Amoxycillin + Cloxacillin + Serratiopeptidase

Usage

• Medical Conditions: This combination medication is primarily prescribed for bacterial infections, especially those affecting the respiratory tract (e.g., pneumonia, bronchitis, sinusitis, tonsillitis, pharyngitis), skin and soft tissues (e.g., cellulitis, boils, abscesses), urinary tract (e.g., cystitis, pyelonephritis), dental and oral infections, bone and joint infections (e.g., osteomyelitis), and other infections where a broader spectrum of coverage is needed or polymicrobial infections are suspected. It is also used to reduce inflammation and promote healing.

• Pharmacological Classification: Antibiotic (Amoxycillin and Cloxacillin) and Anti-inflammatory enzyme (Serratiopeptidase)

• Mechanism of Action: Amoxycillin and Cloxacillin are beta-lactam antibiotics that inhibit bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs). This leads to cell wall weakening, lysis, and bacterial death. Cloxacillin is penicillinase-resistant, making it effective against bacteria that produce beta-lactamases. Serratiopeptidase is a proteolytic enzyme that breaks down proteins involved in inflammation, reducing swelling and promoting tissue repair.

Alternate Names

• No widely recognized alternate names exist for this specific combination. However, various brand names are used depending on the manufacturer.

• Brand Names: Amoclas, Bacban S, Gatdox SP, Dupen S, Amoclox, etc. (Brand names can vary regionally and are subject to change).

How It Works

• Pharmacodynamics: Amoxycillin and Cloxacillin exert bactericidal effects by disrupting bacterial cell wall synthesis. Serratiopeptidase reduces inflammation by breaking down inflammatory mediators like bradykinin, histamine, and serotonin. It also helps liquefy pus and sputum, facilitating their drainage.

• Pharmacokinetics: Amoxycillin and Cloxacillin are well-absorbed orally. Serratiopeptidase is often enteric-coated to protect it from degradation in the stomach. All three components are primarily eliminated renally, so dosage adjustments may be necessary in patients with renal impairment.

• Mode of Action: Amoxycillin and Cloxacillin bind to PBPs located on the bacterial cell membrane, inhibiting transpeptidation and peptidoglycan synthesis, leading to bacterial cell wall disruption and death. Serratiopeptidase cleaves peptide bonds in proteins involved in the inflammatory cascade.

Dosage

Standard Dosage

Adults: 250-500 mg of Amoxycillin and 250-500 mg of Cloxacillin, along with 10 mg of Serratiopeptidase, every 6 to 8 hours. The exact dosage and duration of therapy should be determined by the physician based on the infection’s severity and patient factors.

Children: Pediatric dosing should be determined by a physician based on the child’s weight and age. The combination is generally not recommended for children under 12 years of age unless specifically directed by a doctor.

Special Cases:

• Elderly Patients: Dosage adjustments may be required based on renal function.

• Patients with Renal Impairment: Dose reduction is necessary based on the degree of renal impairment.

• Patients with Hepatic Dysfunction: Caution is advised, and dosage adjustments may be needed.

• Patients with Comorbid Conditions: Individualized dosing based on the specific comorbid conditions (e.g., diabetes, cardiovascular disease) is essential.

Clinical Use Cases

Dosage in these clinical situations is determined by the physician on a case-by-case basis considering the infection’s severity, patient’s condition, and other clinical factors. No standard recommendations exist for these specific scenarios. Intravenous administration of Amoxycillin and Cloxacillin may be preferred in severe infections or when oral administration is not feasible.

Side Effects

Common Side Effects:

• Nausea
• Vomiting
• Diarrhea
• Abdominal pain/discomfort
• Skin rash

Rare but Serious Side Effects:

• Allergic reactions (anaphylaxis, angioedema, serum sickness)
• Stevens-Johnson syndrome
• Erythema multiforme
• Pseudomembranous colitis
• Hepatotoxicity (rare)
• Seizures (rare)
• Blood dyscrasias (rare)

Contraindications

• Hypersensitivity to penicillins or cephalosporins
• History of severe allergic reactions to beta-lactam antibiotics
• Cholestatic jaundice or hepatic dysfunction associated with prior penicillin use

Drug Interactions

• Allopurinol: Increased risk of rash
• Oral contraceptives: Potential reduction in efficacy
• Anticoagulants (e.g., warfarin): May enhance anticoagulant effects
• Probenecid: Increases serum levels of Amoxycillin and Cloxacillin
• Methotrexate: Increased risk of methotrexate toxicity
• Tetracyclines: May decrease the effectiveness of Amoxycillin and Cloxacillin
• Other antibiotics (e.g., azithromycin): May alter the effectiveness of this combination or increase the risk of adverse effects

Pregnancy and Breastfeeding

The safety during pregnancy and breastfeeding has not been fully established. Consult a physician to assess the benefit-risk ratio before use.

Drug Profile Summary

• Mechanism of Action: Inhibits bacterial cell wall synthesis (Amoxycillin and Cloxacillin); reduces inflammation by breaking down inflammatory mediators (Serratiopeptidase)
• Side Effects: Nausea, vomiting, diarrhea, rash, allergic reactions.
• Contraindications: Penicillin/cephalosporin allergy, previous cholestatic jaundice/hepatic dysfunction with penicillin.
• Drug Interactions: Other antibiotics, anticoagulants, oral contraceptives, allopurinol, probenecid, methotrexate.
• Pregnancy & Breastfeeding: Safety not established; consult a physician.
• Dosage: Varies; determined by physician based on patient factors and infection severity.
• Monitoring Parameters: Renal function, liver function, signs of superinfection (e.g., candidiasis), allergic reactions.

Popular Combinations

This combination itself is sometimes considered a standalone therapy. Other combinations with Amoxycillin/Cloxacillin include Clavulanic acid or Lactobacillus.

Precautions

• Allergy screening is essential before initiating therapy.
• Monitor for signs of superinfection, especially with prolonged use.
• Renal and hepatic function should be assessed, and dosage adjusted accordingly.
• Caution in pregnancy and breastfeeding.
• Advise patients to complete the full course of therapy even if symptoms improve.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Amoxycillin + Cloxacillin + Serratiopeptidase?

A: Dosages vary based on the individual patient and the severity of the infection. A common regimen for adults is 250-500 mg each of Amoxicillin and Cloxacillin, with 10 mg of Serratiopeptidase, every 6 to 8 hours. Pediatric dosing must be established by a doctor.

Q2: What are the main uses of this combination?

A: Primarily to treat bacterial infections where combined action of Amoxycillin and Cloxacillin, along with Serratiopeptidase’s anti-inflammatory effects are beneficial.

Q3: Is this combination effective against all types of bacteria?

A: No. It is primarily effective against Gram-positive and some Gram-negative bacteria susceptible to Amoxycillin and Cloxacillin. It is not effective against viruses or fungi.

Q4: What are the most serious side effects to watch out for?

A: Allergic reactions (anaphylaxis, angioedema), Stevens-Johnson Syndrome, severe skin reactions, and any signs of liver dysfunction.

Q5: Can this drug be given to pregnant or breastfeeding women?

A: The safety profile in pregnancy and breastfeeding is not fully established. Use only if clearly needed and under the supervision of a physician.

Q6: How should patients with renal impairment be managed?

A: Dosage adjustment is necessary in renal impairment based on creatinine clearance or estimated glomerular filtration rate (eGFR).

Q7: What patient education points are important?

A: Complete the full course of antibiotics even if symptoms improve; report any signs of allergic reactions immediately; maintain adequate hydration; avoid alcohol during treatment.

Q8: What are the common drug interactions?

A: Interactions can occur with allopurinol, oral contraceptives, anticoagulants, probenecid, methotrexate, and other antibiotics. Inform the prescribing physician of all concomitant medications.

Q9: How should this medication be stored?

A: Store in a cool, dry place away from direct sunlight and moisture, as per the manufacturer’s instructions.

Q10: How to manage mild gastrointestinal side effects like nausea and diarrhea?

A: Taking the medication with food can help reduce gastrointestinal upset. For diarrhea, advise patients to maintain hydration and consider probiotics if necessary. If symptoms persist or worsen, medical advice should be sought.