Usage
Amoxycillin + Carbocisteine is prescribed for respiratory tract infections, particularly those associated with excessive mucus (phlegm) production, such as acute and chronic bronchitis.
Pharmacological Classification:
- Amoxycillin: Beta-lactam antibiotic
- Carbocisteine: Mucolytic
Mechanism of Action: Amoxycillin, a penicillin-like antibiotic, inhibits bacterial cell wall synthesis, leading to bacterial cell death. Carbocisteine reduces the viscosity of mucus by breaking down disulphide bonds in mucoproteins, facilitating expectoration.
Alternate Names
No widely recognized alternate names exist for this specific combination. However, it is crucial to differentiate this combination from similar ones, such as Amoxycillin + Clavulanate (co-amoxiclav) or Amoxycillin + Bromhexine.
Brand Names: Brand names vary regionally. Some examples include Carbomox, Muconal, and Cismox, but the availability of specific brand names depends on the region.
How It Works
Pharmacodynamics: Amoxycillin exerts bactericidal effects by inhibiting the synthesis of bacterial cell walls, primarily affecting Gram-positive and some Gram-negative bacteria. Carbocisteine alters the structure of mucus glycoproteins, thereby decreasing its viscosity and promoting clearance from the respiratory tract.
Pharmacokinetics:
- Amoxycillin: Well-absorbed orally, reaching peak plasma concentrations within 1-2 hours. It distributes widely in body tissues and fluids, including the lungs and bronchial secretions. Primarily excreted renally.
- Carbocisteine: Readily absorbed after oral administration, reaching peak plasma levels in 1-2 hours. It is metabolized in the liver and excreted primarily in urine.
Mode of Action: Amoxycillin binds to penicillin-binding proteins (PBPs) on bacterial cell membranes, disrupting peptidoglycan synthesis and weakening the cell wall. Carbocisteine disrupts disulphide bonds in mucus, making it less viscous.
Elimination Pathways: Amoxycillin is eliminated primarily by renal excretion. Carbocisteine is metabolized in the liver and excreted primarily in urine.
Dosage
Standard Dosage
Adults: A common dosage is 500 mg amoxycillin and 150 mg carbocisteine, taken three times daily. The dosage and duration of treatment can vary depending on the severity and type of infection.
Special Cases:
- Elderly Patients: Dosage adjustments may be necessary in elderly patients with reduced renal function.
- Patients with Renal Impairment: Dose reduction is often needed based on creatinine clearance levels.
- Patients with Hepatic Dysfunction: Carbocisteine metabolism may be affected; hence dosage adjustments should be considered.
- Patients with Comorbid Conditions: No specific dosage adjustments are universally established for comorbid conditions like diabetes or cardiovascular disease. Treat each case individually.
Clinical Use Cases
Amoxycillin + Carbocisteine is not typically indicated for intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Its primary role is in the management of respiratory tract infections.
Dosage Adjustments
Dose modifications may be necessary for patients with renal or hepatic dysfunction, based on the severity of impairment and individual patient response.
Side Effects
Common Side Effects: Nausea, vomiting, diarrhea, abdominal pain, rash, headache, dizziness, drowsiness.
Rare but Serious Side Effects: Allergic reactions (including anaphylaxis, angioedema), Stevens-Johnson syndrome, toxic epidermal necrolysis, blood dyscrasias, seizures.
Long-Term Effects: Potential for Clostridium difficile - associated diarrhea with prolonged antibiotic use.
Contraindications
- Hypersensitivity to penicillin or cephalosporins.
- History of severe allergic reaction to carbocisteine.
- Active peptic ulcer disease.
- Severe renal impairment (for carbocisteine).
Drug Interactions
- Allopurinol: Increased risk of rash.
- Oral contraceptives: May reduce efficacy of oral contraceptives.
- Probenecid: May increase amoxycillin levels.
- Anticoagulants: Amoxycillin may enhance the effect of warfarin.
Pregnancy and Breastfeeding
Amoxycillin is generally considered safe during pregnancy (Pregnancy Category B). Carbocisteine should be used with caution and only if clearly needed during pregnancy, especially in the first trimester. Both drugs are excreted in breast milk. Monitor infants for potential side effects, such as diarrhea or thrush.
Drug Profile Summary
- Mechanism of Action: Amoxycillin inhibits bacterial cell wall synthesis, carbocisteine reduces mucus viscosity.
- Side Effects: Nausea, diarrhea, rash, allergic reactions (rarely severe).
- Contraindications: Penicillin allergy, active peptic ulcer, severe renal impairment (carbocisteine).
- Drug Interactions: Allopurinol, oral contraceptives, probenecid, anticoagulants.
- Pregnancy & Breastfeeding: Generally safe, but use with caution and monitor infant.
- Dosage: Adults: 500 mg amoxycillin + 150 mg carbocisteine TDS. Pediatric: weight-based dosing.
- Monitoring Parameters: Observe for signs of infection resolution, monitor for adverse effects, assess renal function if needed.
Popular Combinations
While amoxycillin is often combined with clavulanate or bromhexine, combining it with other mucolytics beyond carbocisteine is less common. Always assess the individual patient’s needs and potential drug interactions when considering combination therapy.
Precautions
-
General Precautions: Assess for penicillin allergy. Renal and hepatic function should be monitored, especially in elderly patients and those with pre-existing conditions.
-
Specific Populations: Use with caution in pregnancy and breastfeeding. Monitor infants for diarrhea and thrush.
-
Lifestyle Considerations: Alcohol doesn’t directly interact but may exacerbate gastrointestinal side effects. No specific dietary restrictions.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Amoxycillin + Carbocisteine?
A: Adults: Typically 500 mg amoxycillin + 150 mg carbocisteine three times a day. Pediatric dosing is weight-based and depends on the specific product formulation.
Q2: What are the common side effects?
A: Nausea, vomiting, diarrhea, abdominal pain, and skin rash are among the common side effects.
Q3: Is this combination safe in pregnancy?
A: Amoxycillin is generally considered safe. Carbocisteine should be used cautiously and only if clearly needed, especially during the first trimester. Consult a specialist for individual assessment.
Q4: Can I breastfeed while taking this medicine?
A: Both drugs are excreted in breast milk. Monitor the infant for potential side effects like diarrhea and thrush.
Q5: What are the contraindications?
A: Known penicillin allergy, active peptic ulcer, and severe renal impairment (for carbocisteine) are key contraindications.
Q6: Are there any significant drug interactions?
A: Interactions with allopurinol, oral contraceptives, probenecid, and anticoagulants can occur. Provide a detailed medication history before prescribing.
Q7: How does carbocisteine work with amoxycillin?
A: Carbocisteine improves mucus clearance, which can help amoxycillin reach the site of infection in the respiratory tract more effectively.
Q8: What should I monitor in patients taking this medication?
A: Monitor for clinical improvement of the infection, resolution of symptoms, and any adverse effects. Monitor renal and hepatic function as needed.
Q9: What is the duration of treatment?
A: The duration of treatment depends on the infection type and severity and the patient’s response. Consult treatment guidelines for specific infections.
