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Amoxicillin Nursing Considerations & Implications | Bioavailable

Compound database
Penicillins
Amoxicillin

AmoxicillinNursing considerations

Known brand names include Moxatag and Trimox.

A penicillin-type antibiotic taken by mouth for common bacterial infections of the ear, nose, throat, lungs, skin, and urinary tract, and as part of H. pylori treatment. It does not work against colds or other viral infections.

Nursing implications

Hold parameters

Ask about prior penicillin, cephalosporin, and other allergies before the first dose
Stop at the first sign of an allergic reaction and treat
Stop if a rash progresses or mucosal lesions appear
Stop if drug-induced enterocolitis syndrome occurs
Evaluate any diarrhea for C. difficile
Do not give to patients with mononucleosis

Sources: [1][2][3][4][5]

Administration

Oral, every 8 or 12 hours depending on the regimen
Take at the start of a meal to reduce stomach upset
Suspension: shake well, measure with a calibrated oral syringe, refrigeration preferred, discard 14 days after mixing
Continue 48 to 72 hours past symptom resolution, and at least 10 days for S. pyogenes to prevent rheumatic fever

Sources: [1][2][3]

Assess and report

Side effects by what to assess

GI

Diarrhea, nausea, vomiting
C. difficile diarrhea, up to 2 months after the course (serious)
Drug-induced enterocolitis syndrome (protracted vomiting 1 to 4 hours after a dose), mostly in children (serious)

Skin and allergy

Rash
Anaphylaxis, occasionally fatal, more likely with prior penicillin allergy or multiple allergies (serious)
Severe skin reactions: SJS, TEN, DRESS, AGEP (serious)
Red rash in patients with mononucleosis (serious)

Sources: [1][2][3][4][5][6]

Labs and vitals

INR (prothrombin time)

Why: INR rise when combined with warfarin
When: During combined use
Act on: Adjust the anticoagulant dose
Normal: INR 0.8 to 1.1 when not on a blood thinner. On warfarin, the usual target is 2.0 to 3.0.

Sources: [1][2]

Serum creatinine

Why: Renal clearance in older adults and renal impairment
When: Consider in older adults
Act on: Reduce dosing when GFR is below 30 mL/min
Normal: 0.7 to 1.3 mg/dL in men and 0.5 to 0.95 mg/dL in women.

Sources: [1][2][3]

Safety

High-alert status

Oral antibiotics are not on the ISMP acute care high-alert list.

Sources: [1]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1]

Boxed warning

None on the current label.

Sources: [1]

Antidote or reversal

No antidote. Stop the drug and give supportive care, keeping fluid intake and urine output up to prevent crystalluria. Hemodialysis removes amoxicillin.

Sources: [1]

Patient teaching

It is a penicillin; tell every provider about any penicillin or other drug allergy
Stop and report right away a rash, mouth or skin sores, or other allergic signs
Diarrhea is common, but watery or bloody stools, even 2 or more months later, need prompt medical attention
Finish the full course even after feeling better; skipping doses breeds resistance
Antibiotics do not treat colds or other viral infections
It may make combined birth control pills less effective

Sources: [1][2]

Sound-alike and look-alike names

None listed in the ISMP list of confused drug names.

Sources: [1]

Dosing

Doses come from the FDA label. Study tool, not for clinical decisions.

Adult dose

ENT, skin, or GU infection, mild to moderate: Either 250 mg three times daily (every 8 hours) or 500 mg twice daily (every 12 hours).
ENT, skin, or GU infection, severe; any lower respiratory infection: Either 500 mg three times daily (every 8 hours) or 875 mg twice daily (every 12 hours).
H. pylori, triple therapy: 1 gram amoxicillin plus clarithromycin 500 mg plus lansoprazole 30 mg, all twice daily for 14 days.
H. pylori, dual therapy: 1 gram amoxicillin plus lansoprazole 30 mg, each three times daily for 14 days.

Sources: [1][2]

Renal adjustment

Only severe impairment needs a change. GFR below 30 mL/min: avoid the 875 mg tablet. GFR 10 to 30: 250 or 500 mg every 12 hours. GFR below 10: 250 or 500 mg every 24 hours. Hemodialysis: every 24 hours plus a dose during and at the end of dialysis.

Sources: [1]

Hepatic adjustment

The label gives no hepatic dose adjustment.

Sources: [1]

How it works

Mechanism

A bactericidal beta-lactam. It blocks bacterial cell wall synthesis in actively multiplying bacteria, which kills them. Beta-lactamase enzymes break its beta-lactam ring, which is the main form of resistance.

Sources: [1]