Usage
Amoxycillin + Cloxacillin is a combination antibiotic used to treat a wide range of bacterial infections. This combination medication is effective against both Gram-positive and Gram-negative bacteria, including those resistant to penicillinase, an enzyme produced by some bacteria that inactivates penicillin.
Pharmacological Classification: Antibiotic
Mechanism of Action: Amoxycillin and Cloxacillin both belong to the beta-lactam class of antibiotics. They inhibit bacterial cell wall synthesis by binding to and inactivating penicillin-binding proteins (PBPs). This action weakens the bacterial cell wall, leading to cell lysis and bacterial death. The combination of these two antibiotics broadens the spectrum of activity and addresses potential penicillin resistance.
Alternate Names
No widely recognized alternate names exist for this combination, though individual components may be known by different names in various regions.
Brand Names: Amonex, Ampiclox, Ampix, Cloxapen, Novamox (This is not an exhaustive list, and brand names may vary depending on location)
How It Works
Pharmacodynamics: Amoxycillin + Cloxacillin exerts a bactericidal effect by disrupting the synthesis of the peptidoglycan layer, a crucial component of the bacterial cell wall. This leads to weakening of the cell wall and eventual lysis of the bacterial cell.
Pharmacokinetics:
- Absorption: Both Amoxycillin and Cloxacillin are well-absorbed orally, although food may reduce the absorption of Cloxacillin. Taking the medication with food may minimize gastrointestinal side effects and maximize absorption.
- Metabolism: Amoxycillin undergoes minimal metabolism, while Cloxacillin undergoes some metabolism in the liver.
- Elimination: Both drugs are primarily excreted unchanged by the kidneys. Dose adjustment may be required in patients with renal impairment.
Dosage
Standard Dosage
Children: Pediatric dosage is typically calculated based on body weight (25 to 100 mg/kg/day) and is generally administered in divided doses every 6 to 8 hours.
Special Cases:
- Elderly Patients: Dosage adjustment may be necessary in elderly patients with impaired renal function.
- Patients with Renal Impairment: Dose reduction is usually recommended depending on creatinine clearance.
- Patients with Hepatic Dysfunction: Caution is advised and dose adjustments may be necessary.
- Patients with Comorbid Conditions: Dosage adjustments should be considered for patients with pre-existing conditions like gastrointestinal diseases, allergies to other antibiotics, or infectious mononucleosis.
Clinical Use Cases
Dosage for specific clinical use cases like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations should be determined on a case-by-case basis, factoring in the infection severity, patient condition, and other relevant clinical factors. General guidelines recommend higher doses for severe infections. Intravenous administration may be preferred in these settings.
Dosage Adjustments:
Renal impairment necessitates dose reductions. For severe renal impairment (creatinine clearance below 10 mL/min), the normal unit dose is often given once or twice daily. Similar adjustments should be considered for patients with hepatic dysfunction and those with other comorbid conditions.
Side Effects
Common Side Effects:
- Nausea
- Vomiting
- Diarrhea
- Stomach pain/discomfort
- Rash
- Allergic reactions
Rare but Serious Side Effects:
- Anaphylaxis (severe allergic reaction)
- Clostridium difficile-associated diarrhea (severe, potentially life-threatening diarrhea)
- Cholestatic jaundice
- Hepatitis
- Blood dyscrasias (abnormal blood counts)
Long-Term Effects:
Prolonged use of this antibiotic can lead to antibiotic-associated colitis (inflammation of the colon) or the development of resistant bacterial strains.
Adverse Drug Reactions (ADR):
Any signs of hypersensitivity reactions like skin rashes, itching, or difficulty breathing should be treated as potential ADRs requiring urgent medical attention.
Contraindications
- Hypersensitivity to penicillins or cephalosporins.
- History of severe allergic reactions to penicillins or cephalosporins.
Drug Interactions
- Allopurinol (for gout)
- Probenecid (for gout)
- Warfarin or other anticoagulants
- Methotrexate
- Oral contraceptives
- Bacteriostatic antibiotics (e.g., chloramphenicol, erythromycin, tetracyclines)
Pregnancy and Breastfeeding
Amoxycillin is considered generally safe during pregnancy, whereas Cloxacillin’s safety profile is less established. Use only if clearly needed and under close medical supervision. Both antibiotics are excreted in breast milk, potentially causing effects like diarrhea or candidiasis in infants. Monitor the infant for any such reactions.
Drug Profile Summary
- Mechanism of Action: Inhibits bacterial cell wall synthesis.
- Side Effects: Nausea, vomiting, diarrhea, rash, allergic reactions. Serious side effects include anaphylaxis and Clostridium difficile infection.
- Contraindications: Hypersensitivity to penicillins or cephalosporins.
- Drug Interactions: Allopurinol, Probenecid, Warfarin, Methotrexate, oral contraceptives, bacteriostatic antibiotics.
- Pregnancy & Breastfeeding: Use cautiously if benefits outweigh risks. Monitor infant for side effects during breastfeeding.
- Dosage: Adults: 250mg-2g every 6 hours, children: 25-100mg/kg/day divided every 6-8 hours. Adjustments needed for renal/hepatic impairment.
- Monitoring Parameters: Renal function, liver function, complete blood count (CBC), observation for allergic reactions and superinfections.
Popular Combinations
Amoxicillin + Cloxacillin is sometimes combined with Lactobacillus (a probiotic) to mitigate gastrointestinal side effects, especially diarrhea.
Precautions
Assess for penicillin or cephalosporin allergy. Monitor renal and hepatic function, especially in elderly patients. Observe for signs of superinfection (e.g., candidiasis, C. difficile infection). Caution advised in patients with a history of gastrointestinal problems.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Amoxycillin + Cloxacillin?
A: Adults: 250mg to 2g every 6 hours, children: 25 to 100 mg/kg/day divided every 6 to 8 hours. Dosage depends on the severity of the infection and requires adjustment for renal/hepatic impairment.
Q2: What are the common side effects?
A: Common side effects include nausea, vomiting, diarrhea, stomach discomfort, rash, and allergic reactions.
Q3: Is Amoxycillin + Cloxacillin safe during pregnancy?
A: Amoxycillin is generally considered safe. Cloxacillin should be used only if clearly needed and under close medical supervision during pregnancy.
Q4: Can I breastfeed while taking this medication?
A: Both drugs are excreted in breast milk. Monitor infants for potential side effects such as diarrhea or candidiasis.
Q5: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember. If it’s almost time for your next dose, skip the missed dose and continue your regular schedule. Do not double the dose.
Q6: What are the signs of an allergic reaction?
A: Allergic reactions can manifest as rash, hives, itching, swelling (especially of the face, tongue, or throat), difficulty breathing, or dizziness. Seek immediate medical attention if any of these occur.
Q7: How should Amoxycillin + Cloxacillin be stored?
A: Store the medication in a cool, dry place away from direct sunlight. Oral suspensions might require refrigeration after reconstitution. Always refer to the manufacturer’s instructions.
Q8: Can I drink alcohol while taking Amoxycillin + Cloxacillin?
A: It’s generally recommended to avoid alcohol during antibiotic treatment.
Q9: Can this medication cause Clostridium difficile infection?
A: Prolonged use of antibiotics, including Amoxycillin + Cloxacillin, can increase the risk of C. difficile infection, a severe form of diarrhea. Inform your doctor if you experience persistent or worsening diarrhea.
