Usage
This combination medication is primarily prescribed for bacterial infections susceptible to amoxicillin and dicloxacillin, particularly skin and soft tissue infections, respiratory tract infections (like tonsillitis, bronchitis, and pneumonia), and urinary tract infections. The addition of Lactobacillus aims to prevent or treat antibiotic-associated diarrhea.
Pharmacological Classification: Antibiotic, Probiotic (specifically Lactobacillus) combination.
Mechanism of Action: Amoxicillin and Dicloxacillin are beta-lactam antibiotics that inhibit bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), leading to bacterial cell lysis and death. Dicloxacillin is penicillinase-resistant, expanding its activity against penicillinase-producing bacteria. Lactobacillus, a probiotic, helps restore the gut flora balance, mitigating the diarrheal side effects often associated with antibiotic use.
Alternate Names
Novaclox-LB, PDLIN-D Plus, MOXSTA-DX-LB, Amyvox DLB, Diamox LB. International and regional name variations exist. Different formulations with varying strengths and Lactobacillus species/strains (e.g., L. sporogenes, L. acidophilus) may also be available.
How It Works
Pharmacodynamics: Amoxicillin and Dicloxacillin are bactericidal, disrupting bacterial cell wall integrity. Lactobacillus exerts its probiotic effect by competing with pathogenic bacteria for resources and adhesion sites in the gut.
Pharmacokinetics: Amoxicillin and Dicloxacillin are well-absorbed orally. Food may slightly affect the absorption of Dicloxacillin, which is preferably taken on an empty stomach. They are metabolized in the liver to a limited extent and primarily excreted renally. Lactobacillus acts locally in the gastrointestinal tract, with its survival and colonization varying depending on the strain.
Mode of Action: Inhibition of bacterial cell wall synthesis (Amoxicillin and Dicloxacillin); Restoration of gut flora (Lactobacillus).
Receptor binding, enzyme inhibition, or neurotransmitter modulation: Amoxicillin and Dicloxacillin primarily target PBPs, enzymes crucial for bacterial cell wall synthesis. Lactobacillus mechanisms are complex and not fully elucidated, involving competition for nutrients and adhesion sites and modulating the immune system.
Elimination pathways: Primarily renal excretion (Amoxicillin and Dicloxacillin); Lactobacillus is removed through the gastrointestinal tract.
Dosage
Standard Dosage
Adults:
The typical adult dose is 250-500 mg of Amoxicillin and 250-500mg of Dicloxacillin, every 6 hours. The Lactobacillus component might vary (e.g., 2.5 billion spores, 60 million spores).
Children:
Dosage in children below 12 years should be determined based on weight and the specific formulation, consulting pediatric guidelines.
Special Cases:
- Elderly Patients: Dose adjustment based on renal function may be necessary.
- Patients with Renal Impairment: Dosage reduction or extended dosing intervals are usually required.
- Patients with Hepatic Dysfunction: Caution is advised, though significant dose adjustment may not always be necessary.
- Patients with Comorbid Conditions: Individualized assessment is essential, especially with conditions like asthma, allergies, or gastrointestinal disorders.
Clinical Use Cases
The combination is generally not specifically indicated for the listed clinical scenarios (Intubation, Surgical Procedures, Mechanical Ventilation, ICU Use, Emergency Situations), but rather based on the infection being targeted.
Dosage Adjustments:
Dose adjustments are often based on renal function, age, and the severity of infection.
Side Effects
Common Side Effects:
Nausea, vomiting, diarrhea, abdominal discomfort, heartburn, bloating, gas, mouth ulcers, changes in taste, and allergic reactions (rash, itching).
Rare but Serious Side Effects:
Severe allergic reactions (anaphylaxis, angioedema), Clostridium difficile-associated diarrhea, blood dyscrasias (rare), hepatitis (rare).
Long-Term Effects:
With prolonged use, potential for antibiotic resistance, vitamin K deficiency (rare), and superinfections (e.g., fungal infections).
Adverse Drug Reactions (ADR):
Anaphylaxis, angioedema, severe skin reactions (Stevens-Johnson syndrome - rare), drug-induced liver injury (rare).
Contraindications
Hypersensitivity to penicillins or cephalosporins, history of cholestatic jaundice or hepatic dysfunction associated with penicillin use.
Drug Interactions
Probenecid, allopurinol, anticoagulants (e.g., warfarin), methotrexate, oral contraceptives, other antibiotics (e.g., tetracyclines). Food rich in calcium or grapefruit may decrease absorption of Dicloxacillin.
Pregnancy and Breastfeeding
Amoxicillin and Dicloxacillin are generally considered safe during pregnancy (Pregnancy Category B) but should be used only if clearly needed. They are excreted in breast milk. Consult specialist guidelines regarding use during breastfeeding. Lactobacillus safety profile during pregnancy and lactation is less well-established.
Drug Profile Summary
- Mechanism of Action: Amoxicillin and Dicloxacillin: Inhibition of bacterial cell wall synthesis. Lactobacillus: Modulation of gut flora.
- Side Effects: Nausea, vomiting, diarrhea, allergic reactions, abdominal discomfort.
- Contraindications: Penicillin or cephalosporin allergy.
- Drug Interactions: Probenecid, anticoagulants, methotrexate, oral contraceptives.
- Pregnancy & Breastfeeding: Generally considered safe but use with caution if benefits outweigh risks.
- Dosage: Varies depending on the infection and patient factors; generally 250-500mg of each antibiotic every 6 hours for adults.
- Monitoring Parameters: Renal and liver function, signs of superinfection, and allergic reactions.
Popular Combinations
This three-drug combination itself is commonly used. However, the formulation might contain different Lactobacillus species or strains.
Precautions
Assess for penicillin allergy before administration. Monitor renal and hepatic function, particularly with prolonged use. Be vigilant for signs of superinfections (e.g., candidiasis, C. difficile infection). Patients with asthma or allergies should be monitored closely. Advise patients to complete the entire course of therapy.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Amoxycillin + Dicloxacillin + Lactobacillus?
A: The standard adult dosage is typically 250-500mg of both Amoxicillin and Dicloxacillin every 6 hours. Pediatric and special population dosages should be determined based on weight, age, renal function, and the specific product formulation, considering pediatric and renal dosing guidelines.
Q2: Can this combination be used in children?
A: Yes, but the dosage needs to be carefully adjusted based on the child’s weight and specific product formulation. Consult pediatric guidelines.
Q3: What are the most common side effects?
A: Gastrointestinal side effects like nausea, vomiting, and diarrhea are common. Allergic reactions ranging from skin rashes to severe anaphylaxis can occur.
Q4: Are there any serious drug interactions I should be aware of?
A: Yes, interactions can occur with probenecid, allopurinol, anticoagulants (like warfarin), methotrexate, and oral contraceptives. Inform patients to disclose all medications, supplements, and probiotics they are using.
Q5: Can this combination be used during pregnancy or breastfeeding?
A: While generally considered safe, these antibiotics should be used during pregnancy and breastfeeding only if the potential benefit justifies the potential risk to the fetus or infant. Consult specialist guidelines for updated recommendations.
Q6: How should I adjust the dosage for patients with kidney disease?
A: Dosage adjustments are generally needed for patients with renal impairment. Consult renal dosing guidelines based on creatinine clearance or estimated glomerular filtration rate (eGFR).
Q7: What should I monitor in patients taking this combination?
A: Monitor for signs of hypersensitivity reactions, changes in renal and liver function (especially during prolonged treatment), and evidence of superinfections (e.g., C. difficile infection, oral or vaginal candidiasis).
Q8: Can this combination be used with other antibiotics?
A: Combining with certain other antibiotics might affect efficacy. For example, tetracyclines can interfere with the bactericidal action of penicillins. Consult drug interaction resources or expert advice if considering combination antibiotic therapy.
Q9: What advice should I give patients regarding the Lactobacillus component?
A: The Lactobacillus is included to help prevent or manage antibiotic-associated diarrhea. Emphasize that it doesn’t negate the importance of reporting any gastrointestinal symptoms, particularly severe or persistent diarrhea.
Q10: Should Dicloxacillin be taken with food?
A: Dicloxacillin is best absorbed when taken on an empty stomach (1 hour before or 2 hours after meals). Amoxicillin can be taken with or without food. Ensure adequate hydration.
