Usage
Amoxycillin + Bromhexine is prescribed for respiratory tract infections, especially those characterized by thick mucus. It is particularly effective in conditions like acute and chronic bronchitis, pneumonia, bronchiectasis, sinusitis, and other respiratory infections where mucus clearance is beneficial. It’s also used in conditions like bronchial asthma and obstructive airway disease when complicated by infections.
Pharmacological Classification:
- Amoxycillin: Beta-lactam antibiotic (Penicillin group)
- Bromhexine: Mucolytic expectorant
Mechanism of Action:
Amoxycillin inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins, leading to bacterial lysis. Bromhexine breaks down mucopolysaccharides in the mucus, reducing its viscosity and making it easier to expectorate. It also stimulates the serous glands in the respiratory tract to increase the volume of secretions in the respiratory tract, making the mucus more liquid.
Alternate Names
While “Amoxycillin + Bromhexine” is the standard generic name, variations like “Amoxicillin + Bromhexine” may be encountered. Brand names vary depending on the manufacturer and region. A few examples from various countries includes Aeromox Cap, Amexine Cap, Bromolin Cap, Moxbro Cap, Mycocin Cap, Oxybro Tab, etc.
How It Works
Pharmacodynamics:
Amoxycillin exerts bactericidal effects by disrupting bacterial cell wall integrity. Bromhexine reduces mucus viscosity, facilitating expectoration and improving airflow in the airways.
Pharmacokinetics:
- Absorption: Amoxycillin is well-absorbed orally, with bioavailability around 75-90%. Bromhexine is rapidly absorbed orally, but undergoes significant first-pass metabolism, resulting in a bioavailability of approximately 20-30%. Concomitant food intake can slightly increase Bromhexine’s bioavailability.
- Metabolism: Amoxycillin is primarily excreted unchanged in the urine. Bromhexine is extensively metabolized in the liver, with ambroxol as a major active metabolite.
- Elimination: Both drugs are primarily eliminated via renal excretion.
Mode of Action:
Amoxycillin targets penicillin-binding proteins, enzymes essential for bacterial cell wall synthesis. Bromhexine breaks down mucopolysaccharides and activates lysosomal enzymes that alter mucus structure, reducing viscosity.
Receptor Binding, Enzyme Inhibition, or Neurotransmitter Modulation: Amoxycillin inhibits penicillin-binding proteins, disrupting bacterial cell wall synthesis. Bromhexine doesn’t directly interact with receptors or neurotransmitters but influences mucus properties through enzymatic actions.
Elimination Pathways: Primarily renal excretion for both drugs.
Dosage
Standard Dosage
Adults:
- Amoxycillin 250-500mg + Bromhexine 8mg, every 8 hours.
- Alternatively, Amoxycillin 500-875mg + Bromhexine 8mg, every 12 hours.
- Treatment duration is typically up to 48 hours or as prescribed by the physician.
Children:
- Dosing based on weight (40mg/kg/day of Amoxicillin) divided into three doses, every 8 hours.
Special Cases:
- Elderly Patients: Dosage adjustments based on renal function are often necessary.
- Patients with Renal Impairment: Dose reduction or increased dosing intervals may be required.
- Patients with Hepatic Dysfunction: Caution is advised, and dose adjustments may be necessary for Bromhexine.
- Patients with Comorbid Conditions: Careful evaluation and potential dose modifications may be necessary depending on the comorbidity.
Clinical Use Cases
Dosage recommendations are provided in the Standard Dosage section. Dosages may vary slightly in these specific settings due to variations in patient response or disease severity.
- Intubation: Standard Dosage
- Surgical Procedures: Standard Dosage
- Mechanical Ventilation: Standard Dosage
- Intensive Care Unit (ICU) Use: Standard Dosage
- Emergency Situations: Standard Dosage
Dosage Adjustments
Dose adjustments are based on renal or hepatic function, age, and other relevant factors. Follow specific product guidelines for detailed instructions.
Side Effects
Common Side Effects:
Nausea, vomiting, diarrhea, skin rash, headache, dizziness, abdominal discomfort, and altered taste.
Rare but Serious Side Effects:
Allergic reactions (ranging from mild rash to anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis, pseudomembranous colitis, hepatitis, and blood dyscrasias.
Long-Term Effects:
Chronic complications from prolonged use are rare but include antibiotic-associated colitis and the emergence of resistant bacteria.
Adverse Drug Reactions (ADR):
Any severe allergic reactions (anaphylaxis, angioedema) and severe skin reactions like Stevens-Johnson syndrome require urgent attention.
Contraindications
Hypersensitivity to penicillins or cephalosporins. Lactation is generally considered a contraindication.
Drug Interactions
Amoxycillin may interact with allopurinol, probenecid, oral contraceptives, methotrexate, and warfarin. Bromhexine may interact with some antibiotics and non-steroidal anti-inflammatory drugs. Interactions with food are rare, although some have been reported, such as the reduction of Amoxicillin absorption with tannins.
Pregnancy and Breastfeeding
Amoxycillin is generally considered safe during pregnancy (FDA Category B). Bromhexine use during pregnancy should be evaluated based on the potential benefit versus risk. Amoxycillin is excreted in breast milk in small quantities. Limited information is available for bromhexine and breast milk, hence it’s generally avoided during breastfeeding.
Drug Profile Summary
- Mechanism of Action: Amoxycillin: Inhibits bacterial cell wall synthesis. Bromhexine: Reduces mucus viscosity.
- Side Effects: Nausea, vomiting, diarrhea, rash, allergic reactions.
- Contraindications: Penicillin allergy, lactation.
- Drug Interactions: See the “Drug Interactions” section for specifics.
- Pregnancy & Breastfeeding: Amoxycillin generally safe, Bromhexine avoid during pregnancy. Use caution during breastfeeding.
- Dosage: See the “Dosage” section.
- Monitoring Parameters: Renal function, liver function, signs of allergic reactions.
Popular Combinations
Amoxycillin + Clavulanate (for broader-spectrum coverage), or Amoxycillin + Doxycycline are sometimes used in specific clinical scenarios.
Precautions
Evaluate renal and hepatic function, history of gastric ulcers, and any history of hypersensitivity reactions. Monitor for allergic reactions and gastrointestinal side effects.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Amoxycillin + Bromhexine?
A: See “Dosage” section for details, varying by age, indication, and patient-specific factors.
Q2: What are the common side effects?
A: Nausea, diarrhea, and skin rash are among the commonly reported side effects.
A: Severe allergic reactions (anaphylaxis, angioedema, and severe skin reactions like Stevens-Johnson syndrome require immediate medical attention.
Q4: Can Amoxycillin + Bromhexine be used in pregnant women?
A: Amoxycillin is generally considered safe during pregnancy. Bromhexine use during pregnancy should be carefully considered.
Q5: Is it safe to take Amoxycillin + Bromhexine while breastfeeding?
A: Amoxicillin is excreted in breast milk in small amounts. Due to limited data available, caution is recommended when administering Bromhexine.
Q6: What are the contraindications for this combination?
A: Known allergy to penicillins or cephalosporins. Lactation.
Q7: What are the potential drug interactions?
A: See the “Drug Interactions” section.
Q8: What precautions should be taken before prescribing Amoxycillin + Bromhexine?
A: Evaluate renal and hepatic function, history of hypersensitivity reactions, and history of gastric ulcers.
Q9: How does Bromhexine help in respiratory infections?
A: It reduces mucus viscosity, making it easier to cough up and clear the airways.
Q10: What is the duration of treatment with Amoxycillin + Bromhexine?
A: Treatment duration is typically for 48 hours up to 14 days as per the clinical response and severity of infections.
