Amoxicillin / Cloxacillin / Lactic Acid Bacillus

MODE OF ACTION

Amoxicillin
Amoxicillin is a semisynthetic penicillin (beta-lactam antibiotic) that inhibits one or more enzymes (often referred to as penicillin-binding proteins, PBPs) in the biosynthetic pathway of bacterial peptidoglycan, which is an integral structural component of the bacterial cell wall. Inhibition of peptidoglycan synthesis leads to weakening of the cell wall, which is usually followed by cell lysis and death.

Cloxacillin

Exerts bactericidal activity via inhibition of bacterial cell wall synthesis by binding one or more of the penicillin binding proteins (PBPs). Exerts bacterial autolytic effect by inhibition of certain PBPs related to the activation of a bacterial autolytic process1Acred, P., and D. M. Brown. “Further pharmacology and chemotherapy of cloxacillin.” British journal of pharmacology and chemotherapy 21.2 (1963): 339-354.

Lactic Acid Bacillus

Lactic acid bacillus are inactivated bacteria that are good for the gut. They prevent the growth of the other pathogenic bacteria that cause diarrhea or other bacterial infections. Thus, it helps in treating bacterial infections.2Negm El-Dein, Asmaa, et al. “Probiotic Properties and Bile Salt Hydrolase Activity of Some Isolated Lactic Acid Bacteria.” Egyptian Journal of Microbiology 52.1 (2017): 87-100.

INDICATIONS

Acute bacterial sinusitis3Barza, Michael. “Antimicrobial spectrum, pharmacology and therapeutic use of antibiotics, Part 2: penicillins.” American Journal of Health-System Pharmacy 34.1 (1977): 57-67.

Acute otitis media

Acute streptococcal tonsillitis and pharyngitis

Acute exacerbations of chronic bronchitis

Community acquired pneumonia

Acute cystitis

Asymptomatic bacteriuria in pregnancy

Acute pyelonephritis

Typhoid and paratyphoid fever

Dental abscess with spreading cellulitis

Prosthetic joint infections

Lyme disease

Amoxicillin is also indicated for the prophylaxis of endocarditis.

Consideration should be given to official guidance on the appropriate use of antibacterial agents.

CONTRAINDICATIONS

Hypersensitivity to the active substance, to any of the penicillins or to any of the excipients.

History of a severe immediate hypersensitivity reaction (e.g. anaphylaxis) to another beta-lactam agent (e.g. a cephalosporin, carbapenem or monobactam).

DRUG INTERACTIONS

Probenecid

Concomitant use of probenecid is not recommended. Probenecid decreases the renal tubular secretion of amoxicillin and or cloxacillin. Concomitant use of probenecid may result in increased and prolonged blood levels of this drug.

Allopurinol

Concurrent administration of allopurinol during treatment with this can increase the likelihood of allergic skin reactions.

Tetracyclines

Tetracyclines and other bacteriostatic drugs may interfere with the bactericidal effects of amoxicillin.

Oral anticoagulants

Oral anticoagulants and penicillin antibiotics have been widely used in practice without reports of interaction. However, in the literature there are cases of increased international normalised ratio in patients maintained on acenocoumarol or warfarin and prescribed a course of amoxicillin. If co-administration is necessary, the prothrombin time or international normalised ratio should be carefully monitored with the addition or withdrawal of this drug. Moreover, adjustments in the dose of oral anticoagulants may be necessary .

Methotrexate

Penicillins may reduce the excretion of methotrexate causing a potential increase in toxicity.

ADVERSE EFFECTS

Gastrointestinal: Nausea, vomiting, diarrhea, epigastric distress, abdominal pain and hemorrhagic / pseudomembranous colitis.

Onset of pseudomembranous colitis symptoms may occur during or after antibiotic treatment.

Hypersensitivity Reactions: Serum sickness–like reactions, erythematous maculopapular rashes, erythema multiforme, Stevens-Johnson syndrome, exfoliative dermatitis, toxic epidermal necrolysis, acute generalized exanthematous pustulosis, hypersensitivity vasculitis and urticaria have been reported.

NOTE: These hypersensitivity reactions may be controlled with antihistamines and, if necessary, systemic corticosteroids. Whenever such reactions occur, amoxicillin should be discontinued unless, in the opinion of the physician, the condition being treated is life-threatening and amenable only to amoxicillin therapy.

Liver: A moderate rise in AST (SGOT) and/or ALT (SGPT) has been noted, but the significance of this finding is unknown. Hepatic dysfunction including cholestatic jaundice, hepatic cholestasis and acute cytolytic hepatitis have been reported.

Renal: Crystalluria has also been reported (

Hemic and Lymphatic Systems: Anemia, including hemolytic anemia, thrombocytopenia, thrombocytopenic purpura, eosinophilia, leukopenia, and agranulocytosis have been reported during therapy with penicillins. These reactions are usually reversible on discontinuation of therapy and are believed to be hypersensitivity phenomena.

Central Nervous System: Reversible hyperactivity, agitation, anxiety, insomnia, confusion, convulsions, behavioral changes, and/or dizziness have been reported rarely.
Lethargy, hallucinations, seizures, depression, dizziness and fatigue

Miscellaneous: Tooth discoloration (brown, yellow, or gray staining) has been rarely reported. Most reports occurred in pediatric patients. Discoloration was reduced or eliminated with brushing or dental cleaning in most cases.

Reporting of suspected adverse reactions:

The PPB Department of Pharmacovigilance was set up with a vision to develop, implement and continuously upgrade an appropriate system for detecting, reporting, and monitoring adverse drug reactions (ADRs) and other relevant problems with medicines in Kenya. The department strives to ensure the safety and efficacy of pharmaceutical products in Kenya.
Reporting suspected adverse reactions after authorization of the medicinal product are important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals/ Patients are encouraged to report any suspected adverse reactions via Pharmacovigilance Yellow Form, pv@pharmacyboardkenya.org or clicking below button:


Amoxicillin / Cloxacillin / Lactic Acid Bacillus in Kenya
Amoxicillin / Cloxacillin / Lactic Acid Bacillus in Kenya
Amoxicillin / Cloxacillin / Lactic Acid Bacillus in Kenya
Amoxicillin / Cloxacillin / Lactic Acid Bacillus in Kenya
Amoxicillin / Cloxacillin / Lactic Acid Bacillus in Kenya

Clinical | Pharmacokinetic data


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References/ Citation:

  1. Acred, P., and D. M. Brown. “Further pharmacology and chemotherapy of cloxacillin.” British journal of pharmacology and chemotherapy 21.2 (1963): 339-354.
  2. Negm El-Dein, Asmaa, et al. “Probiotic Properties and Bile Salt Hydrolase Activity of Some Isolated Lactic Acid Bacteria.” Egyptian Journal of Microbiology 52.1 (2017): 87-100.
  3. Barza, Michael. “Antimicrobial spectrum, pharmacology and therapeutic use of antibiotics, Part 2: penicillins.” American Journal of Health-System Pharmacy 34.1 (1977): 57-67.



What was the patient being treated for