Amoxicillin EXPRESS, 500 mg 20 pcs

Pharmacodynamics

Amoxicillin is a semisynthetic penicillin (a beta-lactam antibiotic) that inhibits one or more enzymes (known as penicillin-binding proteins – PBPs) that play a role in peptidoglycan biosynthesis. Peptidoglycan is a structural element of the bacterial cell wall. Inhibition of peptidoglycan synthesis leads to weakening of the cell wall, which is usually followed by lysis and death of the bacterial cell.

Amoxicillin is degraded by beta-lactamases that can be produced by some bacteria, making them resistant to amoxicillin. Thus, the spectrum of activity of unprotected amoxicillin does not include microorganisms producing these enzymes.

Pharmacokinetics/pharmacodynamics

The time beyond the minimum suppressive concentration (T > MPC) is considered a major determinant of amoxicillin efficacy.

Resistance mechanisms

The main mechanisms of resistance to amoxicillin are:

enzymatic inactivation by beta-lactamases;

PBS mutation, which decreases the affinity of the antibiotic for the target.

Permeability of the bacterial cell wall or active excretion of the antibiotic from the cell (efflux) can cause or contribute to bacterial resistance in Gram-negative bacteria.

The prevalence of resistance can vary by geographic location and over time for certain species. It is advisable to focus on local information about resistance, especially when treating severe infections. If necessary, qualified advice should be sought if local prevalence is such that the efficacy of the drug in treating specific types of infections is questionable.

MMP limit values

Minimum suppressive concentrations (MSCs) for amoxicillin according to European Committee on Antibiotic Susceptibility Testing (EUCAST) criteria, version 5.0:

Microorganisms Marginal MPC value (mg/L)

Sensitive ≤ Resistant >

Enterobacteriaceae 81 8

Staphylococcus spp. note2 note2

Enterococcus spp.3 4 8

Streptococcus spp. group A, B, C and G note4 note4

Streptococcus pneumoniae note5 note5

Viridans group streptococci 0.5 2

Haemophilus influenzae 26 26

Moraxella catarrhalis note7 note7

Neisseria meningitidis 0.125 1

Gram-positive anaerobes except Clostridium difficile8 4 8

Gram-negative anaerobes8 0.5 2

Helicobacter pylori 0.1259 0.1259

Pasteurella multocida 1 1

/p>

Nonspecific borderline values10 2 8

1 Wild-type strains of Enterobacteriaceae are classified as sensitive to aminopenicillins. In some countries, E. coli and P. mirabilis wild-type isolates are classified as moderately resistant. In this case, a borderline IPC value of S≤0.5 mg/L is used.

2 Most staphylococci produce penicillinases and are resistant to amoxicillin. Methicillin-resistant strains of staphylococci, with rare exceptions, are resistant to all beta-lactam antibiotics.

3 Amoxicillin sensitivity is assessed by ampicillin.

4 The sensitivity of group A, B, C and G streptococci to penicillins is evaluated based on their sensitivity to benzylpenicillin.

5 Borderline values refer to isolates isolated in all types of infection except meningitis. If an isolate is evaluated as moderately resistant to ampicillin, oral amoxicillin should not be administered. Sensitivity is assessed by the MPC of ampicillin.

6 Borderline values are based on intravenous administration. Beta-lactamase-producing strains are classified as resistant.

7 Microorganisms that produce beta-lactamases are classified as resistant.

8 Sensitivity to amoxicillin is assessed by sensitivity to benzylpenicillin.

9 Boundary values are set at the epidemiologic cut-off point (ECOFF) value, which distinguishes wild-type isolates from those with reduced sensitivity.

10 Non-vidospecific borderline values are based on doses of 0.5 g 3 or 4 times daily (1.5 to 2 g/day).

Sensitivity of microorganisms to amoxicillin in vitro

Sensitive microorganisms usually

Gram-positive aerobes:

Enterococcus faecalis

Beta-haemolytic streptococci (groups A, B, C and G)

Listeria monocytogenes

Microorganisms that may have acquired resistance mechanisms to amoxicillin

Gram-negative aerobes:

Escherichia coli

Haemophilus injluenzae

Helicobacter pylori

Proteus mirabilis

p> Salmonella typhi

Salmonella paratyphi

Pasteurella multocida

Gram-positive aerobes

/p>

Coagulase-negative staphylococci

Staphylococcus aureus £

Streptococcus pneumoniae

The Streptococcus viridans group

Gram-positive aerobes:

Clostridium spp.

Gram-negative aerobes:

Fusobacterium spp.

Others:

Borrelia burgdorferi

Microorganisms with natural resistance ţ

Gram-positive aerobes:

Enterococcus faesiumţium

Gram-negative aerobes:

Acinetobacter spp.

Enterobacter spp.

Klebsiella spp.

Pseudomonas spp.

Gram-negative aerobes:

Bacteroides spp. (many strains of Bacteroides fragilis are resistant)

Others:

Chlamydia spp

Mycoplasma spp.

Legionella spp.

ţ Natural intermediate sensitivity in the absence of acquired resistance mechanisms.

£ Almost all strains of S. aureus are resistant to amoxicillin due to production of penicillinases. Methicillin-resistant strains of Staphylococcus aureus (MRSA) are also resistant to amoxicillin.

Pharmacokinetics

Amoxicillin completely dissociates in aqueous solution at physiological pH. Amoxicillin is quickly and well absorbed after oral administration. When oral administration the bioavailability of amoxicillin is about 70% and the time to reach maximum plasma concentration (Tmax) is 1 -2 hours.

The following are the results of pharmacokinetic studies obtained when amoxicillin 250 mg 3 times daily is taken by groups of healthy volunteers on an empty stomach:

C max Tmaõ* AUC(0-24 h) T 1/2

(µg/mL) (h) (µg x h/mL) (h)

3.3±1.12 1.5 (1.0-2.0) 26.7±4.56 1.36±0.56

*Median (range) value

In the 250-3000 mg dose range, bioavailability varies linearly with dose (measured by C max and AUC). Simultaneous intake of food has no effect on the absorption of amoxicillin.

Hemodialysis may be used to eliminate amoxicillin from the circulation.

Distribution

About 18% of the total amount of amoxicillin in plasma is bound to plasma proteins. The apparent volume of distribution is approximately 0.3-0.4 L/kg. After intravenous administration, amoxicillin is detected in the gallbladder, abdominal tissues, skin, adipose tissue, muscle, synovial and peritoneal fluids, bile and pus. Amoxicillin poorly penetrates into the cerebrospinal fluid.

Amoxicillin, like most penicillins, can be detected in breast milk. Amoxicillin passes through the placental barrier.

Biotransformation

Amoxicillin is partially excreted in the urine as inactive penicillic acid in amounts equivalent to 10-25% of the dose taken.

Elimination

Amoxicillin is mainly excreted through the kidneys.

The elimination half-life is on average 1 h, and the average total clearance is approximately 25 l/h in healthy subjects who participated in the study. Approximately 60-70% of amoxicillin is excreted unchanged in the urine within the first 6 h after a single dose of 250 mg or 500 mg. In many studies the period of excretion of 50-85% of amoxicillin with urine was 24 hours.

The concomitant administration of probenecid slows the excretion of amoxicillin.

Age

The half-life of amoxicillin is about the same in children aged 3 months to 2 years, in older children and in adults. Very young children (including premature infants) are not administered amoxicillin more than twice daily during the first week of life, taking into account the immaturity of the renal excretion route. Since decreased renal function may occur in the elderly, the dose should be adjusted with caution and renal function should be periodically monitored for this category of patients.

Gender

After oral administration of amoxicillin in male and female patients who participated in the studies, no significant effect of gender on the pharmacokinetics of amoxicillin was found.

Renal dysfunction

The total plasma clearance of amoxicillin decreases in proportion to the deterioration of renal function.

Hepatic impairment

Caution should be exercised in patients with hepatic impairment, and periodic monitoring of liver function should be performed.

Indications

Infections caused by microorganisms sensitive to the drug, including:

– acute bacterial sinusitis;

– acute otitis media;

– acute streptococcal tonsillitis and pharyngitis;

– exacerbation of chronic bronchitis;

– community-acquired pneumonia;

– acute cystitis;

– asymptomatic bacteriuria during pregnancy;

– acute pyelonephritis;

– typhus and paratyphoid;

– dental abscess with inflammation of the subcutaneous tissue;

– infections of prosthetic joints;

– Lyme disease;

– prevention of bacterial endocarditis during surgical procedures in the oral cavity and upper respiratory tract.

In combination with other drugs, according to eradication schemes, it is used to treat diseases of the digestive tract associated with Helicobacter pylori.

When choosing an antibiotic, official clinical guidelines for antibiotic therapy should be taken into account.

Pharmacological effect

Pharmacodynamics

Mechanism of action

Amoxicillin is a semisynthetic penicillin (beta-lactam antibiotic) that inhibits one or more enzymes (known as penicillin binding proteins – PBPs) that play a role in peptidoglycan biosynthesis. Peptidoglycan is a structural element of the bacterial cell wall. Inhibition of peptidoglycan synthesis leads to weakening of the cell wall, which is usually followed by lysis and death of the bacterial cell.

Amoxicillin is broken down by beta-lactamases, which can be produced by some bacteria, making them resistant to amoxicillin. Thus, the spectrum of activity of unprotected amoxicillin does not cover microorganisms that produce these enzymes.

Pharmacokinetics/pharmacodynamics

The time above the minimum inhibitory concentration (T > MIC) is considered the main determinant of the effectiveness of amoxicillin.

Mechanisms of resistance

The main mechanisms of resistance to amoxicillin are:

enzymatic inactivation by beta-lactamases;

mutation of PBP, resulting in a decrease in the affinity of the antibiotic to the target.

Impermeability of the bacterial cell wall or active removal of antibiotic from the cell (efflux) can cause or contribute to bacterial resistance in Gram-negative bacteria.

The prevalence of resistance may vary geographically and over time for certain species. It is advisable to rely on local resistance information, especially when treating severe infections. If necessary, qualified advice should be sought if the local prevalence is such that the effectiveness of the medicinal product in treating specific types of infections is questionable.

MPC boundary values

Minimum inhibitory concentration (MIC) breakpoints for amoxicillin according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria, version 5.0:

Microorganisms MIC boundary value (mg/l)

Sensitive ≤ Resistant >

Enterobacteriaceae 81 8

Staphylococcus spp. note2 note2

Enterococcus spp.3 4 8

Streptococci of groups A, B, C and G note4 note4

Streptococcus pneumoniae note5 note5

Streptococci of the Viridans group 0.5 2

Haemophilus influenzae 26 26

Moraxella catarrhalis note7 note7

Neisseria meningitidis 0.125 1

Gram-positive anaerobes excluding Clostridium difficile8 4 8

Gram-negative anaerobes8 0.5 2

Helicobacter pylori 0.1259 0.1259

Pasteurella multocida 1 1

Non-species-specific breakpoints10 2 8

1 Wild-type Enterobacteriaceae strains are classified as susceptible to aminopenicillins. In some countries, wild-type E. coli and P. mirabilis isolates are considered moderately resistant. In this case, the MIC boundary value S≤ 0.5 mg/l is used.

2 Most staphylococci produce penicillinases and are resistant to amoxicillin. Methicillin-resistant strains of staphylococci, with rare exceptions, are resistant to all beta-lactam antibiotics.

3 Sensitivity to amoxicillin is assessed using ampicillin.

4 The sensitivity of group A, B, C and G streptococci to penicillins is assessed based on their sensitivity to benzylpenicillin.

5 Borderline values ​​apply to isolates isolated from all types of infection, except meningitis. If the isolate is assessed as moderately resistant to ampicillin, oral amoxicillin should not be given. Sensitivity is assessed by ampicillin MIC.

6 Breakpoints are based on intravenous administration. Strains that produce beta-lactamases are classified as resistant.

7 Microorganisms that produce beta-lactamases are classified as resistant.

8 Sensitivity to amoxicillin is assessed by sensitivity to benzylpenicillin.

9 Breakpoints are set at the epidemiological cutoff point (ECOFF) value that distinguishes wild-type isolates from those with reduced susceptibility.

10 Non-species-specific breakpoints are based on doses of 0.5 g 3 or 4 times daily (1.5 to 2 g/day).

Sensitivity of microorganisms to amoxicillin in vitro

Usually susceptible microorganisms

Gram-positive aerobes:

Enterococcus faecalis

Beta-hemolytic streptococci (groups A, B, C and G)

Listeria monocytogenes

Microorganisms that may have acquired resistance mechanisms to amoxicillin

Gram-negative aerobes:

Escherichia coli

Haemophilus injluenzae

Helicobacter pylori

Proteus mirabilis

Salmonella typhi

Salmonella paratyphi

Pasteurella multocida

Gram-positive aerobes

Coagulase-negative staphylococci

Staphylococcus aureus £

Streptococcus pneumoniae

Streptococcus viridans group

Gram-positive aerobes:

Clostridium spp.

Gram-negative aerobes:

Fusobacterium spp.

Other:

Borrelia burgdorferi

Microorganisms with natural resistance ţ

Gram-positive aerobes:

Enterococcus faeciumţ

Gram-negative aerobes:

Acinetobacter spp.

Enterobacter spp.

Klebsiella spp.

Pseudomonas spp.

Gram-negative aerobes:

Bacteroides spp. (many strains of Bacteroides fragilis are resistant)

Other:

Chlamydia spp.

Mycoplasma spp.

Legionella spp.

ţ Natural intermediate sensitivity in the absence of acquired resistance mechanisms.

£ Almost all strains of S. aureus are resistant to amoxicillin due to the production of penicillinases. Methicillin-resistant strains of Staphylococcus aureus (MRSA) are also resistant to amoxicillin.

Pharmacokinetics

Suction

Amoxicillin completely dissociates in aqueous solution at physiological pH. Amoxicillin is quickly and well absorbed after oral administration. When taken orally, the bioavailability of amoxicillin is approximately 70%, and the time to reach maximum plasma concentration (Tmax) is 1-2 hours.

Below are the results of pharmacokinetic studies obtained when taking amoxicillin 250 mg 3 times a day in groups of healthy volunteers on an empty stomach:

C max Tmax* AUC(0-24 h) T 1/2

(µg/ml) (h) (µg x h/ml) (h)

3.3±1.12 1.5 (1.0-2.0) 26.7±4.56 1.36±0.56

*Median (range) value

In the dose range of 250-3000 mg, bioavailability varies linearly with dose (measured by Cmax and AUC). Concomitant food intake does not affect the absorption of amoxicillin.

Hemodialysis can be used to remove amoxicillin from the circulation.

Distribution

About 18% of the total amount of amoxicillin found in plasma is bound to plasma proteins. The apparent volume of distribution is approximately 0.3-0.4 l/kg. After intravenous administration, amoxicillin is found in the gallbladder, abdominal tissue, skin, adipose tissue, muscle, synovial and peritoneal fluids, bile and pus. Amoxicillin penetrates poorly into the cerebrospinal fluid.

Amoxicillin, like most penicillins, can be found in breast milk. Amoxicillin penetrates the placental barrier.

Biotransformation

Amoxicillin is partially excreted in the urine as inactive penicillic acid in amounts equivalent to 10-25% of the dose taken.

Removal

Amoxicillin is primarily excreted through the kidneys.

The half-life averages 1 hour, and the average total clearance is approximately 25 L/h in healthy subjects participating in the study. Approximately 60-70% of amoxicillin is excreted unchanged in the urine during the first 6 hours after taking a single dose of 250 mg or 500 mg. In many studies, the period of excretion of 50-85% of amoxicillin in urine was 24 hours.

Concomitant use of probenecid slows down the elimination of amoxicillin.

Age

The half-life of amoxicillin is approximately the same in children aged 3 months to 2 years, in older children, and in adults. For very young children (including premature newborns), amoxicillin is administered no more than twice a day during the first week of life, taking into account the immaturity of the renal excretion route. Since decreased renal function may occur in the elderly, the dose should be adjusted with caution and renal function periodically monitored in this category of patients.

Floor

After oral administration of amoxicillin to males and females participating in the studies, there was no significant effect of gender on the pharmacokinetics of amoxicillin.

Renal dysfunction

The total plasma clearance of amoxicillin decreases in proportion to the deterioration of renal function.

Liver failure

Caution must be exercised in patients with liver failure, and periodic monitoring of liver function is also necessary.

Special instructions

Hypersensitivity reactions

Before starting treatment with amoxicillin, attention should be paid to a history of hypersensitivity reactions to penicillins, cephalosporins or other beta-lactam antibiotics.

Severe and sometimes fatal hypersensitivity reactions (including anaphylactic reactions and severe skin reactions) have been reported in patients receiving penicillin therapy. The development of these reactions is more likely in people with a history of hypersensitivity to penicillins and in people with atopy. If an allergic reaction occurs, discontinue treatment with amoxicillin and institute appropriate alternative treatment.

Acute coronary syndrome associated with hypersensitivity (Kounis syndrome)

In rare cases, hypersensitivity reactions (acute coronary syndrome associated with hypersensitivity) have been reported during treatment with amoxicillin. If this reaction occurs, amoxicillin should be discontinued and appropriate treatment should be prescribed.

Insensitive microorganisms

For some types of infections, before prescribing amoxicillin, it is necessary to first establish the pathogen and its sensitivity to the drug, or make sure that the pathogen is likely to be treatable with amoxicillin. This particularly applies to patients with urinary tract infections and severe ear, nose and throat infections.

Convulsions

Convulsions may occur in patients with renal failure, in patients receiving high doses of the drug, as well as in patients with predisposing factors – a history of seizures, treatment of epilepsy or meningitis, etc.

Kidney failure

In patients with renal impairment, the dose should be adjusted according to the degree of renal impairment.

Skin reactions

The occurrence of generalized erythema with fever, accompanied by pustules, at the initial stage of treatment may be a symptom of OHEP (see section “Side effects”). In this case, amoxicillin should be discontinued, and its subsequent use will be contraindicated in any situation.

The use of amoxicillin should be avoided in patients who are suspected of having infectious mononucleosis, since a measles-like rash (exanthema) may occur due to the use of amoxicillin for this disease.

Jarosz-Herxheimer reaction

The Jarisch-Herxheimer reaction has been observed following the use of amoxicillin in patients with Lyme disease. This reaction is associated with the bactericidal effect of amoxicillin on the causative agent of Lyme disease, the spirochete Borrelia burgdorferi. Patients should be advised that this reaction is a common side effect of antibiotic treatment for Lyme disease and usually goes away on its own.

Excessive growth of non-susceptible microorganisms

Long-term use of the drug can sometimes lead to excessive growth of microorganisms that are not sensitive to amoxicillin (superinfection).

When using almost all antibacterial drugs, the development of colitis associated with taking antibiotics is possible. Its severity can range from mild to severe (life-threatening). Therefore, it is important to consider the possibility of this diagnosis in patients who develop diarrhea during or after antibiotic use. If diarrhea develops, the patient should immediately stop taking amoxicillin, consult a doctor and begin appropriate treatment. Medicines that inhibit peristalsis are contraindicated in this situation.

Long-term treatment

During long-term therapy, it is necessary to periodically monitor the function of the hematopoietic organs, kidneys and liver. Increased activity of liver enzymes and changes in the number of blood cells were reported.

Anticoagulants

Rare cases of increased prothrombin time have been reported in patients receiving amoxicillin. When prescribing the drug simultaneously with anticoagulants, appropriate monitoring should be carried out, and the dose of oral anticoagulants may need to be adjusted to maintain the required level of blood clotting.

Crystalluria

In patients with reduced diuresis, crystalluria was very rarely observed, mainly during parenteral therapy. When using high doses of amoxicillin, it is recommended to maintain adequate fluid intake and diuresis to reduce the likelihood of developing crystalluria associated with amoxicillin use. In patients with a catheterized bladder, catheter patency should be checked regularly.

Impact on diagnostic tests

Increased levels of amoxicillin in serum and urine may interfere with some laboratory tests. Due to high concentrations of amoxicillin in urine, chemical methods often give false-positive results.

When determining glucose in urine during treatment with amoxicillin, it is recommended to use enzymatic glucose oxidase tests.

The use of amoxicillin may affect the results of the quantitative determination of estradiol in urine in pregnant women.

Impact on the ability to drive vehicles. Wed and fur.:

Studies of the effect of amoxicillin on the ability to drive vehicles or operate other machinery have not been conducted. However, side effects may occur (for example, allergic reactions, dizziness, convulsions) that affect the ability to drive vehicles or use other machinery.

Active ingredient

Amoxicillin

Composition

Composition per tablet:

Active ingredient:

Amoxicillin trihydrate -573.89 mg [in terms of amoxicillin – 500.00 mg].

Excipients:

saccharin – 16.60 mg;

crospovidone – 51.52 mg;

microcrystalline cellulose – 26.31 mg;

vanillin – 0.52 mg;

tangerine flavor – 4.56 mg;

lemon flavor – 5.60 mg;

magnesium stearate – 3.00 mg.

Pregnancy

Pregnancy

Animal studies have shown no direct or indirect harmful effects in terms of reproductive toxicity. Limited data on the use of amoxicillin during pregnancy in humans does not indicate an increased risk of congenital malformations. Amoxicillin may be used during pregnancy if the potential benefit to the mother outweighs the potential risk to the fetus.

Breastfeeding period

Amoxicillin is excreted into breast milk in small quantities; if necessary, the drug can be used during breastfeeding. A breastfed baby may develop diarrhea, sensitization and fungal infection of the mucous membranes, so it may be necessary to stop breastfeeding. Amoxicillin should be used during breastfeeding only after the attending physician has assessed the benefit/risk ratio.

Contraindications

Hypersensitivity to amoxicillin, other penicillins or any other component of the drug.

History of severe immediate hypersensitivity reactions (eg, anaphylaxis) to another beta-lactam antibiotic (eg, cephalosporin, carbapenem, or monobactam).

With caution:

Allergic reactions (including bronchial asthma, polyposis, hypersensitivity to acetylsalicylic acid) in the anamnesis, diseases of the gastrointestinal tract in the anamnesis (especially colitis associated with the use of antibiotics), renal failure, infectious mononucleosis, lymphocytic leukemia, pregnancy, breastfeeding, prematurity, old age.

Side Effects

The most common side effects are diarrhea, nausea and skin rash.

The frequency of side effects is defined as follows: very common (≥1/10), common (≥1/100, <1/10), uncommon (≥1/1000, <1/100), rare (≥1/10000, <1/1000), very rare (<1/10000), unknown (cannot be estimated based on available data).

Infectious and parasitic diseases

very rarely candidiasis of the skin and mucous membranes

Blood and lymphatic system disorders

very rarely, reversible leukopenia (including severe neutropenia or agranulocytosis), reversible thrombocytopenia, hemolytic anemia; prolongation of bleeding time and prothrombin time

Immune system disorders

very rarely severe allergic reactions such as angioedema, anaphylaxis, serum sickness and allergic vasculitis

unknown Jarisch-Herxheimer reaction, acute coronary syndrome associated with hypersensitivity (Kounis syndrome)

Nervous system disorders

very rarely hyperkinesia, dizziness, convulsions

unknown aseptic meningitis

Gastrointestinal disorders

Clinical trial data

*often diarrhea and nausea

*rarely vomiting

Post-registration data

very rarely, antibiotic-associated colitis (including pseudomembranous colitis and hemorrhagic colitis), black “hairy” tongue;

superficial discoloration of teeth**

Disorders of the liver and biliary tract

very rarely hepatitis, cholestatic jaundice, moderate increase in the activity of aspartate aminotransferase and/or alanine aminotransferase in blood plasma

Skin and subcutaneous tissue disorders

Clinical trial data

*often skin rash

*rarely urticaria, itching

Post-registration data

very rarely, skin reactions such as erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, bullous and exfoliative dermatitis, acute generalized exanthematous pustulosis (AGEP), drug rash with eosinophilia and systemic symptoms (DRESS syndrome).

Renal and urinary system disorders

very rare Interstitial nephritis, crystalluria

* the frequency of these adverse reactions was obtained from clinical studies that included a total of about 6,000 adults and children taking amoxicillin.

**Superficial tooth discoloration has been reported in children. Good oral hygiene helps prevent tooth discoloration, which can be corrected by brushing.

Interaction

Probenecid

The simultaneous use of amoxicillin and probenecid is not recommended. Probenecid reduces the secretion of amoxicillin in the renal tubules. Concomitant use of probenecid may lead to increased concentrations of amoxicillin in the blood.

Allopurinol

Concomitant use of allopurinol during treatment with amoxicillin increases the likelihood of developing allergic skin reactions.

Tetracyclines

Tetracyclines and other bacteriostatic antibiotics may interfere with the bactericidal effect of amoxicillin.

Oral anticoagulants

Oral anticoagulants and penicillin-based antibiotics are often used together in practice, with no reports of interaction. However, the literature describes cases of increased international normalized ratio in patients receiving treatment with acenocoumarol or warfarin during a prescribed course of amoxicillin. If simultaneous administration of drugs is necessary, it is necessary to carefully monitor the prothrombin time or international normalized ratio at the beginning of treatment and after discontinuation of treatment with amoxicillin. In addition, dosage adjustments of oral anticoagulants may be necessary.

Methotrexate

Penicillin antibiotics may reduce the excretion of methotrexate, which may be accompanied by increased toxicity.

Overdose

Symptoms: dysfunction of the gastrointestinal tract – nausea, vomiting, diarrhea; Vomiting and diarrhea may result in water and electrolyte imbalance.

Amoxicillin-associated crystalluria has been observed, which in some cases can lead to renal failure. Convulsions may occur in patients with impaired renal function or in patients receiving high doses of the drug.

Treatment: induce vomiting or perform gastric lavage followed by ingestion of activated charcoal and osmotic laxatives (sodium sulfate); measures are taken to restore water and electrolyte balance, hemodialysis.

Short product description

Amoxicillin EXPRESS is a semi-synthetic antibiotic. Amoxicillin is a semisynthetic penicillin that inhibits one or more enzymes that play a role in peptidoglycan biosynthesis.

The drug is taken for acute bacterial sinusitis, acute otitis media, acute streptococcal tonsillitis and pharyngitis, exacerbation of chronic bronchitis, community-acquired pneumonia, acute cystitis, acute pyelonephritis, infections of prosthetic joints, Lyme disease.

Available in the form of tablets (125 mg, 250 mg, 500 mg, 1000 mg), which must be dissolved in water (at least 50 ml). The resulting mixture, which has a light fruity taste, should be taken immediately after preparation.

Dispensed by prescription.

Storage conditions

In original packaging at a temperature not exceeding 25 ºС.

Keep out of the reach of children.

Shelf life

2 years

Manufacturer

Lecco CJSC, Russia