Amoxicillin versus Penicillin

Based on "Antibiotic and Chemotherapy"
written by Roger G. Finch

Difference between Amoxicillin and Penicillin

	Amoxicillin	Penicillin
Drug class	Aminopenicillin antibiotic	Natural penicillin antibiotic
Formulations	• Oral	• Oral • Intramuscular (IM) • Intravenous (IV)
FDA approved uses	• Streptococcal pharyngitis • Ear, nose, and throat infections • Skin and skin structure infections • Genitourinary tract infections • Lower respiratory tract infections • Gonorrhea	• Streptococcal pharyngitis • Skin and soft tissues infections • Fusospirochetosis (Vincent's gingivitis) • Infections of the oropharynx • Syphilis, yaws, bejel, pinta, Rheumatic fever (only penicillin G benzathine) • Upper respiratory tract infections caused by susceptible streptococci (only penicillin G benzathine) • Septicemia, empyema, pneumonia, pericarditis, endocarditis, meningitis, disseminated gonococcal infections, syphilis, Listeria infections, actinomycosis (only penicillin G potassium)
Half-life	1 hour	0.5 to 1 hour
Bioavailability	74-92%	25-73%
Absorption	Amoxicillin is better absorbed from the gastrointestinal tract than penicillin. Amoxicillin is more stable in acid.
Food	Food has minimal or no effect on bioavailability of amoxicillin.	Food reduces the absorption of penicillin V and may result in lower and delayed peak serum concentrations 4
Protein binding	20%	75-89%
Antimicrobial spectrum
Gram-positive bacteria	Similar activity to penicillin. Better activity against Enterococcus spp. 1	Streptococcus spp., some Enterococcus spp., non-beta-lactamase-producing Staphylococci, Listeria monocytogenes 1
*Gram-negative bacteria*	Enhanced activity against gram-negative bacteria: Escherichia coli, Proteus mirabilis, Shigella, Salmonella, Listeria, Haemophilus influenza, Neisseria meningitidis 1	Neisseria meningitidis, some spp. of Haemophilus influenzae 1
Other bacteria	Borrelia burgdorferi 1	Treponema pallidum Leptospira spp., Clostridia spp. (except C. difficile), Actinomyces israelii, Corynebacterium diphtheriae 1
Concentrations	Better capacity for reaching effective concentrations
Safety	Pregnancy category B Suitable for use in infants and children

Amoxicillin advantages over Penicillin

Better oral absorption.
Longer duration of action and less frequent dosing.
Broader antimicrobial spectrum.

Penicillin advantages over Amoxicillin

Parenteral penicillin is used to treat serious infections, including syphilis, meningitis, septicemia.

Amoxicillin vs Penicillin V in Streptococcal pharyngitis

Amoxicillin is at least as effective as penicillin V for the treatment of streptococcal pharyngitis in children 2

Results of randomized non-inferiority trial of amoxicillin versus penicillin V in group A beta-haemolytic streptococcal pharyngitis 2	Amoxicillin	Penicillin V
Regimen	1500 mg once daily for 10 days	500 mg twice daily for 10 days
Treatment failures (including relapses):
on days 3-6	5.8%	6.2%
on days 12-16	12.7%	11.9%
on days 26-36	10.7%	11.3%
Resolution of symptoms	No significant differences

Results of prospective, comparative, open, randomized, trial of amoxicillin vs. penicillin V for streptococcal tonsillopharyngitis 6	Amoxicillin	Penicillin V
Regimen	50 mg/kg/day twice daily for 6 days	45 mg/kg/d three times a day for 10 days
Pretreatment GAS eradication rate at 4 day after the completion of treatment	83.7% (118 children of 141)	85.3% (116 children of 136)
Bacteriologic relapses at one month after the outset of treatment	9.9% (11 children)	5.7% (6 children)
Conclusion: The efficacy and safety of amoxicillin were not statistically different from those of penicillin in the treatment of GAS tonsillopharyngitis.

Results of prospective observational study of penicillin vs. amoxicillin for streptococcal tonsillopharyngitis in children 5	Amoxicillin	Penicillin V
Bacteriologic cure	76%	64%
Clinical cure	84%	73%

Amoxicillin vs Penicillin in Pneumonia

Injectable penicillin and oral amoxicillin are equivalent for severe pneumonia in children aged 3-59 months 3.

Amoxicillin vs Penicillin in Dental Infections

Both penicillin and amoxicillin are considered the first line of treatments for odontogenic infections 9. They target most bacteria causing odontogenic infections.

Bacteraemia after dental extraction

Both penicillin V (2 g oral dose) and amoxicillin are effective in reducing the incidence of bacteraemia following dental extraction 7. There is little difference in their antibacterial activity against viridans streptococci and dental anaerobes. However, amoxicillin is preferable to penicillin V for the oral prophylaxis of endocarditis as it can provide much higher serum levels than penicillin V during the 6 to 8 hours following extraction.

Primary teeth abscess

Amoxicillin is as efficacious as penicillin in the treatment of acute abscess of primary teeth 8. Amoxicillin may provide more rapid improvement of swelling.

Dentoalveolar abscess (co-amoxiclav vs penicillin V)

A randomized operator-blind comparative study 10, tested the efficacy of co-amoxiclav and penicillin V for dentoalveolar infections. Both antibiotics provided improvement after drainage. Co-amoxiclav treatment provided significantly greater decrease in toothache during the second and third days after drainage. This may be explained by the eradication of the beta-lactamase producing bacteria with co-amoxiclav that would not be eradicated by penicillin V.

References

1. Alan J. Hauser Antibiotic Basics for Clinicians. LWW; Second edition March 9, 2012, pp.22-24
2. Lennon DR, Farrell E, Martin DR, Stewart JM. Amoxicillin versus Penicillin V in Group A beta -Hemolytic Streprococcus Pharyngitis.Arch Dis Child. 2008 Jun;93(6):474-8. PubMed
3. Addo-Yobo E, Chisaka N, Hassan M, Hibberd P, Lozano JM, Jeena P, MacLeod WB, Maulen I, Patel A, Qazi S, Thea DM, Nguyen NT. Oral amoxicillin versus injectable penicillin for severe pneumonia in children aged 3 to 59 months: a randomised multicentre equivalency study. Lancet. 2004 Sep 25-Oct 1;364(9440):1141-8. PubMed
4. Finkel Y, Bolme P, Eriksson M. The effect of food on the oral absorption of penicillin V preparations in children. Acta Pharmacol Toxicol (Copenh). 1981 Oct;49(4):301-4. 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. Cohen R, Levy C, Doit C, De La Rocque F, Boucherat M, Fitoussi F, Langue J, Bingen E. Six-day amoxicillin vs. ten-day penicillin V therapy for group A streptococcal tonsillopharyngitis. Pediatr Infect Dis J. 1996 Aug;15(8):678-82. PubMed
7. Shanson DC, Cannon P, Wilks M. Amoxycillin compared with penicillin V for the prophylaxis of dental bacteraemia. J Antimicrob Chemother. 1978 Sep;4(5):431-6.
8. Paterson SA, Curzon ME. The effect of amoxycillin versus penicillin V in the treatment of acutely abscessed primary teeth. Br Dent J. 1993 Jun 19;174(12):443-9. PubMed
9. Curtis Gregoire. How are odontogenic infections best managed? JCDA April 19, 2010
10. Lewis MA, Carmichael F, MacFarlane TW, Milligan SG. A randomised trial of co-amoxiclav versus penicillin V in the treatment of acute dentoalveolar abscess. Br Dent J. 1993 Sep 11;175(5):169-74. PubMed