What Is the Connection Between Metronidazole and Amoxicillin?

Amoxicillin, also known as amoxicillin or amoxicillin, is a most commonly used semi-synthetic penicillin broad-spectrum -lactam antibiotic. It is a white powder with a half-life of approximately 61.3 minutes. Stable under acidic conditions, the gastrointestinal absorption rate reaches 90%. Amoxicillin has a strong bactericidal effect and a strong ability to penetrate cell membranes. It is one of the currently widely used semi-synthetic penicillins. Its preparations include capsules, tablets, granules, dispersible tablets, etc. Now it is often combined with clavulanic acid to make dispersible tablets.

Drug Name: Amoxicillin
Alias: Amoxicillin
Foreign name: Amoxicillin
Whether prescription drugs: prescription
Main indications: Bacterial infections
Dosage: Adult 0.5g, once every 6 to 8 hours.

Adverse reactions: Nausea, vomiting, diarrhea
Dosage form: Capsules, dispersible tablets, injections
Athletes use with caution: Inadvertent use
Whether to include health insurance: Not included
Drug type: antibiotic
Forbidden crowd: Infectious diseases, lymphoma and other patients disabled

Amoxicillin compounds

Amoxicillin Basic Information

Chinese name Amoxicillin

Chinese aliases: Amo Feng, Amo Ling, Amo Xian, Amo Xin, Amoxicillin, Amoxicillin, Anfuxi, Aoxin, Flemox, Phenaxyl, Guanglin, Netamit, Qiang Billin, Power Amosian, Tellus, Xinda Benin, Yisarin, Oxacilin, Zain, Zailing Amosian, Vic Amosi

English name: Amoxicillin

English aliases: Almodan, Amolin, Bristamox, Amoxa, Amoxicilline, Amoxicillinum, Amoxicllin, Amoxil, Amoxipen, Amoxycillin, BRL-2333, Bristamox, Capsules, Clamoxil, Clamoxyl, Daxipen, Flemoxin, Larocin, Natamox, Oxetacillin

Chemical name: (2S, 5R, 6R) -3,3-dimethyl-6-[(R)-(-)-2-amino-2- (4-hydroxyphenyl) acetylamino] -7-oxygen Substituted-4-thia-1-azabicyclo [3.2.0] heptane-2-carboxylic acid trihydrate.

Phonetic name: AMOXILIN

CAS: No. 26787-78-0

SMILES: Oc1ccc (cc1) [C @@ H] (N) C (= O) N [C @@ H] 1C (= O) N2 [C @@ H] 1SC (C) (C) [C @@ H] 2C (= O) O

Molecular formula: C ₁₆ H ₁₉ N ₃ O ₅ S · 3H ₂ O

Molecular weight: 419.46

Physicochemical properties of amoxicillin

Appearance and properties: solid

Density: 1.54g / cm ³

Boiling point: 743.2ºC at 760 mmHg

Flash point: 403.3ºC

Stability: stable, incompatible with strong oxidants

Storage conditions: 2-8ºC

Vapor pressure: 3.39E-23mmHg at 25 ° C

Amoxicillin Safety Information

Customs Code: 2941109200

Danger category code: R42 / 43

Safety instructions: S22-S36 / 37

Dangerous goods sign: Xn

Amoxicillin use

Antibiotics. Amoxicillin has a strong bactericidal effect and a strong ability to penetrate the cell wall. It is one of the currently widely used oral penicillins, and its preparations include capsules, tablets, granules, dispersible tablets and so on. Penicillin allergy and penicillin skin test positive patients are contraindicated ^[1] .

Amoxicillin Pharmacopoeia Standard

Source (name), content (potency) of amoxicillin

This product is (2S, 5R, 6R) -3,3-dimethyl-6-[(R)-(-)-2-amino-2- (4-hydroxyphenyl) acetylamino] -7-oxygen Substituted-4-thia-1-azabicyclo [3.2.0] heptane-2-carboxylic acid trihydrate. Calculated as anhydrous, containing C16H19N3O5S shall not be less than 95.0%.

Amoxicillin traits

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

Specific rotation

Take this product, weigh it accurately, add water to dissolve and quantitatively dilute it to make a solution containing about 2mg per 1ml, and measure it according to law (Appendix VIE of Part Two of the Pharmacopoeia, 2010 Edition).

Amoxicillin identification

(1) Take about 0.125g each of this product and amoxicillin reference, add 4.6% sodium bicarbonate solution to dissolve and dilute each to make a solution containing about 10mg of amoxicillin per 1ml, as the test solution and reference Solution; another appropriate amount of amoxicillin reference and cefazolin reference were added, dissolved with 4.6% sodium bicarbonate solution and diluted to make a solution containing approximately 10 mg of amoxicillin and 5 mg of cefazolin per 1 ml as system applicability Test solution. According to the thin-layer chromatography (2010 edition Pharmacopoeia Part II Appendix VB) test, draw 2 l of each of the above three solutions, point them on the same silica gel GF254 thin-layer plate, and use ethyl acetate-acetone-glacial acetic acid-water (5: 2 : 2: 1) As a developing agent, unfold, dry, and inspect under UV light at 254nm. The system suitability test solution should show two clearly separated spots, and the position and color of the main spot displayed by the test solution should be the same as the position and color of the main spot of the reference solution.

(2) In the chromatogram recorded under the content determination item, the retention time of the main peak of the test solution should be consistent with the retention time of the main peak of the reference solution.

(3) The infrared light absorption spectrum of this product should be consistent with the control spectrum ("Infrared Spectra of Drugs" 441).

The above two items (1) and (2) are optional.

Amoxicillin check

acidity

Take this product, add water to make a solution containing 2mg per 1ml, and determine it according to law (Appendix VI H of the Pharmacopoeia Part II of the 2010 edition). The pH value should be 3.5 5.5.

Clarity of the solution

Take 5 parts of this product, 1.0g each, add 10ml of 0.5mol / L hydrochloric acid solution, and observe immediately after dissolution, take another 5 parts of this product, each 1.0g, add 2mol / L ammonia solution, 10ml, observe immediately after dissolution, solution All should be clarified. If it is turbid, it must not be more concentrated than the turbidity standard solution No. 2 (Appendix B of Part Two of the 2010 Pharmacopoeia).

relative substance

Take an appropriate amount of this product, accurately weigh it, add mobile phase A to dissolve and quantitatively dilute it to make a solution containing about 2.0mg per 1ml as a test solution; take another appropriate amount of amoxicillin reference substance, accurately weigh it, and use mobile Phase A was dissolved and quantitatively diluted to make a solution containing about 20 g per 1 ml as a control solution. Measured according to high performance liquid chromatography (Appendix D of Part Two of the Pharmacopoeia, 2010 edition), using octadecylsilane bonded silica as a filler; 0.05mol / L phosphate buffer (0.05mol / L potassium dihydrogen phosphate) Solution, adjust pH to 5.0 with 2mol / L potassium hydroxide solution-acetonitrile (99: 1) as mobile phase A; 0.05mol / L phosphate buffer (pH 5.0)-acetonitrile (80:20) as mobile phase Phase B; detection wavelength 254nm. Elute first with mobile phase A-mobile phase B (92; 8). After the elution of the amoxicillin peak is completed, immediately elute the linear gradient according to the table below. Take an appropriate amount of amoxicillin system suitability reference, add mobile phase A to dissolve and dilute it to make a solution containing about 2.0mg per 1ml, and take 20l into the liquid chromatograph. The recorded chromatogram should be consistent with the standard map. Take 20 l of the control solution and inject it into the liquid chromatograph, and adjust the detection sensitivity so that the peak height of the main component chromatographic peak is about 25% of the full scale. Then accurately measure 20l each of the test solution and the control solution, and inject them into the liquid chromatograph respectively to record the chromatogram. If there are impurity peaks in the chromatogram of the test solution, the area of a single impurity peak must not be greater than the area of the main peak of the control solution (1.0% ), The sum of the peak areas of each impurity must not be greater than 3 times (3.0%) the area of the main peak of the control solution, and any peaks less than 0.05 times the area of the main peak of the control solution in the chromatogram of the test solution can be ignored.

Time (minutes)	Mobile phase A (%)	Mobile phase B (%)
0	92	8
25	0	100
40	0	100
41	92	8
55	92	8

Amoxicillin polymer

It was determined by molecular exclusion chromatography (Appendix V H, Part Two of the Pharmacopoeia, 2010 Edition).

1 Chromatographic conditions and system suitability tests

Dextran gel G-10 (40 120m) was used as the filler, the inner diameter of the glass column was 1.0 1.4cm, the length of the column was 30 40cm, and the mobile phase A was 0.05mol / L phosphate buffer (0.05mol / L disodium hydrogen phosphate solution-0.05mol / L sodium dihydrogen phosphate solution (95: 5)], the mobile phase B is water, the flow rate is 1.5 ml per minute, and the detection wavelength is 254 nm. Measure 0.2 mg / ml blue 100 200l of dextran 2000 solution was injected into the liquid chromatograph, and the mobile phase A and B were used as the mobile phase for measurement and the chromatogram was recorded. According to the blue dextran 2000 peak calculation, the number of theoretical plates is not less than 500, drag The tail factor should be less than 2.0. The ratio of the retention time of the blue glucan 2000 peak in the two mobile phase systems should be between 0.93 and 1.07. The polymer peak in the control solution and the test solution should be in the corresponding chromatography system. The retention time ratio of the blue dextran 2000 peak should be between 0.93 and 1.07. Weigh about 0.2g of amoxicillin and place it in a 10ml measuring bottle, add 4ml of 2% anhydrous sodium carbonate solution to dissolve, and use 0.3 mg / ml blue dextran 2000 solution was diluted to the mark, and shaken. Measure 100 200l into the liquid chromatograph and measure with mobile phase A Record the chromatogram. The ratio of the peak height of the polymer to the valley height of the monomer and the polymer should be greater than 2.0. In addition, the mobile phase B is used as the mobile phase. Second, the relative standard deviation of the peak area should not be greater than 5.0%.

2 Preparation of control solution

Take an appropriate amount of the penicillin reference substance, accurately weigh, add water to dissolve and quantitatively dilute to make a solution containing about 0.2mg per 1ml.

3 Assay

Take about 0.2g of this product, weigh it accurately, put it in a 10ml measuring bottle, add 4ml of 2% anhydrous sodium carbonate solution to dissolve, dilute with water to the mark, shake well, immediately accurately measure 100 200l into the chromatograph to flow Phase A was measured as a mobile phase and the chromatogram was recorded. In addition, 100-200 l of the reference solution was accurately measured and injected into the chromatograph, and the mobile phase B was used as the mobile phase. Calculate the peak area according to the external standard method, and divide the result by 10 to get. Based on amoxicillin, amoxicillin-containing polymers must not exceed 0.15% (amoxicillin: penicillin = 1:10).

5 residual solvents

Weigh 0.25g of acetone and dichloromethane accurately, place it in a headspace bottle, add 5ml of dimethylacetamide to dissolve, seal, and use it as a test solution. Acetamide is quantitatively diluted to make a solution containing about 40 g of acetone and 30 g of dichloromethane per 1 ml. 5 ml is precisely measured, placed in a headspace bottle, sealed, and used as a reference solution. According to the residual solvent determination method (2010 edition Pharmacopoeia Part II Appendix P second method). Capillary column with 6% cyanopropylphenyl-94% dimethyl polysiloxane (or similar polarity) as the fixed liquid; the initial temperature is 40 ° C, maintained for 4 minutes, and then 30 ° C per minute The temperature was raised to 200 ° C for 6 minutes; the inlet temperature was 300 ° C and the detector temperature was 250 ° C; the headspace bottle equilibrium temperature was 80 ° C and the equilibration time was 30 minutes; the reference solution was sampled from the headspace Record the chromatogram. The resolution of acetone and dichloromethane should meet the requirements. Take the test solution and the reference solution for headspace injection and record the chromatograms. Calculate the peak area according to the external standard method. The content of dichloromethane should not exceed 0.12%, and the content of acetone should meet the requirements.

6 moisture

Take this product and measure it according to the Moisture Determination Method (Appendix M, Method 1, Part A of the Pharmacopoeia, 2010 Edition), and the moisture content should be 12.0% ~ 15.0%.

7Ignition residue

Take 1.0g of this product and check it according to law (Appendix N of Part Two of the 2010 Pharmacopoeia). The residual residue shall not exceed 1.0%.

Determination of amoxicillin

It was determined by high performance liquid chromatography (Appendix D, Part Two of the Pharmacopoeia, 2010 Edition).

1 Chromatographic conditions and system suitability tests

Use octadecylsilane bonded silica as filler; use 0.05mol / L potassium dihydrogen phosphate solution (adjust pH to 5.0 with 2mol / L potassium hydroxide solution)-acetonitrile (97.5: 2.5) as mobile phase; check The wavelength is 254nm. Take about 25mg of amoxicillin system suitability reference, put it into a 50ml volumetric flask, dissolve with mobile phase and dilute to the mark, shake well, take 20l into the liquid chromatograph, and the recorded chromatogram should be consistent with the standard map.

2 Assay

Take about 25mg of this product, weigh it accurately, place it in a 50ml measuring flask, add mobile phase to dissolve and dilute to the mark, shake well, and accurately measure 20l into the liquid chromatograph and record the chromatogram; also take an appropriate amount of amoxicillin reference substance , Same method. Calculate the peak area according to the external standard method.

Amoxicillin Categories

-lactam antibiotics, penicillins.

Amoxicillin storage

Shaded and sealed ^[2-3] .

Amoxicillin Drug Description

Amoxicillin dosage form specifications

Tablet: 0.125g * 50, 0.25g * 50, 0.25g * 20. Capsule: 0.12g, 0.2g, 0.5g (based on C16H19N3O5S). Injection: 0.5g. Dry syrup: 125mg, 250mg.

Pharmacological effects of amoxicillin

Amoxicillin is a semi-synthetic broad-spectrum penicillin drug. Its antibacterial spectrum and antibacterial activity are basically the same as those of ampicillin, but its acid resistance is stronger than that of ampicillin, its bactericidal effect is stronger and faster than the latter, but it cannot be used for the treatment of meningitis. . The half-life is approximately 61.3 minutes. Amoxicillin is stable under acidic conditions, and the gastrointestinal absorption rate is 90%, which is more rapid and complete than that of ampicillin. The effect is similar except that the effect on shigella is worse than that of ampicillin.

Amoxicillin has a strong bactericidal effect and a strong ability to penetrate the cell wall. After oral administration, the lactam group in the drug molecule is immediately hydrolyzed to generate peptide bonds, which is quickly combined with the transpeptidase in the bacteria to inactivate it, cutting off the only way for the bacteria to rely on transpeptidase to synthesize glycopeptides to build the cell wall. Cells quickly become spheroids, rupture and lyse, and the bacteria eventually swell and die due to the loss of cell walls and continuous penetration of water. It has strong antibacterial and bactericidal effects on most pathogenic G + and G- bacteria (including cocci and bacilli). Among them, aerobic Gram-positive cocci such as Streptococcus pneumoniae, hemolytic streptococcus, non-penicillinase-producing Staphylococcus, Enterococcus faecalis, etc., Escherichia coli, Proteus mirabilis, Salmonella, Haemophilus influenzae , Neisseria gonorrhoeae and other aerobic gram-negative bacteria that do not produce -lactamase strains and H. pylori have good antibacterial activity. Hemodialysis can clear some drugs, but peritoneal dialysis does not clear this product.

Sensitive bacteria: Streptococcus A, B, C, F, G and non-grouping, Listeria monocytogenes, diphtheria, Neisseria meningococcus, pertussis, perfringens, propionic acid Bacillus, Streptococcus bovis, Streptococcus bovis, Salmonella, Eubacterium, Actinomyces, Leptospira, Treponema pallidum.

Unstable susceptible bacteria: penicillin-sensitive or drug-resistant pneumococcus, enterococcus faecalis, E. coli, Proteus mirabilis, Shigella, Vibrio cholerae, Haemophilus influenzae, Neisseria gonorrhoeae, Clostridium.

Drug-resistant bacteria: Staphylococcus, Kata, Genus Klebsiella, Klebsiella pneumoniae, Proteus common, Pseudomonas, Acinetobacter, Campylobacter, Veillonella, Mycoplasma, Rickett Tertiary, Legionella, Mycobacterium, Fragile.

Toxicology: Unclear ^[4] .

Amoxicillin indication

Amoxicillin can be used to treat typhoid fever, other salmonella infections and typhoid carriers. Treatment of urinary tract infections caused by strains that do not produce -lactamase to sensitive bacteria has also achieved good results. For patients with lower urinary tract infections and non-enzymatic Neisseria gonorrhoeae urethritis and cervicitis, a single oral dose of 3g is sufficient. Get satisfactory results. Ear, nose, and throat infections, respiratory infections, and skin and soft tissue infections caused by Streptococcus pneumoniae, S. aureus, penicillinase-free S. aureus, and Haemophilus influenzae without -lactamase are indications. Leptospirosis is also available with amoxicillin. This product can also be used for urogenital infections caused by sensitive Escherichia coli, Proteus mirabilis and Enterococcus faecalis. This product combined with clarithromycin and lansoprazole has a good effect in the treatment of Helicobacter pylori infection.

Amoxicillin is suitable for the following infections caused by sensitive bacteria (strains that do not produce -lactamase):

(1) Upper respiratory tract infections such as otitis media, sinusitis, pharyngitis, and tonsillitis caused by Streptococcus hemolyticus, Streptococcus pneumoniae, Staphylococcus or Haemophilus influenza;

(2) urogenital infections caused by Escherichia coli, Proteus mirabilis, or Enterococcus faecalis;

(3) skin and soft tissue infections caused by hemolytic streptococcus, staphylococcus or Escherichia coli;

(4) Acute bronchitis, pneumonia and other lower respiratory tract infections caused by Streptococcus hemolyticus, Streptococcus pneumoniae, Staphylococcus or Haemophilus influenza;

(5) Acute simple gonorrhea;

(6) can be used to treat typhoid fever, other salmonella infections, typhoid carriers, and leptospirosis; amoxicillin can also be combined with clarithromycin and lansoprazole to eradicate stomach and duodenal Helicobacter pylori, reduce Recurrence rate of gastrointestinal ulcer.

Amoxicillin adverse reactions

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

1. Symptoms of allergic reactions: drug fever, urticaria, rash and asthma can occur, especially in patients with infectious mononucleosis, and anaphylactic shock is rare.

2. Symptoms of the digestive system: diarrhea, nausea, vomiting are common, and gastrointestinal reactions such as pseudomembranous colitis are occasionally seen.

3. Hematological symptoms: occasional eosinophilia, leukopenia, thrombocytopenia, anemia, etc.

4. Skin and mucosal reactions: occasional maculopapular rash, exudative erythema polymorpha, Lyell syndrome, exfoliative dermatitis.

5. Liver and kidney dysfunction: A small number of patients occasionally saw a slight increase in serum aminotransferase and acute interstitial nephritis after administration.

6. Others: central nervous system symptoms such as excitement, anxiety, insomnia, dizziness, and abnormal behavior. Long-term use of this drug can cause double infection caused by Candida or drug-resistant bacteria.

7. Convulsions and eosinophilia can be seen when the intravenous injection is large.

Amoxicillin Taboo

The national health department stipulates that penicillin skin tests must be performed before using amoxicillin, and those who respond positively are banned. In addition, penicillin sodium and potassium penicillin are also penicillin antibiotics, and a skin test must be performed before use. If it is not convenient for skin test, you can take one third of a capsule first. If there is no adverse reaction after one hour, you can take it normally. If you feel unwell, go to the hospital as soon as possible.

1. People who are allergic to one penicillin may be allergic to other penicillins, and may also be allergic to penicillamine or cephalosporins. A penicillin skin test must be performed before use, and those who are positive are prohibited.

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

3. Patients with a history of allergic diseases such as asthma, eczema, hay fever, urticaria; patients with herpes virus infection, especially those with infectious mononucleosis (can increase the risk of skin adverse reactions); should be used with caution.

4. The use of copper sulfate-containing sheet reagent (R) and Fehling solution to determine urine glucose may cause false positive reactions; a small number of patients may have increased serum transaminase, increased eosinophils, and decreased white blood cells after administration.

5. Use with caution for pregnant and lactating women and children under 3 months. After application in late pregnant women, the concentration of estrogen in plasma can be reduced, but it has no effect on free estrogen and progesterone. This product can be excreted through milk, and lactating women can sensitize infants after using this product.

Amoxicillin has a variety of dosage forms, including injections, capsules, tablets, granules, etc., no matter which dosage form, the storage environment requirements are very high, it should be shaded, sealed, and stored in a cool, dark and dry place. Even if the storage conditions are suitable, during the storage of amoxicillin, chemical changes such as decomposition and polymerization may still occur, forming new allergenic substances. In hot and humid seasons, the rate of this deterioration will increase. In addition, amoxicillin and aminoglycosides (such as gentamicin, kanamycin), ciprofloxacin, and pefloxacin are contraindicated and cannot be placed in the same container. The use of amoxicillin capsules must be prescribed by a doctor, and it is both blind and dangerous to take it as a family medicine. In the course of taking amoxicillin, if you have an allergic reaction such as a rash, or a serious digestive system adverse reaction, such as diarrhea, vomiting, etc., you must stop taking the drug immediately.

Amoxicillin drug interactions

1. Probenecid can delay the renal excretion of amoxicillin (competitively reduce the renal tubular secretion of amoxicillin), extend its serum half-life, and thus increase the plasma concentration of this product.

2. Amoxicillin combined with aminoglycosides can enhance the in vitro bactericidal effect of amoxicillin on Streptococcus faecalis at sub-bacteriostatic concentrations.

3. When amoxicillin is used in combination with -lactamase inhibitors such as clavulanic acid, the antibacterial effect is significantly enhanced. Clavulanic acid can not only enhance the sensitivity of -lactamase-producing strains to amoxicillin, but also enhance the effect of amoxicillin on certain non-sensitive strains, including Bacteroides, Legionella, Nocardia Bacteria and Pseudomonas anthracis.

4. Chloramphenicol, macrolides, amines and tetracyclines can interfere with the antibacterial effect of this product in vitro, but its clinical significance is unknown.

5. When amoxicillin is used in combination with contraceptives, it can interfere with the enterohepatic circulation of the contraceptives, thereby reducing its effectiveness.

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

7. When amoxicillin is combined with methotrexate, this product can reduce the renal clearance rate of methotrexate, thereby increasing the methotrexate toxicity.

8. Food can delay the absorption of amoxicillin, but food does not significantly reduce the total amount of drug absorption.

Amoxicillin pharmacokinetics

It is quickly absorbed after oral administration, and about 75% ~ 90% can be absorbed from the gastrointestinal tract, and food has no significant effect on drug absorption. After oral administration of 0.25g and 0.5g, the peak plasma concentrations (Cmax) were 3.5 to 5.0 ml / L and 5.5 to 7.5 mg / L, respectively, and the peak time was 1 to 2 hours. This product is well distributed in most tissues and body fluids. Patients with acute exacerbation of pneumonia or chronic bronchitis had an average drug concentration of 0.52 mg / L and 0.53 mg / L in the sputum 2 to 3 hours and 6 hours after oral administration of 0.5 g of this product, respectively, while the blood drug concentration was 11 mg / L and 3.5 mg / L. Children with chronic otitis media took 1 g of this product 1 to 2 hours after oral administration, and the drug concentration in the middle ear fluid was 6.2 mg / L. Patients with tuberculous meningitis have a concentration of 0.1 g to 1.5 mg / L in the cerebrospinal fluid 2 hours after taking 1 g of this product, which is equivalent to 0.9% to 21.1% of the blood concentration in the same period. This product can pass through the placenta, and the concentration in the umbilical cord blood is 1/4 ~ 1/3 of the maternal blood concentration. It is also contained in milk, sweat and tears. The protein binding rate of amoxicillin is 17% ~ 20%. The blood clearance half-life (t1 / 2) of this product is 1 to 1.3 hours. After administration, about 24% to 33% of the dose is metabolized in the liver, and within 4 hours, 45% to 68% of the dose is eliminated from the urine with the original drug. There are still some drugs excreted through the biliary tract, and the serum half-life of patients with severe renal insufficiency can be extended to 7 hours. Hemodialysis can clear this product. Peritoneal dialysis has no effect of removing this product.

Amoxicillin administration instructions

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 to 1 mL of 0.1% epinephrine into the patient. 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 easy to hydrolyze, -lactam ring in aqueous solution is easy to cleavage, and the hydrolysis rate is accelerated with the increase of temperature, so 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.

Amoxicillin dosage

1. Oral: 0.5g for adults once every 6 to 8 hours, the daily dose does not exceed 4g; Children 20 to 40mg / kg daily, once every 8 hours. For the treatment of uncomplicated acute urinary tract infections, a single oral dose of 3g of this product is sufficient, and a 3g dose can be added after 10 to 12 hours. A single 3g dose can also be used to prevent infective endocarditis or to treat simple gonorrhea. The former is given 1 hour before oral surgery (such as tooth extraction), and the latter is often added with probenecid 1g. Newborns and premature babies take 50 mg orally once every 12 hours; severe infection can occur once every 8 hours. The half-life of this product can be extended from normal 0.9 to 2.3 hours to 5 to 20 hours in patients with advanced renal failure; therefore, patients with glomerular filtration rate of 10 to 50ml / min and less than 10ml / min The drug interval should be 8-12 hours and 16 hours, respectively. Hemodialysis can affect blood drug concentration, 1g amoxicillin should be given after each hemodialysis. 2. Intramuscular injection or dilution after intravenous infusion, 0.5 ~ 1g once, 3 to 4 times a day; children 50 ~ 100mg / kg daily, divided into 3 to 4 intravenous infusions.

Oral: 1 to 2 capsules (0.25 to 0.5 g) for adults and children weighing more than 40 kg, once every 6 to 8 hours, with a daily dose not exceeding 4 g (16 capsules); children weighing less than 40 kg are weighted 20 40mg / kg / day, divided into 2 or 3 times; 30mg / kg / day for infants under three months, divided into doses, once every 12 hours; Patients with severely impaired renal function need to adjust the dosage, including endogenous Patients with a creatinine clearance of 10 to 30 ml / min are 0.25 to 0.5 g every 12 hours. This product can be taken on an empty stomach or after a meal, and can be taken with food such as milk. Neisseria gonorrhoeae urethritis can be taken orally in a single dose of 3g ;.

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

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

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

Medication for children

still uncertain

Medication for the elderly

still uncertain

Amoxicillin poisoning

Amoxicillin (Ampicillin) is used to treat typhoid fever, other salmonella infections and typhoid carriers, urinary tract infections caused by sensitive bacteria, pneumococcus, Staphylococcus aureus which does not produce penicillinase, hemolytic streptococcus, influenzae Infected Leptospirosis. Oral absorption is good, the protein binding rate of this product is 17% to 20%, the half-life is 1 to 1.3 hours, and in the case of advanced renal failure, the half-life can be extended to 5 to 20 hours. The usual amount is 0.5 1.0g, 3 / d, orally.

Clinical manifestation

1. Common adverse reactions are gastrointestinal symptoms such as diarrhea, nausea and vomiting, which account for 3.1%.

2. The incidence of rash is about 2%. Drug fever and asthma still occur, and serum transaminase increases in some cases. Eosinophilia and granulocytopenia occur occasionally.

treatment

The main points of treatment of amoxicillin poisoning are:

1. See the related content of penicillin.

2. Hemodialysis can remove products from the blood, and peritoneal dialysis is ineffective ^[5] .

Amoxicillin overdose

A prospective study involving 51 pediatric patients suggested that amoxicillin did not cause significant clinical symptoms when administered at doses not exceeding 250 mg / Kg. There have been reports of a small number of patients with renal insufficiency and oliguria caused by amoxicillin overdose, but renal function impairment is reversible after discontinuation.

Amoxicillin Stomach Treatment

110mg bismuth potassium citrate, 4 times a day, orally 30 minutes before meals and before bedtime; amoxicillin 500mg, metronidazole 0.2g, three times a day. Omeprazole 10mg, once a day, four weeks as a course of treatment. Combined with gold phase and pollen can alleviate the symptoms of gastric disease, treat gastric disease, and also repair gastric mucosa and damaged parts of the stomach, reducing the side effects of western medicine.