Amoxil: Subdued Prescriptions from Doctors - in Australia

The lay of the land

Active substance: amoxicillin. Trade name commonly used: Amoxil. Available presentations include 250 mg and 500 mg tablets or capsules and a range of oral suspensions; formulation sizes and strengths vary by manufacturer.

Amoxil is an antibiotic prescribed for susceptible bacterial infections. It does not work for viral illnesses such as the common cold or seasonal influenza. Always complete the full course prescribed to lower the chance of relapse and antimicrobial resistance. Glance at the dosing examples at Dosage Information and How to Handle It Best.

• Used for many infections when the causative bacteria are likely to be sensitive to aminopenicillins.
• Part of responsible antibiotic use - take only when indicated and finish the prescribed course.
• Not suitable for pure viral or fungal infections unless a bacterial co-infection is present or strongly suspected.

What Amoxil Treats

Amoxil is selected for infections caused by bacteria that remain sensitive to amoxicillin and related penicillins. Predominant clinical uses include:

• Upper airway infections - otitis media, sinusitis and some pharyngitis cases
• Respiratory tract infections - selected bronchitis and community-acquired pneumonia when appropriate
• Uncomplicated urinary tract infections due to susceptible organisms
• Infections of the skin and soft tissue compartments caused by sensitive bacteria
• Component of some Helicobacter pylori eradication regimens when combined with other agents

Choice of antibiotic should take into account local resistance patterns and clinical assessment. If beta-lactamase producing bacteria are suspected, a combination with a beta-lactamase inhibitor may be preferable. Take a look at the an alternate path choices at Alternate Medicines and Analogous Medicines.

How the substance works in the body

Amoxicillin is an aminopenicillin that disrupts bacterial cell wall synthesis. By binding to penicillin-binding proteins it weakens the cell wall, causing bacterial lysis in susceptible strains. Typical targets include many Streptococcus species, Enterococcus strains and non-beta-lactamase producing The Haemophilus influenzae bacterium and The microorganism Escherichia coli.

It has no direct effect on viruses, fungi or many atypical organisms. When bacteria produce beta-lactamase enzymes, amoxicillin alone may be ineffective unless paired with a beta-lactamase inhibitor such as clavulanic acid.

Guidelines for Dose Regimen and How to Handle It Best

Always follow the instructions given by your prescriber. Do not modify dose or stop treatment early without consulting a clinician. Pediatric doses are weight based and should be calculated by a prescriber or pharmacist.

• Administration: can be taken with or without food; taking with food often reduces stomach upset.
• Solid forms: swallow tablets or capsules whole with water; chewable tablets must be chewed before swallowing.
• Suspensions: shake well and use the dosing device supplied for accuracy.
• Typical adult regimens: 250 to 500 mg every 8 hours, or 500 to 875 mg every 12 hours depending on the infection and guideline recommendations.
• Renal impairment: dose adjustments may be required; inform your prescriber if you have kidney disease.

If you are unsure about your regimen speak with the prescriber or pharmacist. In Australia many clinicians provide telehealth advice to review prescriptions and dosing.

Precautionary safety steps

• Allergy history: disclose any previous penicillin or cephalosporin allergy or other adverse drug reactions.
• Infectious mononucleosis: a non-allergic rash commonly develops if amoxicillin is given during acute Epstein-Barr infection.
• Patients with asthma, atopy or severe allergic tendencies should discuss risks with their prescriber.
• Antibiotic-associated diarrhea may occur; seek clinical advice if diarrhea is severe, persistent, or contains blood.
• The gestational period and lactation period: amoxicillin is frequently used in pregnancy when indicated. Small amounts pass into breast milk; breastfeeding infants may display loose stools or yeast infections.
• Complete the full course to reduce relapse risk and help limit resistance development.

Not indicated conditions

Do not take Amoxil if you have a known hypersensitivity to amoxicillin, other penicillins, or any component of the product. If you have previously experienced anaphylaxis to penicillin discuss an alternative method antibiotics with your prescriber prior to treatment.

Delayed effects that may occur

For the majority, amoxicillin is well tolerated. When deleterious health effects occur they are often mild and resolve on their own. Common and less common effects include:

• Common: nausea, vomiting, diarrhea, abdominal pain, tension headache, dizziness, skin rash, oral or vaginal thrush
• More rare: insomnia, heartburn, itching, altered taste sensation
• An uncommon but grave issue.: anaphylaxis, severe skin reactions (for example Stevens-Johnson syndrome), liver injury including cholestatic jaundice, seizures in cases of extremely high doses or severe renal impairment, blood dyscrasias, severe colitis

Stop the medicine and seek urgent medical attention if you experience hives, facial or throat swelling, breathing difficulty or widespread blistering rash.

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• Warfarin and other anticoagulants - antibiotic therapy may increase INR in some patients; supervision and monitoring is advised.
• Methotrexate drug therapy - penicillins can reduce renal clearance of methotrexate and increase toxicity risk; caution and metric monitoring are required.
• Probenecid remedy - reduces renal excretion of amoxicillin and can increase its plasma levels.
• Allopurinol - combined use may increase the likelihood of skin rash.
• Digoxin tablet - changes in gut flora from antibiotics can affect digoxin absorption; monitor serum levels when indicated.
• Live oral vaccines - antibiotics can reduce effectiveness of some live oral vaccines such as live typhoid; spacing may be recommended.
• Hormonal contraception - routine short courses of amoxicillin are not generally linked to contraceptive failure; use backup methods if you have significant vomiting or diarrhea.

Always tell your healthcare team about all prescription and non-prescription medicines, vitamins and supplements you are taking.

What Should You Do If a Dose Is Missed

If you overlook a dose, take it immediately after you remember, provided the next dose is not due soon. Do not try to make up for a forgot to take a dose with a double dose. Keep to the regular dosing interval advised by your prescriber.

Information Regarding Overdoseds

Overdose occurrence symptoms can include marked nausea, vomiting, diarrhea and fluid or electrolyte disturbances. Very high doses, particularly in patients with kidney impairment, may increase seizure risk. In Australia contact the Poisons Information Centre on 13 11 26 or attend the nearest emergency department for immediate advice.

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• Keep tablets and capsules at room temperature, ideally between 15 and 25 degrees C, protected from moisture and direct light.
• Place all medicines in a cabinet out of reach and out of sight of children.
• Some reconstituted suspensions require refrigeration and should be discarded after the labelled period once mixed.

Alternate Medicines and Analogous Medicines

Depending on the infection, patient allergy history and local resistance, prescribers may select other antibiotics. Typical option choices include:

• Amoxicillin with clavulanic acid (for example Augmentin) - useful when beta-lactamase producing organisms are suspected
• Phenoxymethylpenicillin (penicillin V) - often used for streptococcal throat infections
• Flucloxacillin - preferred for staphylococcal skin infections that produce penicillinase
• Cephalexin - a first generation cephalosporin for some skin and urinary tract infections
• Doxycycline or azithromycin - options for patients with penicillin allergy or for particular pathogens
• Trimethoprim or nitrofurantoin - agents commonly used for uncomplicated urinary tract infections when appropriate

Choice will depend on organism susceptibility, allergy risk, infection site and local resistance trends. Determine differences options with your prescriber or pharmacist before switching therapy.

Australian value based pricing (AUD)

Costs depend on pharmacy, whether a product is brand or generic, pack size and PBS subsidy status. The figures below are approximate ranges for community pharmacy purchases and are indicative only.

• Amoxicillin 500 mg - small packs (about 20 to 24 tablets): PBS general co-payment commonly around AUD 31 to 32, concession around AUD 7 to 8. Private retail prices for non-PBS small packs typically AUD 10 to 25.
• Amoxicillin 250 mg - similar PBS co-payments; private purchase prices often in the AUD 8 to 20 range depending on quantity.
• Amoxicillin/clavulanic acid combinations - usually cost more than plain amoxicillin; PBS co-payments apply for listed strengths and private prices are higher.
• Alternative agents such as cephalexin or phenoxymethylpenicillin - prices are often comparable to amoxicillin under PBS but private prices vary by preparation and pack size.

For exact current prices and PBS eligibility check with your local pharmacy or the PBS website. Generic substitution and pharmacy discount programs can change out-of-pocket cost.

The legal position in Australia

• Classification - amoxicillin is a Schedule 4 prescription-only medicine within the Commonwealth of Australia.
• Regulatory oversight - products are approved and regulated by the Therapeutic Goods Administration (TGA).
• Supply - a valid Australian prescription is required and dispensing occurs through community or hospital drug selling points.
• Pharmaceutical Benefits Scheme (PBS) - many amoxicillin formulations are PBS listed, reducing cost for eligible patients according to co-payment rules.
• Online pharmacies - Australian-registered online pharmacies require a prescription; avoid overseas sites that advertise antibiotics without prescription as this may be illegal and unsafe.
• Personal importation - under the TGA A Personal Importation Scheme it may be possible to import up to a three month supply for personal use with a valid prescription, subject to conditions.
• Sport - amoxicillin is not a prohibited substance under WADA, but athletes should confirm with medical staff when required.

FAQs

• How fast will I improve? Many bacterial infections start to improve within 48 to 72 hours of appropriate therapy, but finish the full course unless your doctor advises otherwise.
• Could I take an alcoholic beverage? Moderate alcohol consumption is not known to interfere with amoxicillin, but avoid excessive drinking and stay well hydrated.
• Will amoxicillin affect my birth control? Short courses do not usually reduce the effectiveness of combined oral contraceptives. Use additional protection if you have vomiting or severe diarrhea.
• Are probiotics useful? Some people take probiotics or eat cultured yoghurt to reduce the risk of antibiotic-associated diarrhea; discuss specific products with your pharmacist.
• What if I get a rash? Contact a clinician to assess any new rash. Seek emergency medical care for rash accompanied by fever, blisters, or breathing difficulty.