Molecular structure of amoxicillin
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Amoxicillin (INN) or amoxycillin (former BAN) is a moderate-spectrum β-lactam antibiotic used to treat bacterial infections caused by susceptible microorganisms. It is usually the drug of choice within the class because it is better absorbed, following oral administration, than other beta-lactam antibiotics. Amoxicillin is susceptible to degradation by β-lactamase-producing bacteria, and so may be given with clavulanic acid to increase its susceptability (see below). It is currently marketed by GlaxoSmithKline under the trade name Amoxil®. more...

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Mode of action

Amoxicillin acts by inhibiting the synthesis of bacterial cell walls. It inhibits cross-linkage between the linear peptidoglycan polymer chains that make up a major component of the cell wall of Gram-positive bacteria.

Microbiology

Amoxicillin is a moderate-spectrum antibiotic active against a wide range of Gram-positive, and a limited range of Gram-negative organisms. Some examples of susceptible and resistant organisms, from the Amoxil® Approved Product Information (GSK, 2003), are listed below.

Susceptible Gram-positive organisms

Streptococcus spp., Diplococcus pneumoniae, non β-lactamase-producing Staphylococcus spp., and Streptococcus faecalis.

Susceptible Gram-negative organisms

Haemophilus influenzae, Neisseria gonorrhoeae, Neisseria meningitidis, Escherichia coli, Proteus mirabilis and Salmonella spp.

Resistant organisms

Penicillinase producing organisms, particularly penicillinase producing Staphylococcus spp. Penicillinase-producing N. gonorrhoeae and H. influenzae are also resistant

All strains of Pseudomonas spp., Klebsiella spp., Enterobacter spp., indole-positive Proteus spp., Serratia marcescens, and Citrobacter spp. are resistant.

The incidence of β-lactamase-producing resistant organisms, including E. coli, appears to be increasing.

Doubling the routinely given concentration (in pediatrics) of amoxicillin has been shown to eradicate intermediately resistant organisms (Red Book, 2003 Report of the Committee on Infectious Diseases, American Academy of Pediatrics).

Amoxicillin and Clavulanic acid

Amoxicillin is sometimes combined with clavulanic acid, a β-lactamase inhibitor, to increase the spectrum of action against Gram-negative organisms, and to overcome bacterial antibiotic resistance mediated through β-lactamase production. This formulation is referred to as co-amoxiclav (British Approved Name), but more commonly by proprietary names such as Augmentin® and Clamoxyl®.

Proprietary Preparations

The patent for amoxicillin has expired. Thus amoxicillin is marketed under many trade names including: Actimoxi®, Amoxibiotic®, Amoxicilina®, Pamoxicillin®, Lamoxy®, Ospamox®, Polymox®, Trimox®, Tolodina®, Wymox® and Zimox®.

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Early intrathecal analgesia does not increase cesarean sections
From Journal of Family Practice, 6/1/05 by C.A. Wong

Wong CA, Scavone BM, Peaceman AM, et al. The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. N Eng J Med 1005; 352:655-665.

* Clinical Question

Does early administration of neuraxial analgesia in labor increase the risk of cesarean delivery?

* Bottom Line

Intrathecal fentanyl followed by epidural bupivacaine plus fentanyl, if needed for pain relief, in early labor is not associated with a higher cesarean delivery than systemic hydromorphone for early labor. The neuraxial approach also provides more effective analgesia and a shorter mean duration of first-stage labor. (LOE=1b)

Study Design

Randomized controlled trial (nonblinded)

Allocation

Concealed

Setting

Inpatient (ward only)

Synopsis

Epidural analgesia, when given before a cervical dilatation of 4 cm, has been associated with higher cesarean delivery rate. Systemic narcotics are often used for women requesting analgesia in early labor.

In this trial, 750 women with cervical dilatation of less than 4 cm were randomized at the first request for analgesia to a neuraxial analgesia group that received intrathecal fentanyl 25 mg or to a control group that received 1 mg intravenous hydromorphone plus 1 mg intramuscular hydromorphone. At the second request for analgesia, even with cervical dilatation still less than 4 cm, the neuraxial group received epidural analgesia with bupivacaine at half the usual strength plus fentanyl, while the control group received the same dosing of hydromorphone.

The cesarean delivery rate was a similar 18% to 20% in the 2 groups. The mean time from first administration of analgesia to complete dilatation was 90 minutes shorter in the neuraxial group (295 minutes vs 385 minutes). Pain control after the first dose of analgesia was better in the neuraxial group (mean = 2 vs 6, on a 0-10 scale).

DRUG BRAND NAMES

Amoxicillin * Amoxil; Trimox; Wymox Amoxicillin-clavulanate * Augmentin Hydromorphone * Dilaudid Telithromycin * Ketek Zolpidem * Ambien

COPYRIGHT 2005 Dowden Health Media, Inc.
COPYRIGHT 2005 Gale Group

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