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• Strep throat (Streptococcal tonsillo-pharyngitis)
  Amoxicillin may be superior to penicillin in the treatment of strep throat (streptococcal tonsillopharyngitis).
  In a prospective study5 bacteriologic cure was achieved in 76% of amoxicillin-treated children versus 64% of penicillin-treated children. The clinical cure rate for amoxicillin-treated children was 84% compared to 73% in the penicillin-treated children.
• Streptococcal pharyngitis (Strep throat)
  Once-daily amoxicillin is at least as effective as twice-daily penicillin V for the treatment streptococcal pharyngitis in children.
  
  Randomised non-inferiority trial22 was conducted to test the non-inferiority of once-daily oral amoxicillin to the recommended twice-daily oral penicillin V in streptococcal pharyngitis. 353 children with positive throat swabs for GABHS were randomised to amoxicillin 1500 mg once-daily (n=177) or penicillin V (n=176) 500mg twice-daily for 10 days. Eradication of GABHS was determined with follow-up throat cultures on days 3-6, 12-16 and 26-36. Treatment failures (including relapses) occurred at each visit in 5.8%, 12.7% and 10.7% of amoxicillin recipients and 6.2%, 11.9% and 11.3% of penicillin V recipients respectively. No significant differences in resolution of symptoms were noted between treatment groups. In this adequately-powered study, once-daily oral amoxicillin is not inferior to twice-daily penicillin V for the treatment and eradication of GABHS in children with pharyngitis.

• Side effects
  Recent Italian study21 found that skin reactions occur more frequently with amoxicillin than with amoxicillin/clavulanic acid. The incidence of gastrointestinal, hepatic and haematological side effects is significantly higher for amoxicillin/clavulanic acid than for amoxicillin. Amoxicillin/clavulanic acid seems to be associated with a higher risk of Stevens-Johnson syndrome, purpura and hepatitis than amoxicillin alone.

• Recurrent Otitis media (infection of the middle ear)
  For recurrent ear infection (otitis media) treatment with amoxycillin/clavulanate for 7 days is comparable to the treatment with amoxycillin for 10 days.
  A double-blind study17 with parallel groups, compared treatment with amoxicillin/clavulanate suspension (Spektramox) for 7 days with amoxicillin suspension (Imacillin) for 10 days. Amoxicillin/clavulanate and amoxicillin showed equally high, satisfactory treatment results, i.e. more than a 90% response. Similarly, there was no statistically significant difference between the treatment groups at the second follow-up visit (about 30 days after start of treatment). Elimination of the initially occurring pathogens was equal in the two study groups with the exception of Branhamella catarrhalis which was eliminated to a significantly higher extent with amoxicillin/clavulanate. Both drugs were well tolerated.
• Secretory Otitis media (fluid in the middle ear, or "Glue ear")
  Amoxicillin/clavulanate may have some advantages over amoxicillin in the treatment of otitis media with effusion (fluid in the middle ear).
  A double-blind randomized clinical trial19 compared amoxicillin/clavulanate potassium (Augmentin) and amoxicillin trihydrate for the treatment of otitis media with effusion. At ten days following entry, 29 (51.8%) of 56 patients in the amoxicillin/clavulanate group were effusion free compared with 16 (32.0%) of 50 patients in the amoxicillin group. At four weeks following entry, 26 (50%) of 50 patients in the amoxicillin/clavulanate group were effusion free compared with 23 (51.1%) of 45 patients in the amoxicillin group. By the 16-week visit, 8 (36.4%) of 22 patients in the amoxicillin/clavulanate group who were effusion free at four weeks had recurrence of effusion, compared with 12 (63.2%) of 19 patients in the amoxicillin group.
• Respiratory tract infections (pneumonia, bronchitis, bronchiectasis)
  Amoxicillin plus clavulanic acid is more effective than amoxicillin in the treatment of respiratory infections. Amoxicillin/clavulanic acid is superior to amoxicillin against strains of Branhamella catarrhalis, E. coli, coagulase-negative staphylococci and K. pneumoniae.
  A Croatian study18 compared amoxicillin/clavulanic acid and amoxicillin in the treatment of respiratory tract infections. Leucocytosis and macroscopic purulence of sputum significantly improved with amoxicillin/clavulanate therapy while with amoxicillin there was no significant improvement. With respect to the presence of fever, there was no significant difference between two antibiotics. The overall symptoms improvement and bacteriological response (eradication of bacteria) were very good and good in 88.5% of patients treated with amoxicillin/clavulanate compared to 75% of those receiving amoxicillin.
• Sinusitis (sinus infection)
  Both amoxicillin/clavulanate and amoxicillin are equally effective in the treatment of acute sinusitis.
  A double-blind, placebo-controlled study20 compared the relative effectiveness of amoxicillin and amoxicillin/clavulanate potassium (Augmentin), in the treatment of acute maxillary sinusitis in children 2 to 16 years of age. 93 children were evaluated: 30 received amoxicillin, 28 received amoxicillin/clavulanate potassium, and 35 received placebo. Clinical assessment was performed at three and ten days. On each occasion, children treated with an antibiotic were more likely to be cured than children receiving placebo. The overall cure rate was 67% for amoxicillin, 64% for amoxicillin/clavulanate potassium, and 43% for placebo.

• Chlamydia infection
  Chlamydia infection during pregnancy. Both amoxicillin and azithromycin are effective in the treatment of cervical Chlamydia trachomatis infection during pregnancy. However, azithromycin seems to have a lower rate of recurrent infection3. Amoxicillin is slightly better tolerated than azithromycin.
  In a randomized controlled trial2 comparing amoxicillin and azithromycin there was similar treatment efficacy between amoxicillin and azithromycin (58% vs 64%, respectively). In the study 5.5% of women were intolerant to amoxicillin, compared with 10.9% to azithromycin.
• Otitis media
  Single dose azithromycin is as effective as high dose amoxicillin for 10 days for the treatment of children with otitis media. Diarrhea occurs more frequently with amoxicillin therapy than with azithromycin.
  In a randomized, multicenter, double blind trial1 children (6-30 months of age) with acute otitis media (AOM) were randomized to treatment with single dose azithromycin (30 mg/kg) or high dose amoxicillin (90 mg/kg/d, in 2 divided doses) for 10 days. The clinical success rates for azithromycin and amoxicillin were comparable for all patients (84% and 84%, respectively) and for children < or =2 years of age (82% and 82%, respectively). The clinical efficacies among all microbiologic modified intent-to-treat evaluable subjects were comparable for patients treated with azithromycin (80%) and patients treated with amoxicillin (83%). The rates of side effects for azithromycin and amoxicillin were 20% and 29%, respectively. Diarrhea was more common with amoxicillin therapy than with azithromycin (17.5% and 8.2%, respectively). Compliance was higher in the azithromycin group (100%) than in the amoxicillin group (90%).
• Lyme disease
  Amoxicillin is more effective than azithromycin for erythema migrans.
  In a double-blind, randomized, controlled trial6 patients treated with amoxicillin were significantly more likely than those treated with azithromycin to achieve complete resolution of disease at day 20, the end of therapy (88% compared with 76%). More azithromycin-treated patients (16%) than amoxicillin-treated patients (4%) had relapse. For patients treated with azithromycin, development of an antibody response increased the possibility of achieving a complete response (81% of seropositive patients achieved a complete response compared with 60% of seronegative patients). Patients with multiple erythema migrans lesions were more likely than patients with single erythema migrans lesions to have a positive antibody titer at baseline. Fifty-seven percent of patients who had relapse were seronegative at the time of relapse.

• Sinusitis
  Clarithromycin and amoxicillin appears to have comparable effectiveness in the treatment of sinusitis.
  In a randomized clinical trial7 the success rates of clarithromycin and amoxicillin in the treatment of patients with acute maxillary sinusitis were comparable. A clinical (based on direct observation of the patient) success rate of 91% and a roentgenographic success rate of 78% were achieved in the clarithromycin group; comparable results for the amoxicillin group were 89% and 92%, respectively. Differences between the two groups were not statistically significant. Both drugs caused mild gastrointestinal side effects. Dropout rates were low in both groups: 3% for clarithromycin and 4% for amoxicillin.
• Pneumonia
  Amoxicillin and clarithromycin are equally effective in the treatment of community-acquired pneumonia in children.
  In a randomized clinical trial8 the mean hospital stay in patients treated with amoxicillin was 3.3 days and with clarithromycin was 3.2 days. Ninety-seven percent patients in both treatment groups achieved symptoms improvement.
• Otitis media
  Clarithromycin and amoxicillin similarly effective in the treatment of acute ear infection (otitis media).
  Single blind, randomized, multicenter clinical trial16 compared the safety and efficacy of clarithromycin and amoxicillin suspensions in the treatment of acute otitis media in children 1 to 12 years of age. Clarithromycin suspension was given in a dose of 7.5 mg/kg (max 500 mg) twice daily, and amoxicillin suspension in a dose of 20 mg/kg (max 750 mg) was given twice daily for 7 to 10 days in a 1:1 ratio. Clinical success (cure and symptoms improvement) rates at 0 to 4 days posttreatment were 93% for clarithromycin and 90% for amoxicillin. Altogether 17 children (10 receiving clarithromycin, 7 receiving amoxicillin) experienced some side effect. Gastrointestinal disorders were the most common complaint. No clinically significant differences in laboratory tests were found between the groups.

• Lyme disease
  Both amoxicillin and cefuroxime axetil are safe and effective treatments for Lyme disease.
  Randomized, unblinded study4 compared 2 dosage regimens of cefuroxime axetil (20 mg/kg/d and 30 mg/kg/d) with amoxicillin (50 mg/kg/d), each given for 20 days. At the completion of treatment, there was total resolution of erythema migrans in 67% of the amoxicillin group, 92% of the low-dose cefuroxime group, and 87% of the high-dose cefuroxime group, and resolution of constitutional symptoms occurred in 100%, 69%, and 87%, respectively. Mild diarrhea occurred in a small number of participants in each group (1 patient was diagnosed and treated for Clostridium difficile-associated diarrhea, which occurred after completing the full course of study medication). No hypersensitivity reactions occurred.
• Bronchitis
  Both amoxicillin and cefuroxime are similarly effective in the improvement of bronchitis symptoms. However, amoxicillin therapy results in a significantly higher relapse rates.
  In an investigator-blind, randomised, parallel group, multicentre study9 the two antibiotics had broadly similar efficacy. Amoxicillin afforded clinical cure or improvement in 123/153 (80.4%) of patients and cefuroxime axetil in 109/143 (76.2%). However, the amoxicillin cure rate was not sustained and there were significantly more clinical relapses during the 4-week follow-up period following the end of treatment. Only 4/68 (5.9%) of patients receiving cefuroxime axetil relapsed and required further treatment, whereas 16/77 (20.8%) of those receiving amoxicillin needed further treatment. The significant difference in relapse rates suggests that the apparent clinical success with amoxicillin was not sustained. There were no differences between the two treatments in the numbers of patients experiencing side effects, which were generally mild and transient.
• Otitis media
  Cefuroxime axetil has comparable efficacy to amoxicillin in the treatment of children with middle ear infection.
  In a multicentre general practice study10 of cefuroxime axetil suspension and amoxycillin syrup in the treatment of acute otitis media the overall cure or improvement rate was 94.3% for patients treated with cefuroxime axetil and 94.5% for those receiving amoxicillin. Both antibiotics were well tolerated. Some Streptococcus pneumoniae and Moraxella catarrhalis infections were resistant to amoxicillin.

• Sinusitis
  Minocycline may be somewhat more effective than amoxicillin in the treatment of acute bacterial sinusitis.
  In a comparative study15 after 11 days of antibiotic therapy, clinical cure or improvement and bacterial eradication were evident in 100% of the patients treated with minocycline and in 95% of the patients treated with amoxicillin. Roentgenographic results indicated clearing or improvement in 91% of the minocycline recipients and in 70% of those who received amoxicillin.

• Lyme disease (Erythema migrans)
  Amoxycillin (500 mg plus probenecid 500 mg three times a day) and doxycycline (100 mg twice a day) for 21 days are equally effective for treatment of Lyme disease.
  In a randomised prospective study11 comparing amoxycillin/probenecid with doxycycline both antibiotic regimens were chosen because of the known in-vitro sensitivity of Borrelia burgdorferi, the antibiotic tissue penetration, the pharmacokinetics of the drugs, and because the organism can disseminate early in the course of infection. The two regimens were equally effective for treatment of erythema migrans. Mild fatigue or arthralgia were the only post-treatment complaints, which resolved within 6 months. None of the patients needed further antibiotic treatment for Lyme borreliosis.
• Cervicitis (cervix of the uterus infection)
  Doxycycline and amoxicillin are equally effective for treating chlamydial and nonchlamydial cervicitis.
  In a randomized trial12 of doxycycline versus amoxicillin in the treatment of mucopurulent cervicitis patients were followed up for 3 months, and the effect of treatment was assessed by clinical (presence of endocervical mucopus, cervicitis severity score, and number of polymorphonuclear leukocytes on Gram-stained smears of endocervical secretions) and microbiologic criteria. Doxycycline and amoxicillin were equally effective for treating chlamydial and nonchlamydial cervicitis. However, endocervical mucopus was still present in 18% of the patients in both treatment groups after 2 months and in 23% of the doxycycline group and 33% of the amoxicillin group after 3 months of therapy. The cause of persistent/recurrent mucopus after antimicrobial treatment was not explained by relapse or reinfection with Chlamydia trachomatis, Neisseria gonorrhoeae, genital mycoplasmas, or Gardnerella vaginalis, but persistence was associated with the degree of cervical ectopy.
• Respiratory tract infections
  Doxycycline seems to be superior to amoxicillin in respiratory tract infections.
  Clinical observational study13 found statistically significant better response in those patients with acute and acute-on-chronic bronchitis who were treated with doxycycline. It is possible that this may have been related to a local upsurge in mycoplasma infection at the time of the study.

• Chronic obstructive airways disease (acute exacerbations).
  Ciprofloxacin is much more effective than amoxycillin in the treatment of acute exacerbations of chronic obstructive airways disease 14.
  In comparative study ciprofloxacin produced a 91.8% success rate (complete success 21.9%; partial success 69.9%) while amoxycillin produced 73.1% rate (complete success 10.4%; partial success 62.7%).

• Amoxicillin (Amoxil) Medical Facts

• 1. Arguedas A, Emparanza P, Schwartz RH, Soley C, Guevara S, de Caprariis PJ, Espinoza G. A randomized, multicenter, double blind, double dummy trial of single dose azithromycin versus high dose amoxicillin for treatment of uncomplicated acute otitis media. Pediatr Infect Dis J. 2005 Feb;24(2):153-61. PubMed
• 2. Jacobson GF, Autry AM, Kirby RS, Liverman EM, Motley RU. A randomized controlled trial comparing amoxicillin and azithromycin for the treatment of Chlamydia trachomatis in pregnancy. Am J Obstet Gynecol. 2001 Jun;184(7):1352-4; discussion 1354-6. PubMed
• 3. Kacmar J, Cheh E, Montagno A, Peipert JF. A randomized trial of azithromycin versus amoxicillin for the treatment of Chlamydia trachomatis in pregnancy. Infect Dis Obstet Gynecol. 2001;9(4):197-202. PubMed
• 4. Eppes SC, Childs JA. Comparative study of cefuroxime axetil versus amoxicillin in children with early Lyme disease. Pediatrics. 2002 Jun;109(6):1173-7. PubMed
• 5. Curtin-Wirt C, Casey JR, Murray PC, Cleary CT, Hoeger WJ, Marsocci SM, Murphy ML, Francis AB, Pichichero ME. Efficacy of penicillin vs. amoxicillin in children with group A beta hemolytic streptococcal tonsillopharyngitis. Clin Pediatr (Phila). 2003 Apr;42(3):219-25. PubMed
• 6. Luft BJ, Dattwyler RJ, Johnson RC, Luger SW, Bosler EM, Rahn DW, Masters EJ, Grunwaldt E, Gadgil SD. Azithromycin compared with amoxicillin in the treatment of erythema migrans. A double-blind, randomized, controlled trial. Ann Intern Med. 1996 May 1;124(9):785-91. PubMed
• 7. Calhoun KH, Hokanson JA. Multicenter comparison of clarithromycin and amoxicillin in the treatment of acute maxillary sinusitis. Arch Fam Med. 1993 Aug;2(8):837-40. PubMed
• 8. Aurangzeb B, Hameed A. Comparative efficacy of amoxicillin, cefuroxime and clarithromycin in the treatment of community -acquired pneumonia in children. J Coll Physicians Surg Pak. 2003 Dec;13(12):704-7. PubMed
• 9. Shah SH, Shah IS, Turnbull G, Cunningham K. Cefuroxime axetil in the treatment of bronchitis: comparison with amoxycillin in a multicentre study in general practice patients. Br J Clin Pract. 1994 Jul-Aug;48(4):185-9. PubMed
• 10. Brodie DP, Griggs JV, Cunningham K. Comparative study of cefuroxime axetil suspension and amoxycillin syrup in the treatment of acute otitis media in general practice. J Int Med Res. 1990 May-Jun;18(3):235-9. PubMed
• 11. Dattwyler RJ, Volkman DJ, Conaty SM, Platkin SP, Luft BJ. Amoxycillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis. Lancet. 1990 Dec 8;336(8728):1404-6. PubMed
• 12. Paavonen J, Roberts PL, Stevens CE, W?lner-Hanssen P, Brunham RC, Hillier S, Stamm WE, Kuo CC, DeRouen T, Holmes KK, et al. Randomized treatment of mucopurulent cervicitis with doxycycline or amoxicillin. Am J Obstet Gynecol. 1989 Jul;161(1):128-35. PubMed
• 13. Richards JG. Doxycycline and amoxycillin in respiratory infections: a comparative assessment in general practice. Curr Med Res Opin. 1980;6(6):393-7. PubMed
• 14. Basran GS, Joseph J, Abbas AM, Hughes C, Tillotson GS. Treatment of acute exacerbations of chronic obstructive airways disease--a comparison of amoxycillin and ciprofloxacin. J Antimicrob Chemother. 1990 Dec;26 Suppl F:19-24. PubMed
• 15. Mattucci KF, Levin WJ, Habib MA. Acute bacterial sinusitis. Minocycline vs amoxicillin. Arch Otolaryngol Head Neck Surg. 1986 Jan;112(1):73-6. PubMed
• 16. Pukander JS, Jero JP, Kaprio EA, Sorri MJ. Clarithromycin vs. amoxicillin suspensions in the treatment of pediatric patients with acute otitis media. Pediatr Infect Dis J. 1993 Dec;12(12 Suppl 3):S118-21. PubMed
• 17. Stenstrom C, Lundgren K, Ingvarsson L, Bertilson SO. Amoxycillin/clavulanate versus amoxycillin in recurrent otitis media and therapeutic failure in children. Acta Otolaryngol. 1991;111(1):120-9. PubMed
• 18. Music E, Kumelj M, Prlja D, Paulin A, Potokar T. Comparison of amoxicillin and amoxiclav in the therapy of respiratory infections. Plucne Bolesti. 1989 Jul-Dec;41(3-4):187-92. PubMed
• 19. Chan KH, Mandel EM, Rockette HE, Bluestone CD, Bass LW, Blatter MM, Breck JM, Reisinger KS, Wolfson JH, Wucher FP, et al. A comparative study of amoxicillin-clavulanate and amoxicillin. Treatment of otitis media with effusion. Arch Otolaryngol Head Neck Surg. 1988 Feb;114(2):142-6. PubMed
• 20. Wald ER, Chiponis D, Ledesma-Medina J. Comparative effectiveness of amoxicillin and amoxicillin-clavulanate potassium in acute paranasal sinus infections in children: a double-blind, placebo-controlled trial. Pediatrics. 1986 Jun;77(6):795-800. PubMed
• 21. Salvo F, Polimeni G, Moretti U, Conforti A, Leone R, Leoni O, Motola D, Dusi G, Caputi AP. Adverse drug reactions related to amoxicillin alone and in association with clavulanic acid: data from spontaneous reporting in Italy. J Antimicrob Chemother. 2007 Jul;60(1):121-6. Epub 2007 Apr 21. PubMed
• 22. Lennon DR Fracp, Farrell E Mhsc, Martin DR Phd, Stewart JM Msc. Once-daily Amoxicillin versus Twice-daily Penicillin V in Group A {beta}-Hemolytic Streprococcus Pharyngitis. Arch Dis Child. 2008 Mar 12 PubMed