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Uses

Otitis Media

Treatment of acute otitis media (AOM). AAP, AAFP, CDC, and others recommend amoxicillin as drug of first choice for initial treatment of AOM, unless patient has severe illness (moderate to severe otalgia or fever ≥39°C) or the infection is suspected of being caused by β-lactamase-producing Haemophilus influenzae or Moraxella catarrhalis, in which case the fixed combination of amoxicillin and clavulanate is recommended for initial treatment. Those who fail to respond to amoxicillin should be retreated with amoxicillin and clavulanate.

Has been used for prevention of recurrent AOM†. Such prophylaxis not generally recommended since it is minimally effective and may promote emergence of resistance. Use only in selected patients with >3 episodes within 6 months or >4 episodes within 12 months; drugs of choice are amoxicillin or sulfisoxazole.

Has been used for management of otitis media with effusion† (OME). Anti-infectives not usually recommended; they provide only limited benefit in enhancing resolution of effusion and may promote resistance. AAP, AAFP, and others recommend watchful waiting for 3 months from date of effusion onset or diagnosis in those 2 months to 12 years of age who are not at risk for speech, language, or learning problems; some suggest a short course of anti-infectives may be considered for possible short-term benefits when parent and/or caregiver expresses a strong aversion to impending surgery. If anti-infectives are used, amoxicillin or the fixed combination of amoxicillin and clavulanate recommended.

Pharyngitis and Tonsillitis

Treatment of pharyngitis and tonsillitis caused by Streptococcus pyogenes (group A β-hemolytic streptococci).

AAP, IDSA, AHA, and others recommend oral penicillin V or IM penicillin G benzathine as treatments of choice; oral cephalosporins and oral macrolides are considered alternatives. Amoxicillin sometimes used instead of penicillin V, especially for young children.

A second episode can be retreated with the same or other treatment of choice; other regimens (amoxicillin and clavulanate, clindamycin, penicillin G benzathine with or without rifampin) recommended for symptomatic patients with multiple, recurrent episodes.

Consider that multiple, recurrent episodes of symptomatic pharyngitis within several months to years may indicate a streptococcal carrier experiencing repeated episodes of nonstreptococcal (e.g., viral) pharyngitis; treatment not usually recommended for streptococcal pharyngeal carriers.

Respiratory Tract Infections

Treatment of lower respiratory tract infections caused by susceptible Streptococcus (α- or β-hemolytic strains only), S. pneumoniae, Staphylococcus, or H. influenzae.

Skin and Skin Structure Infections

Treatment of skin and skin structure infections caused by susceptible Streptococcus (α- or β-hemolytic strains only), Staphylococcus, or Escherichia coli.

Urinary Tract Infections (UTIs)

Treatment of UTIs caused by susceptible Enterococcus faecalis, Escherichia coli, or Proteus mirabilis. A drug of choice for treatment of uncomplicated UTIs caused by E. faecalis; consider high incidence of amoxicillin-resistant E. coli and other Enterobacteriaceae.

Gonorrhea

Previously used for treatment of acute uncomplicated gonorrhea (anogenital and urethral) caused by susceptible Neisseria gonorrhoeae. No longer recommended for gonorrhea by CDC or other experts (high incidence of penicillin-resistant strains).

Typhoid Fever and other Salmonella Infections

Alternative for treatment of typhoid fever† (enteric fever) caused by susceptible Salmonella typhi. Drugs of choice are fluoroquinolones and third generation cephalosporins (e.g., ceftriaxone, cefotaxime); consider that multidrug-resistant strains of S. typhi (strains resistant to ampicillin, amoxicillin, chloramphenicol, and/or co-trimoxazole) reported with increasing frequency.

Treatment of chronic carriers of S. typhi†; drugs of choice are fluoroquinolones (e.g., ciprofloxacin), ampicillin, or amoxicillin (with probenecid).

Alternative for treatment of gastroenteritis caused by nontyphoidal Salmonella†. Anti-infectives not indicated in otherwise healthy individuals with uncomplicated (noninvasive) gastroenteritis, but recommended if gastroenteritis is severe and in those at increased risk of invasive disease (e.g., <6 months or >50 years of age; hemoglobinopathies, severe atherosclerosis, valvular heart disease, prostheses, uremia, chronic GI disease, severe colitis; immunocompromised because of malignancy, immunosuppressive therapy, HIV infection). Drugs of choice are fluoroquinolones, third generation cephalosporins (cefotaxime, ceftriaxone), ampicillin, amoxicillin, co-trimoxazole, or chloramphenicol, depending on in vitro susceptibility.

Helicobacter pylori Infection and Duodenal Ulcer Disease

Treatment of Helicobacter pylori infection and duodenal ulcer disease (active or 1-year history of duodenal ulcer); eradication of H. pylori has been shown to reduce the risk of duodenal ulcer recurrence.

Used in a multidrug regimen that includes amoxicillin, clarithromycin, and either lansoprazole or omeprazole (triple therapy). Used with lansoprazole (dual therapy) in those allergic to or intolerant of clarithromycin or when clarithromycin resistance is suspected.

Lyme Disease

Treatment of early localized or early disseminated Lyme disease† associated with erythema migrans, in the absence of neurologic involvement or third-degree AV heart block.

IDSA, AAP, and others consider amoxicillin a drug of choice for treatment of early localized or early disseminated Lyme disease when oral therapy is appropriate. May be used in those with mild Lyme carditis, Lyme arthritis (without associated neurologic disease), or isolated facial nerve palsy (without other neurologic involvement).

Amoxicillin is the preferred oral agent for treatment in pregnant women and children <8 years of age who should not receive doxycycline.

Chlamydial Infections

Treatment of uncomplicated urethritis and cervicitis caused by Chlamydia trachomatis in pregnant women†. CDC and others recommend amoxicillin or a macrolide (azithromycin, erythromycin) as drugs of choice for treatment of urogenital chlamydial infections in these women.

Prevention of Bacterial Endocarditis

Prevention of bacterial endocarditis in patients undergoing certain dental, oral, respiratory tract, or esophageal procedures† who have cardiac conditions that put them at high or moderate risk. AHA recommends amoxicillin as drug of choice for such prophylaxis.

Prevention of bacterial endocarditis in patients undergoing certain GU and GI (except esophageal) procedures† who have cardiac conditions that put them at moderate-risk.

An alternative for follow-up to an initial parenteral regimen for prevention of bacterial endocarditis in patients undergoing certain GU and GI (except esophageal procedures† who have cardiac conditions that put them at high-risk.

Consult most recent AHA recommendations for specific information on which cardiac conditions are associated with high or moderate risk of endocarditis and which procedures require prophylaxis.

Prevention of S. pneumoniae Infections in Asplenic Individuals

Prevention of S. pneumoniae infections in children with anatomic or functional asplenia† (e.g., congenital, resulting from sickle cell disease or surgery) or children with malignant neoplasms or thalassemia.

Oral penicillin V usually drug of choice; some experts recommend amoxicillin.

Children at increased risk for pneumococcal infections should receive pneumococcal 7-valent conjugate vaccine and pneumococcal 23-valent polysaccharide vaccine. Long-term anti-infective prophylaxis recommended for children with functional or anatomic asplenia regardless of vaccination status.

Anthrax

An alternative for postexposure prophylaxis of anthrax† following exposure to aerosolized Bacillus anthracis spores (inhalational anthrax). Ciprofloxacin or doxycycline are initial drugs of choice for postexposure prophylaxis following a suspected or confirmed bioterrorism-related anthrax exposure. If penicillin susceptibility is confirmed, consideration can be given to changing prophylaxis to a penicillin in infants and children and in pregnant or lactating women; amoxicillin usually recommended.

An alternative for treatment of inhalational anthrax† when a parenteral regimen is not available (e.g., when there are supply or logistic problems in a mass-casualty setting).

An alternative for treatment of cutaneous anthrax†. If cutaneous anthrax occurs in the context of biologic warfare or bioterrorism, initial drugs of choice are ciprofloxacin or doxycycline. If penicillin susceptibility is confirmed, consideration can be given to changing to a penicillin in infants and children or in pregnant or lactating women; amoxicillin usually is recommended.