humans. Given that animal reproduction tests cannot fully predict human response, pregnant women should only use this product when it is really necessary. Because a small amount of amoxicillin is secreted in milk, the baby can cause allergies after taking it.

preparation

Amoxicillin tablets: 0.125g / tablet; 0.25g / tablet

Amoxicillin capsules: (1) 0.125g (2) 0.25g (3) 0.5g

Amoxicillin sodium for injection: 0.5g / branch

Whether Medicare medication: Non-medical insurance

Whether over-the-counter: prescription

Drug Name

Flucloxacillin Sodium Amoxicillin Capsules

[English or Latin name]

Flucloxacillin Sodium and Amoxicillin Capsules

[Chinese Pinyin]

Fulüxilinna Amoxilin Jiaonang

[Main ingredients]

This product is a compound preparation, and its component is flucloxacillin sodium amoxicillin.

[Character]

The capsule of this product is white or off-white powder with hygroscopicity.

[Pharmacology and Toxicology]

This product is a compound antibiotic composed of amoxicillin and flucloxacillin sodium according to a 1: 1 ratio of amoxicillin and flucloxacillin. Amoxicillin is a semi-synthetic broad-spectrum penicillin and belongs to the class of amino penicillins. It has bactericidal effect on Gram-negative and positive bacteria, which is characterized by broad-spectrum and intolerance to penicillinase. Flucloxacillin is a semi-synthetic isoxazole penicillin, which is not easy to be destroyed by penicillinase, and has a bactericidal effect on penicillin-resistant drug-resistant Staphylococcus aureus. It is mainly used for penicillin-resistant Staphylococcus infection, but Gram-negative bacteria are resistant to flucloxacillin. The mechanism of antibacterial action of the two is the same as that of penicillin. They both bind to bacterial penicillin binding proteins (PBPs) and interfere with the synthesis of bacterial cell walls.

The combination of amoxicillin and flucloxacillin sodium can play an antibacterial effect on staphylococcal enzyme-producing strains and some gram-negative bacteria sensitive strains.

Pharmacokinetics

This product is well absorbed by mouth and has a bioavailability of 90%. Wide distribution in the body, high concentration in tissue fluid.

Oral flucloxacillin sodium 250mg 1g, the plasma drug concentration reached a peak after 1 hour, and the Cmax value was about 5 15g / ml. Effective plasma concentration can be maintained for nearly 4 hours. Eating reduces the absorption of the drug through the gastrointestinal tract. After oral absorption of flucloxacillin sodium, more than 95% of it is bound to plasma proteins. Most of the flucloxacillin sodium is cleared in the form of the original drug through renal tubular secretion and glomerular filtration. Within 6 hours after oral administration, the recovery rate of the original drug in the urine accounted for about 50% of the administered dose. The half-life (t1 / 2) is 1.31 to 1.39 hours. The elderly and patients with renal failure have reduced flucloxacillin clearance, and patients with creatinine clearance below 10 mL / min need to adjust the dose.

After oral administration of amoxicillin, absorption is rapid, and about 75% to 90% can be absorbed from the gastrointestinal tract, and the effect of food on drug absorption is not significant. After oral administration of 0.25g and 0.5g, the peak plasma concentrations (Cmax) were 3.5 to 5.0 mg / L and 5.5 to 7.5 mg / L, respectively, and the peak time was 1 to 2 hours. Amoxicillin is well distributed in most tissues and fluids. The protein binding rate of amoxicillin is 17% to 20%. The blood elimination half-life of this product (t1 / 2 () is 1 to 1.3 hours, about 24% to 33% of the administered amount is metabolized in the liver after taking the drug, and 45% to 68% of the administered amount is self-uriated with the original drug within 6 hours. It is excreted in the middle, and some drugs are excreted through the biliary tract. The serum half-life of patients with severe renal insufficiency can be extended to 7 hours. Hemodialysis can clear this product, while peritoneal dialysis has no effect.

[Indications]

This product is suitable for respiratory infections, digestive system infections, urinary tract infections, skin and soft tissue infections, bone and joint infections, oral and ENT infections caused by sensitive bacteria.

[Usage and dosage]

oral. Adult: 500mg (2 capsules) 3 times a day.

Children 2 to 12 years old: 250 mg (1 capsule) 3 times a day.

Severe patients can moderately increase the dosage. To ensure maximum absorption of the drug, it should be administered on an empty stomach, usually taken 1 hour before a meal.

Adverse reactions

1. Allergic reactions: more common, including rash, drug fever, asthma, etc., may cause anaphylactic shock.

2. Gastrointestinal reactions: including nausea, vomiting, diarrhea, and occasionally pseudomembranous enteritis.

3. Hepatotoxic type: A few patients have increased ALT and AST after administration, and there have been reports of acute liver cholestasis.

4. Renal toxicity: occasional reports of acute interstitial nephritis.

5. Nervous system response: High-dose intravenous flucloxacillin can cause nervous system reactions such as headache, convulsions, and convulsions, and this reaction is particularly easy to see in patients with impaired renal function. Occasional reports of excitement, anxiety, or insomnia.

6. Hematological reactions: occasional reports of neutropenia, eosinophilia, thrombocytopenia, or hemolytic anemia.

7. Long-term, high-dose medication can cause dysbiosis and a double infection caused by Candida or drug-resistant bacteria.

Contraindications

1. People who are allergic to any of the ingredients of this medicine or other penicillin drugs.

2. Patients with infectious mononucleosis, cytomegalovirus infection, lymphocytic leukemia, and lymphoma.

Precautions

1. During the treatment of penicillin, severe or even fatal allergic reactions have occurred. Therefore, before using any penicillin drugs, the patient must be asked about the allergy of penicillins, cephalosporins and other allergens. If an allergic reaction occurs during the use of this product, the drug should be discontinued immediately and the appropriate alternative treatment should be used. If a severe allergic reaction occurs, the drug should be discontinued immediately and symptomatic treatment with epinephrine, corticosteroids and antihistamines.

2. Penicillin skin allergy test should be performed before use. If the result is positive, this product should be banned.

3. People with a history of allergic diseases such as asthma, eczema, hay fever, urticaria and allergies should be used with caution.

4. During the long-term use of this product, the functions of patients' kidneys, livers and blood systems should be monitored periodically.

5. In the process of using this product, repeated infection by mold and bacteria may occur. In the event of repeated infections (usually involving Aerobacter, Pseudomonas and Candida), medication should be discontinued and treated with other alternatives.

6. It has been reported that during the long-term use of flucloxacillin, treatment-related hepatitis, especially cholestatic hepatitis, occurred. After a few weeks of treatment, jaundice may occur and most cases can recover. This product should be used with caution in patients with liver dysfunction.

7. In the long-term, large-dose use of broad-spectrum antibiotics, there have been reports of pseudomembranous colitis. Therefore, patients who use this product should pay attention to diarrhea.

[Medication for pregnant and lactating women]

Both flucloxacillin and amoxicillin pass through the placental barrier and are secreted through milk. Therefore, the use of this product by pregnant and lactating women may cause allergic reactions, diarrhea and candidiasis in infants.

The safety of flucloxacillin for women in the first stage of pregnancy has not been established, and the use of medicines in the second, third and third stages of pregnancy and lactation has no effect on newborns. A controlled clinical study of amoxicillin showed that medications during pregnancy had no significant effect on the fetus. influences. Animal tests have shown that the use of flucloxacillin and amoxicillin during pregnancy does not harm the fetus. Although limited clinical research data and animal studies have shown the safety of this product for pregnancy and lactation, considering the potential toxicity of penicillins to humans and the imperfect development of infant / fetal liver and kidney function, the pregnancy / lactation period Women should still exercise caution when using this product.

[Child medication]

Both flucloxacillin and amoxicillin have clinical experience in children and newborns. The dose can be adjusted to 1/4 to 1/2 of the adult dose, and the liver and kidney function of children should be monitored during the period of administration (see Usage and Dosage).

[Medication for elderly patients]

Due to the decline of physiological renal function, the dosage of this product and the interval between medications need to be adjusted.

medicine interactions

1. When flucloxacillin and amoxicillin are used together with probenecid, they can reduce the renal tubular secretion of flucloxacillin and amoxicillin, leading to an increase in blood concentration and prolonged drug half-life.

2. The use of this product with typhoid vaccine can reduce the immune effect of typhoid vaccine. The possible mechanism is that this product has antibacterial activity against Salmonella typhi.

3. Since bacteriostatic drugs (chloramphenicol, erythromycin, sulfonamide, or tetracyclines) can interfere with the bactericidal effect of bactericidal drugs such as penicillin, when treating meningitis or other diseases requiring rapid bactericidal effects This product is best avoided in combination with bacteriostatic drugs.

4. This product may reduce the contraceptive effect of oral contraceptives containing estrogen.

5. The combination of methotrexate and penicillin drugs will reduce the clearance rate of methotrexate and cause poisoning; it is thought to be caused by competition of renal tubule secretion; the condition needs to be closely monitored; the amount of folinic acid and the medication time need to be increased.

6. Allopurine uric acid synthesis inhibitors can increase the risk of skin adverse reactions.

specification

0.25g (125mg flucloxacillin and 125mg amoxicillin)

Storage

Keep in a cool, dry place.

package

Aluminum blister pack.

[Validity Period]

Tentative 12 months.

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