Are you just going to let it run "amox"?

Amuck, amox, if you are as loose with your pronunciations as I am you can make almost anything sound similar. Similar you say? What about all these damn "cillins"? Amoxicillin, ampicillin, oxacillin, nafcillin, piperacillin, what's-that-on-the-cillin? I could keep going, but for your sake I will not. But seriously, what's with all these cillins? Last blog entry I did a little bit on penicillin and this week, amoxicillin. 

Enough with the teasing John, just give me the lowdown on amoxicillin. Since you asked so nicely here you go. Amoxicillin is an amino-penicillin, adding an amino to a penicillin. Don't ask me what that means, aminos to me are something in your preworkout. So is this a buff penicillin? Well, the amino group changes its structure to allow evasion of some methods of antibiotic resistance. It is still a beta-lactam antibiotic, so it breaks down the cell wall like the cool-aid man which causes cell death. 

Quick aside. Bactericidal means to kill the bacteria outright. I don't think you need more examples of "cidal" in English. Bacteriostatic means to stop the proliferation of the bacteria, prevent their division so your immune system can catch up. 

Amoxicillin in used for the same bacteria as penicillin, but with expanded coverage against H. influenza, H. pylori, pneumococcus, E. fecalis, P. mirabilis, and more. It can also be used off label in doxycycline deficit states (tick borne spirochetes like Lyme's) if there is a contradiction to the doxy. It is normally given q8hours PO and is the first line therapy for acute otitis media, acute sinusitis, pharyngitis, and as part of therapy for a wide variety of empiric regimens and second line prophylaxis against anthrax. 

OK, ok, ok, ok, do I care? You probably should. Amoxicillin is the most commonly used antibiotic in many countries and care facilities. A brief scan of the literature showed amoxicillin was the number 1 prescribed antibiotic in parts of Kenya and the United States for 2015, 2019, and 2022, accounting for around 29% of all antibiotic prescriptions. 

It is well tolerated and considered safe for use in pregnancy. As with most or all antibiotics, OCP effectiveness may be decreased, but reports are conflicting. However risks for CDAD, superinfection, nephrotoxicity, and hepatotoxicity are all possible. It is excreted via the kidneys, kinda like my coffee this morning. So be aware of those who cannot pee, aka, have reduced or zero functioning in their kidneys. 

This is kinda all I wanted to say. You can find way more information on amoxicillin out there but I just wanted to give you a little primer. A tiny reminder. A small tidbit. A minuscule blurb. A microblog. So have a great day and think about amoxicillin next time you're at the grocery store, in bed, or watching Godzilla movies. Can you say "Netflix and cillin"? Bye. 

References

Amoxicillin from StatPearls at the NIH National Library of Medicine by Akhavan, Khanna, & Vijhani updated 2022.

Annual Reports, 2015 and 2019 from the CDC website. 

Global antibiotic consumption and usage in humans, 2000–18: a spatial modelling study in The Lancet: Planetary Health by Browne et al., published November 2021.

Image of E. fecalis from www.bacteriainphotos.com

Prevalence and Determinants of Antibiotic Consumption in the Elderly during 2006–2017 from The International Journal of Environmental Research and Public Health May 2020 by de la Cruz and Cebrino. 

Point-prevalence survey of antibiotic use at three public referral hospitals in Kenya from PlosOne by Omulo et al. in June 2022.

What were the most prescribed antibiotics of 2022? from Definitive Healthcare: Healthcare Insights on March 17, 2023.


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