Amoxicillin

INTRODUCTION

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. Unlabeled Use: Lyme disease in children <8 yr.

Action

Binds to bacterial cell wall, causing cell death. Therapeutic Effects: Bactericidal action; spectrum is broader than penicillins. Spectrum: Active against Streptococci, Pneumococci, Enterococci, Haemophilus influenzae, Escherichia coli, Proteus mirabilis, Neisseria meningitidis, Neisseria gonorrhoeae, Shigella, Chlamydia trachomatis, Salmonella, Borrelia burgdorferi, H. pylori.

Adverse Reactions/Side Effects

CNS: SEIZURES (HIGH DOSES). GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting, elevated liver enzymes. Derm: rashes, urticaria. Hemat: blood dyscrasias. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, SERUM SICKNESS, superinfection.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for seizures; notify physician immediately if patient develops or increases seizure activity.

• Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, pus or mucus in stool, and other severe or prolonged GI problems (nausea, vomiting, heartburn). Notify physician or nursing staff immediately of these signs.

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Assess muscle aches and joint pain (arthralgia) that may be caused by serum sickness. Notify physician if these symptoms seem to be drug related rather than caused by musculoskeletal injury, or if muscle and joint pain are accompanied by allergic-like reactions (fever, rashes, etc.)

• Monitor signs of blood dyscrasias such as eosinophilia (fatigue, weakness, myalgia) and leukopenia (fever, sore throat, signs of infection). Report these signs to the physician.

Interventions

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Use universal precautions or isolation procedures as indicated for specific patients.

Patient/Client-Related Instruction

• Instruct patient to notify physician immediately of signs of superinfection, including black, furry overgrowth on tongue, vaginal itching or discharge, and loose or foul-smelling stools.

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged skin problems (rash, itching) or GI problems (nausea, vomiting, diarrhea).

Pharmacokinetics

Absorption: Well absorbed from duodenum (75–90%). More resistant to acid inactivation than other penicillins.

Distribution: Diffuses readily into most body tissues and fluids. CSF penetration increased when meninges are inflamed. Crosses placenta; enters breast milk in small amounts.

Metabolism and Excretion: 70% excreted unchanged in the urine; 30% metabolized ...