Displacement of penicillins from plasma protein binding sites by highly protein bound drugs e. Minor Probenecid competitively inhibits renal tubular secretion and causes higher, prolonged serum levels of penicillins. In general, this pharmacokinetic interaction is not harmful and can be used therapeutically if needed. Minor Due to high protein binding, salicylates could be displaced from binding sites or could displace other highly protein-bound drugs such as penicillins.

Sodium Benzoate; Sodium Phenylacetate: Moderate Antibiotics that undergo tubular secretion such as penicillins may compete with phenylacetlyglutamine and hippuric acid for active tubular secretion. The overall usefulness of sodium benzoate; sodium phenylacetate is due to the excretion of its metabolites. An increase in metabolite concentrations could contribute to failed treatment and worsening of the patient's clinical status.

This combination should be used with caution. Sodium picosulfate; Magnesium oxide; Anhydrous citric acid: Major Prior or concomitant use of antibiotics with sodium picosulfate; magnesium oxide; anhydrous citric acid may reduce efficacy of the bowel preparation as conversion of sodium picosulfate to its active metabolite bis- p-hydroxy-phenyl -pyridylmethane BHPM is mediated by colonic bacteria. If possible, avoid coadministration. Therefore, these antibiotics should be taken at least 2 hours before and not less than 6 hours after the administration of sodium picosulfate; magnesium oxide; anhydrous citric acid solution.

Major Antibiotics which possess bacterial activity against salmonella typhi organisms may interfere with the immunological response to the live typhoid vaccine. Allow 24 hours or more to elapse between the administration of the last dose of the antibiotic and the live typhoid vaccine. Moderate The concomitant use of warfarin with many classes of antibiotics, including penicillins, may result in an increased INR thereby potentiating the risk for bleeding.

Inhibition of vitamin K synthesis due to alterations in the intestinal flora may be a mechanism; however, concurrent infection is also a potential risk factor for elevated INR. Monitor patients for signs and symptoms of bleeding.

Additionally, increased monitoring of the INR, especially during initiation and upon discontinuation of the antibiotic, may be necessary. However, unless the infant is allergic to penicillins, breast-feeding is generally safe during maternal penicillin therapy.

The American Academy of Pediatrics AAP considers amoxicillin a medication that is usually compatible with breast-feeding; however, amoxicillin; clavulanic acid has not been evaluated by the AAP. Amoxicillin; clavulanic acid is excreted in breast milk in small amounts. Penicillins may cause diarrhea due to disruption of GI flora , candidiasis, and skin rash in breast-feeding infants.

In a study assessing adverse events in breast-fed infants of mothers exposed to antibiotics, The adverse events included constipation, rash, diarrhea, irritability, and elevated liver enzymes. The rate of adverse events was positively correlated with the dose of amoxicillin; clavulanic acid..

The infant should be observed for potential effects. Skipping doses or not completing the full course of therapy may: Diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued.

Sometimes after starting treatment with antibiotics, patients can develop watery and bloody stools with or without stomach cramps and fever even as late as 2 or more months after having taken the last dose of the antibiotic. If this occurs, patients should contact their physician as soon as possible.

They are more likely to occur in individuals who have previously demonstrated hypersensitivity to penicillins and in those with a history of allergy, asthma, hay fever, or urticaria. The following adverse reactions have been reported as associated with the use of penicillins: Anaphylaxis see WARNINGS Serum sickness-like reactions, erythematous maculopapular rashes, erythema multiforme, Stevens-Johnson syndrome, exfoliative dermatitis, toxic epidermal necrolysis, acute generalized exanthematous pustulosis, hypersensitivity vasculitis and urticaria have been reported.

These hypersensitivity reactions may be controlled with antihistamines and, if necessary, systemic corticosteroids.

Whenever such reactions occur, amoxicillin should be discontinued unless, in the opinion of the physician, the condition being treated is life-threatening and amenable only to amoxicillin therapy.

Hepatic dysfunction including cholestatic jaundice, hepatic cholestasis and acute cytolytic hepatitis have been reported. Hemic and Lymphatic Systems: Anemia, including hemolytic anemia, thrombocytopenia, thrombocytopenic purpura, eosinophilia, leukopenia, and agranulocytosis have been reported during therapy with penicillins. These reactions are usually reversible on discontinuation of therapy and are believed to be hypersensitivity phenomena.

Tooth discoloration brown, yellow, or gray staining has been rarely reported. Most reports occurred in pediatric patients. Discoloration was reduced or eliminated with brushing or dental cleaning in most cases. Combination Therapy With Clarithromycin and Lansoprazole In clinical trials using combination therapy with amoxicillin plus clarithromycin and lansoprazole, and amoxicillin plus lansoprazole, no adverse reactions peculiar to these drug combinations were observed.

Adverse reactions that have occurred have been limited to those that had been previously reported with amoxicillin, clarithromycin, or lansoprazole. No treatment-emergent adverse events were observed at significantly higher rates with triple therapy than with any dual therapy regimen.

No treatment-emergent adverse events were observed at significantly higher rates with amoxicillin three times daily plus lansoprazole three times daily dual therapy than with lansoprazole alone. CDAD must be considered in all patients who present with diarrhea following antibacterial use. Careful medical history is necessary since CDAD has been reported to occur over 2 months after the administration of antibacterial agents. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C.

Development of Drug-Resistant Bacteria Prescribing amoxicillin in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria. Use in Patients With Mononucleosis A high percentage of patients with mononucleosis who receive amoxicillin develop an erythematous skin rash.

Thus amoxicillin should not be administered to patients with mononucleosis. Adverse Reactions The following are discussed in more detail in other sections of the labeling: For more information on adverse reactions with clarithromycin or lansoprazole, refer to the Adverse Reactions section of their package inserts. Postmarketing or Other Experience In addition to adverse events reported from clinical trials, the following events have been identified during postmarketing use of penicillins.

Because they are reported voluntarily from a population of unknown size, estimates of frequency cannot be made. These events have been chosen for inclusion due to a combination of their seriousness, frequency of reporting, or potential causal connection to amoxicillin. Onset of pseudomembranous colitis symptoms may occur during or after antibacterial treatment [see Warnings and Precautions 5.

Anaphylaxis [see Warnings and Precautions 5. Serum sickness—like reactions, erythematous maculopapular rashes, erythema multiforme, Stevens-Johnson syndrome, exfoliative dermatitis, toxic epidermal necrolysis, acute generalized exanthematous pustulosis, hypersensitivity vasculitis, and urticaria have been reported. Hepatic dysfunction including cholestatic jaundice, hepatic cholestasis and acute cytolytic hepatitis have been reported.

Crystalluria has been reported [see Overdosage 10 ]. Anemia, including hemolytic anemia, thrombocytopenia, thrombocytopenic purpura, eosinophilia, leukopenia, and agranulocytosis have been reported. These reactions are usually reversible on discontinuation of therapy and are believed to be hypersensitivity phenomena.

Tooth discoloration brown, yellow, or gray staining has been reported. Most reports occurred in pediatric patients. Consult your doctor or pharmacist for details. Amoxicillin may cause false positive results with certain diabetic urine testing products cupric sulfate-type. This drug may also affect the results of certain lab tests. Make sure laboratory personnel and the doctors know you use this drug.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

Quick GuideSymptoms of Mono: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at Canadian residents should call their local poison control center directly. Symptoms of overdose may include: Do not share this medication with others. This medication has been prescribed for your current condition only. Do not use it later for another infection unless told to do so by the doctor.

A different medication may be necessary in those cases. Consult the doctor for more details.

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