Amoxicillin

Section 1.1

Midwives may independently prescribe, order and administer this drug.

Amoxicillin inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis.

Indications and Clinical Use:

For the treatment of uncomplicated urinary tract infections (UTIs) in pregnancy and postpartum caused by susceptible strains of Enterococcus faecalis, Escherichia coli, or Klebsiella pneumoniae.

Contraindications:

Documented hypersensitivity or allergy to amoxicillin, other beta-lactam antibacterial drugs or any components of their formulation.

Warnings and Precautions:

Reduces efficacy of oral contraceptives; adjust dose in renal impairment; may enhance chance of candidiasis. Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months post-antibiotic treatment. Use with caution in asthmatic patients. Breastfed infants may develop slightly looser stools than normal. Modification of bowel flora and allergic sensitization of the infant may occur.

Pregnancy:

Category B: animal studies fail to reveal risk.

Lactation:

Category L1 – Compatible

Adverse Reactions:

Upset stomach, diarrhea, vomiting, vaginal infection and mild skin rash. The following should be reported to a medical practitioner immediately: severe skin rash, itching, hives, difficulty breathing or swallowing, wheezing, unusual bleeding or bruising, sore throat, painful mouth or throat sores, jaundice and diarrhea.

Dosage and Administration:

Asymptomatic bacteriuria: 250-500mg PO q8 hours (TID) for 3 days

Cystitis: 250-500mg PO q8 hours (TID) for 5-7 days

Onset of Action:

Oral: Rapid; food does not interfere with absorption.

Half-life:

1-1.4 hours