120-431: Amoxicillin is an antibiotic medication belonging to the aminopenicillin class of the penicillin family. The drug is used to treat bacterial infections such as middle ear infection , strep throat , pneumonia , skin infections , odontogenic infections , and urinary tract infections . It is taken orally (swallowed by mouth), or less commonly by either Intramuscular injection or by an IV bolus injection, which
240-569: A disulfiram -like chemical reaction with alcohol by inhibiting its breakdown by acetaldehyde dehydrogenase , which may result in vomiting, nausea, and shortness of breath. In addition, the efficacy of doxycycline and erythromycin succinate may be reduced by alcohol consumption. Other effects of alcohol on antibiotic activity include altered activity of the liver enzymes that break down the antibiotic compound. The successful outcome of antimicrobial therapy with antibacterial compounds depends on several factors. These include host defense mechanisms ,
360-458: A half-life of 3.7 hours in newborns and 1.4 hours in adults. Amoxicillin attaches to the cell wall of susceptible bacteria and results in their death. It is effective against streptococci, pneumococci, enterococci, Haemophilus influenzae , Escherichia coli , Proteus mirabilis , Neisseria meningitidis , Neisseria gonorrhoeae , Shigella , Chlamydia trachomatis , Salmonella , Borrelia burgdorferi , and Helicobacter pylori . As
480-449: A macrolide . The World Health Organization (WHO) recommends amoxicillin as first-line treatment for pneumonia that is not "severe". Amoxicillin is used in post-exposure inhalation of anthrax to prevent disease progression and for prophylaxis. It is effective as one part of a multi-drug regimen for treatment of stomach infections of Helicobacter pylori . It is typically combined with a proton-pump inhibitor (such as omeprazole ) and
600-441: A macrolide antibiotic (such as clarithromycin ); other drug combinations are also effective. Amoxicillin is effective for treatment of early cutaneous Lyme borreliosis ; the effectiveness and safety of oral amoxicillin is neither better nor worse than common alternatively-used antibiotics. Amoxicillin is used to treat odontogenic infections , infections of the tongue, lips, and other oral tissues. It may be prescribed following
720-501: A molecular weight of less than 1000 daltons . Since the first pioneering efforts of Howard Florey and Chain in 1939, the importance of antibiotics, including antibacterials, to medicine has led to intense research into producing antibacterials at large scales. Following screening of antibacterials against a wide range of bacteria , production of the active compounds is carried out using fermentation , usually in strongly aerobic conditions. Antimicrobial resistance (AMR or AR)
840-562: A tooth extraction , particularly in those with compromised immune systems . Amoxicillin is occasionally used for the treatment of skin infections, such as acne vulgaris . It is often an effective treatment for cases of acne vulgaris that have responded poorly to other antibiotics, such as doxycycline and minocycline . Amoxicillin is recommended by the World Health Organization for the treatment of infants with signs and symptoms of pneumonia in resource-limited situations when
960-1210: A β-lactamase inhibitor . This drug combination is commonly called co-amoxiclav . It is a moderate-spectrum , bacteriolytic , β-lactam antibiotic in the aminopenicillin family used to treat susceptible Gram-positive and Gram-negative bacteria. It is usually the drug of choice within the class because it is better-absorbed, following oral administration, than other β-lactam antibiotics. In general, Streptococcus , Bacillus subtilis , Enterococcus , Haemophilus , Helicobacter , and Moraxella are susceptible to amoxicillin, whereas Citrobacter , Klebsiella and Pseudomonas aeruginosa are resistant to it. Some E. coli and most clinical strains of Staphylococcus aureus have developed resistance to amoxicillin to varying degrees. Adverse effects are similar to those for other β-lactam antibiotics , including nausea , vomiting , rashes , and antibiotic-associated colitis . Diarrhea (loose bowel movements) may also occur. Rarer adverse effects include mental and behavioral changes, lightheadedness , insomnia , hyperactivity , agitation , confusion , anxiety , sensitivity to lights and sounds , and unclear thinking . Immediate medical care
1080-492: A Japanese bacteriologist working with Ehrlich in the quest for a drug to treat syphilis , achieved success with the 606th compound in their series of experiments. In 1910, Ehrlich and Hata announced their discovery, which they called drug "606", at the Congress for Internal Medicine at Wiesbaden . The Hoechst company began to market the compound toward the end of 1910 under the name Salvarsan, now known as arsphenamine . The drug
1200-643: A biological cost, thereby reducing fitness of resistant strains, which can limit the spread of antibacterial-resistant bacteria, for example, in the absence of antibacterial compounds. Additional mutations, however, may compensate for this fitness cost and can aid the survival of these bacteria. Paleontological data show that both antibiotics and antibiotic resistance are ancient compounds and mechanisms. Useful antibiotic targets are those for which mutations negatively impact bacterial reproduction or viability. Several molecular mechanisms of antibacterial resistance exist. Intrinsic antibacterial resistance may be part of
1320-509: A component of the DRESS syndrome . The rash is described as maculopapular or morbilliform ( measles-like ; therefore, in medical literature, it is called "amoxicillin-induced morbilliform rash".). It starts on the trunk and can spread from there. This rash is unlikely to be a true allergic reaction and is not a contraindication for future amoxicillin usage, nor should the current regimen necessarily be stopped. However, this common amoxicillin rash and
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#17328805112061440-541: A correlation between use of PPIs and Clostridioides difficile infection . While the data are contradictory and controversial, the FDA had sufficient concern to include a warning about this adverse effect on the label of PPI medications. Concerns have also been raised about spontaneous bacterial peritonitis (SBP) in older people taking PPIs and in people with irritable bowel syndrome taking PPIs; both types of infections arise in these populations due to underlying conditions and it
1560-548: A dangerous allergic reaction cannot easily be distinguished by inexperienced persons, so a healthcare professional is often required to distinguish between the two. A nonallergic amoxicillin rash may also be an indicator of infectious mononucleosis . Some studies indicate about 80–90% of patients with acute Epstein–Barr virus infection treated with amoxicillin or ampicillin develop such a rash. Amoxicillin may interact with these drugs: When given intravenously or intramuscularly: Amoxicillin (α-amino- p -hydroxybenzyl penicillin)
1680-400: A derivative of ampicillin , amoxicillin is a member of the penicillin family and, like penicillins, is a β-lactam antibiotic . It inhibits cross-linkage between the linear peptidoglycan polymer chains that make up a major component of the bacterial cell wall . It has two ionizable groups in the physiological range (the amino group in alpha-position to the amide carbonyl group and
1800-582: A different mode of action, and heavy use of antacids . A potassium-competitive acid blocker (PCAB) revaprazan was marketed in Korea as an alternative to a PPI. A newer PCAB vonoprazan with a faster and longer lasting action than revaprazan, and PPIs has been marketed in Japan (2013), Russia (2021), and the US (2023). PPIs are among the most widely sold medications in the world. The class of proton-pump inhibitor medications
1920-425: A disease now treated by antibiotics. Proton-pump inhibitor Proton-pump inhibitors ( PPIs ) are a class of medications that cause a profound and prolonged reduction of stomach acid production. They do so by irreversibly inhibiting the stomach's H /K ATPase proton pump . Proton-pump inhibitors have largely superseded the H 2 -receptor antagonists , a group of medications with similar effects but
2040-453: A dissertation, " Contribution à l'étude de la concurrence vitale chez les micro-organismes: antagonisme entre les moisissures et les microbes " (Contribution to the study of vital competition in micro-organisms: antagonism between moulds and microbes), the first known scholarly work to consider the therapeutic capabilities of moulds resulting from their anti-microbial activity. In his thesis, Duchesne proposed that bacteria and moulds engage in
2160-466: A million new cases of multidrug-resistant tuberculosis (MDR-TB) are estimated to occur worldwide. For example, NDM-1 is a newly identified enzyme conveying bacterial resistance to a broad range of beta-lactam antibacterials. The United Kingdom's Health Protection Agency has stated that "most isolates with NDM-1 enzyme are resistant to all standard intravenous antibiotics for treatment of severe infections." On 26 May 2016, an E. coli " superbug "
2280-517: A patient is infected with a β-lactamase -producing strain of bacteria. Antibiotics are commonly classified based on their mechanism of action , chemical structure , or spectrum of activity. Most target bacterial functions or growth processes. Those that target the bacterial cell wall ( penicillins and cephalosporins ) or the cell membrane ( polymyxins ), or interfere with essential bacterial enzymes ( rifamycins , lipiarmycins , quinolones , and sulfonamides ) have bactericidal activities, killing
2400-460: A perpetual battle for survival. Duchesne observed that E. coli was eliminated by Penicillium glaucum when they were both grown in the same culture. He also observed that when he inoculated laboratory animals with lethal doses of typhoid bacilli together with Penicillium glaucum , the animals did not contract typhoid. Duchesne's army service after getting his degree prevented him from doing any further research. Duchesne died of tuberculosis ,
2520-475: A reaction often starts with a change in mental state, skin rash with intense itching (often beginning in fingertips and around groin area and rapidly spreading), and sensations of fever, nausea, and vomiting. Any other symptoms that seem even remotely suspicious must be taken very seriously. However, more mild allergy symptoms, such as a rash, can occur at any time during treatment, even up to a week after treatment has ceased. For some people allergic to amoxicillin,
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#17328805112062640-465: A resistance mechanism encoded by a single gene conveys resistance to more than one antibacterial compound. Antibacterial-resistant strains and species, sometimes referred to as "superbugs", now contribute to the emergence of diseases that were, for a while, well controlled. For example, emergent bacterial strains causing tuberculosis that are resistant to previously effective antibacterial treatments pose many therapeutic challenges. Every year, nearly half
2760-537: A wide range of bacteria. Following a 40-year break in discovering classes of antibacterial compounds, four new classes of antibiotics were introduced to clinical use in the late 2000s and early 2010s: cyclic lipopeptides (such as daptomycin ), glycylcyclines (such as tigecycline ), oxazolidinones (such as linezolid ), and lipiarmycins (such as fidaxomicin ). With advances in medicinal chemistry , most modern antibacterials are semisynthetic modifications of various natural compounds. These include, for example,
2880-811: Is a naturally occurring process. AMR is driven largely by the misuse and overuse of antimicrobials. Yet, at the same time, many people around the world do not have access to essential antimicrobials. The emergence of antibiotic-resistant bacteria is a common phenomenon mainly caused by the overuse/misuse. It represents a threat to health globally. Each year, nearly 5 million deaths are associated with AMR globally. Emergence of resistance often reflects evolutionary processes that take place during antibiotic therapy. The antibiotic treatment may select for bacterial strains with physiologically or genetically enhanced capacity to survive high doses of antibiotics. Under certain conditions, it may result in preferential growth of resistant bacteria, while growth of susceptible bacteria
3000-498: Is a relatively quick intravenous injection lasting from a couple of seconds to a few minutes. Common adverse effects include nausea and rash. It may also increase the risk of yeast infections and, when used in combination with clavulanic acid , diarrhea . It should not be used in those who are allergic to penicillin . While usable in those with kidney problems , the dose may need to be decreased. Its use in pregnancy and breastfeeding does not appear to be harmful. Amoxicillin
3120-425: Is a semisynthetic derivative of penicillin with a structure similar to ampicillin but with better absorption when taken by mouth, thus yielding higher concentrations in blood and in urine. Amoxicillin diffuses easily into tissues and body fluids. It will cross the placenta and is excreted into breastmilk in small quantities. It is metabolized by the liver and excreted into the urine. It has an onset of 30 minutes and
3240-477: Is almost always used as a partner drug. Methicillin-resistant Staphylococcus aureus infections may be treated with a combination therapy of fusidic acid and rifampicin. Antibiotics used in combination may also be antagonistic and the combined effects of the two antibiotics may be less than if one of the antibiotics was given as a monotherapy . For example, chloramphenicol and tetracyclines are antagonists to penicillins . However, this can vary depending on
3360-486: Is also one of the treatment options for some skin conditions including acne and cellulitis . Advantages of topical application include achieving high and sustained concentration of antibiotic at the site of infection; reducing the potential for systemic absorption and toxicity, and total volumes of antibiotic required are reduced, thereby also reducing the risk of antibiotic misuse. Topical antibiotics applied over certain types of surgical wounds have been reported to reduce
3480-399: Is an example of misuse. Many antibiotics are frequently prescribed to treat symptoms or diseases that do not respond to antibiotics or that are likely to resolve without treatment. Also, incorrect or suboptimal antibiotics are prescribed for certain bacterial infections. The overuse of antibiotics, like penicillin and erythromycin, has been associated with emerging antibiotic resistance since
3600-444: Is because PPIs bind and inhibit dimethylargininase , the enzyme that degrades asymmetric dimethylarginine (ADMA), resulting in higher ADMA levels and a decrease in bioavailable nitric oxide . A 2022 umbrella review of 21 meta-analyses shows an association between proton-pump inhibitor use and an increased risk of four types of cancer. Associations have been shown between PPI use and an increased risk of pneumonia, particularly in
3720-423: Is bilateral or accompanied by ear drainage. In the past, amoxicillin was dosed three times daily when used to treat acute otitis media, which resulted in missed doses in routine ambulatory practice . There is now evidence that two times daily dosing or once daily dosing has similar effectiveness. Most sinusitis infections are caused by viruses , for which amoxicillin and amoxicillin-clavulanate are ineffective, and
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3840-468: Is considered one of the drivers of antibiotic misuse. Several organizations concerned with antimicrobial resistance are lobbying to eliminate the unnecessary use of antibiotics. The issues of misuse and overuse of antibiotics have been addressed by the formation of the US Interagency Task Force on Antimicrobial Resistance. This task force aims to actively address antimicrobial resistance, and
3960-684: Is coordinated by the US Centers for Disease Control and Prevention , the Food and Drug Administration (FDA), and the National Institutes of Health , as well as other US agencies. A non-governmental organization campaign group is Keep Antibiotics Working . In France, an "Antibiotics are not automatic" government campaign started in 2002 and led to a marked reduction of unnecessary antibiotic prescriptions, especially in children. The emergence of antibiotic resistance has prompted restrictions on their use in
4080-623: Is critically important as it can reduce the cost and toxicity of the antibiotic therapy and also reduce the possibility of the emergence of antimicrobial resistance. To avoid surgery, antibiotics may be given for non-complicated acute appendicitis . Antibiotics may be given as a preventive measure and this is usually limited to at-risk populations such as those with a weakened immune system (particularly in HIV cases to prevent pneumonia ), those taking immunosuppressive drugs , cancer patients, and those having surgery . Their use in surgical procedures
4200-577: Is distinct from fundic gland polyposis ); these polyps do not cause cancer and resolve when PPIs are discontinued. There is concern that use of PPIs may mask gastric cancers or other serious gastric problems. PPI use has also been associated with the development of microscopic colitis . Associations of PPI use and cardiovascular events have also been widely studied but clear conclusions have not been made as these relative risks are confounded by other factors. PPIs are commonly used in people with cardiovascular disease for gastric protection when aspirin
4320-607: Is driven largely by the misuse and overuse of antimicrobials. Yet, at the same time, many people around the world do not have access to essential antimicrobials. The World Health Organization has classified AMR as a widespread "serious threat [that] is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country". Each year, nearly 5 million deaths are associated with AMR globally. Global deaths attributable to AMR numbered 1.27 million in 2019. The term 'antibiosis', meaning "against life",
4440-497: Is frequently prescribed to treat symptomatic gastroesophageal reflux in otherwise healthy infants (that is: without gastroesophageal reflux disease). A study from 2019 showed that PPI use alone and together with histamine H2-receptor antagonists was associated with an increased bone fracture hazard, which was amplified by days of use and earlier initiation of therapy. The reason is not clear; increased bone break down by osteoclasts has been suggested. A recent 2024 study published in
4560-404: Is given for its antiplatelet actions. An interaction between PPIs and the metabolism of the platelet inhibitor clopidogrel is known and this drug is also often used in people with cardiac disease. There are associations with an increased risk of stroke, but this appears to be more likely to occur in people who already have an elevated risk. One suggested mechanism for cardiovascular effects
4680-599: Is in the β-lactam family of antibiotics . Amoxicillin was discovered in 1958 and came into medical use in 1972. Amoxil was approved for medical use in the United States in 1974, and in the United Kingdom in 1977. It is on the World Health Organization's List of Essential Medicines . It is one of the most commonly prescribed antibiotics in children. Amoxicillin is available as a generic medication . In 2022, it
4800-489: Is inhibited by the drug. For example, antibacterial selection for strains having previously acquired antibacterial-resistance genes was demonstrated in 1943 by the Luria–Delbrück experiment . Antibiotics such as penicillin and erythromycin, which used to have a high efficacy against many bacterial species and strains, have become less effective, due to the increased resistance of many bacterial strains. Resistance may take
4920-509: Is more effective than receptor antagonists in suppressing gastric acid secretion. All of these drugs inhibit the gastric H,K-ATPase by covalent binding, so the duration of their effect is longer than expected from their levels in the blood. Targeting the terminal step in acid production, as well as the irreversible nature of the inhibition, results in a class of medications that are significantly more effective than H 2 antagonists and reduce gastric acid secretion by up to 99%. Decreasing
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5040-561: Is not clear if this is a class effect of PPIs. PPIs may predispose an individual to developing small intestinal bacterial overgrowth or fungal overgrowth. In cirrhotic patients , large volume of ascites and reduced esophageal motility by varices can provoke GERD . Acidic irritation, in return, may induce the rupture of varices. Therefore, PPIs are often routinely prescribed for cirrhotic patients to treat GERD and prevent variceal bleeding. However, it has been recently shown that long term use of PPIs in patients with cirrhosis increases
5160-400: Is not sold in the United States. When an intravenous aminopenicillin is required in the United States, ampicillin is typically used. When there is an adequate response to ampicillin, the course of antibiotic therapy may often be completed with oral amoxicillin. Research with mice indicated successful delivery using intraperitoneally injected amoxicillin-bearing microparticles . Amoxicillin
5280-417: Is on the World Health Organization's List of Essential Medicines . Omeprazole is the specific listed example. These medications are used in the treatment of many conditions, such as: Specialty professional organizations recommend that people take the lowest effective PPI dose to achieve the desired therapeutic result when used to treat gastroesophageal reflux disease long-term. In the United States,
5400-455: Is required upon the first signs of these adverse effects. Similarly to other penicillins, amoxicillin has been associated with increased risk of seizures . Amoxicillin-induced neurotoxicity has been especially associated with concentrations of greater than 110 mg/L. The onset of an allergic reaction to amoxicillin can be very sudden and intense; emergency medical attention must be sought as quickly as possible. The initial phase of such
5520-410: Is resistant to both acids and antibiotics. PPIs also show some weaker additional effects in eradication. The rate of omeprazole absorption is decreased by concomitant food intake. In addition, the absorption of lansoprazole and esomeprazole is decreased and delayed by food. It has been reported, however, that these pharmacokinetic effects have no significant impact on efficacy. In healthy humans,
5640-494: Is the international nonproprietary name (INN), British Approved Name (BAN), and United States Adopted Name (USAN), while amoxycillin is the Australian Approved Name (AAN). Amoxicillin is one of the semisynthetic penicillins discovered by former pharmaceutical company Beecham Group . The patent for amoxicillin has expired, thus amoxicillin and co-amoxiclav preparations are marketed under various brand names across
5760-494: Is to help prevent infection of incisions . They have an important role in dental antibiotic prophylaxis where their use may prevent bacteremia and consequent infective endocarditis . Antibiotics are also used to prevent infection in cases of neutropenia particularly cancer-related. The use of antibiotics for secondary prevention of coronary heart disease is not supported by current scientific evidence, and may actually increase cardiovascular mortality, all-cause mortality and
5880-546: Is to try not to use them, and the second rule is try not to use too many of them." Inappropriate antibiotic treatment and overuse of antibiotics have contributed to the emergence of antibiotic-resistant bacteria. However, potential harm from antibiotics extends beyond selection of antimicrobial resistance and their overuse is associated with adverse effects for patients themselves, seen most clearly in critically ill patients in Intensive care units . Self-prescribing of antibiotics
6000-406: Is unlikely to interfere with many common antibiotics, there are specific types of antibiotics with which alcohol consumption may cause serious side effects. Therefore, potential risks of side effects and effectiveness depend on the type of antibiotic administered. Antibiotics such as metronidazole , tinidazole , cephamandole , latamoxef , cefoperazone , cefmenoxime , and furazolidone , cause
6120-459: The Beecham Group in the 1960s. It was invented by Anthony Alfred Walter Long and John Herbert Charles Nayler, two British scientists. It became available in 1972 and was the second aminopenicillin to reach the market (after ampicillin in 1961). Co-amoxiclav became available in 1981. Amoxicillin is relatively inexpensive. In 2022, a survey of eight generic antibiotics commonly prescribed in
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#17328805112066240-401: The Food and Drug Administration (FDA) has advised that over-the-counter PPIs, such as Prilosec OTC, should be used no more than three 14-day treatment courses over one year. Despite their extensive use, the quality of the evidence supporting their use in some of these conditions is variable. The effectiveness of PPIs has not been demonstrated for every case. For example, although they reduce
6360-498: The Journal of Clinical Endocrinology & Metabolism found that chronic use of PPIs in men is linked to lower trabecular bone quality. Specifically, PPI use was associated with reduced lumbar spine trabecular bone score (TBS), as well as lower bone mineral density (BMD) T-scores in the lumbar spine, total hip, and femoral neck. These findings suggest that long-term PPI use may negatively affect bone health in men. Some studies have shown
6480-458: The beta-lactam antibiotics , which include the penicillins (produced by fungi in the genus Penicillium ), the cephalosporins , and the carbapenems . Compounds that are still isolated from living organisms are the aminoglycosides , whereas other antibacterials—for example, the sulfonamides , the quinolones , and the oxazolidinones —are produced solely by chemical synthesis . Many antibacterial compounds are relatively small molecules with
6600-441: The bioenergetic failure of immune cells seen in sepsis . They also alter the microbiome of the gut, lungs, and skin, which may be associated with adverse effects such as Clostridioides difficile associated diarrhoea . Whilst antibiotics can clearly be lifesaving in patients with bacterial infections, their overuse, especially in patients where infections are hard to diagnose, can lead to harm via multiple mechanisms. Before
6720-416: The carboxyl group ). Amoxicillin is a β-lactam and aminopenicillin antibiotic in terms of chemical structure . It is structurally related to ampicillin . The experimental log P of amoxicillin is 0.87. It is described as an "ambiphilic"—between hydrophilic and lipophilic —antibiotic. Amoxicillin was one of several semisynthetic derivatives of 6-aminopenicillanic acid ( 6-APA ) developed by
6840-452: The hydrogen / potassium adenosine triphosphatase enzyme system (the H /K ATPase , or, more commonly, the gastric proton pump) of the gastric parietal cells . The proton pump is the terminal stage in gastric acid secretion, being directly responsible for secreting H ions into the gastric lumen, making it an ideal target for inhibiting acid secretion. Because the H,K-ATPase is the final step of acid secretion, an inhibitor of this enzyme
6960-558: The sulfonamides . In current usage, the term "antibiotic" is applied to any medication that kills bacteria or inhibits their growth, regardless of whether that medication is produced by a microorganism or not. The term "antibiotic" derives from anti + βιωτικός ( biōtikos ), "fit for life, lively", which comes from βίωσις ( biōsis ), "way of life", and that from βίος ( bios ), "life". The term "antibacterial" derives from Greek ἀντί ( anti ), "against" + βακτήριον ( baktērion ), diminutive of βακτηρία ( baktēria ), "staff, cane", because
7080-513: The treatment and prevention of such infections. They may either kill or inhibit the growth of bacteria. A limited number of antibiotics also possess antiprotozoal activity. Antibiotics are not effective against viruses such as the ones which cause the common cold or influenza . Drugs which inhibit growth of viruses are termed antiviral drugs or antivirals. Antibiotics are also not effective against fungi . Drugs which inhibit growth of fungi are called antifungal drugs . Sometimes,
7200-402: The 1950s. Widespread usage of antibiotics in hospitals has also been associated with increases in bacterial strains and species that no longer respond to treatment with the most common antibiotics. Common forms of antibiotic misuse include excessive use of prophylactic antibiotics in travelers and failure of medical professionals to prescribe the correct dosage of antibiotics on the basis of
7320-443: The 30 days after starting therapy, where it was found to be 50% higher in community use. Other very weak associations of PPI use have been found, such as with chronic kidney disease , dementia and Hepatocellular carcinoma (HCC). As of 2016, results were derived from observational studies, it remained uncertain whether such associations were causal relationships. Proton pump inhibitors act by irreversibly blocking
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#17328805112067440-624: The American Holistic Nurses' Association, the American Medical Association , and the American Public Health Association . Despite pledges by food companies and restaurants to reduce or eliminate meat that comes from animals treated with antibiotics, the purchase of antibiotics for use on farm animals has been increasing every year. There has been extensive use of antibiotics in animal husbandry. In
7560-616: The UK in 1970 (Swann report 1969), and the European Union has banned the use of antibiotics as growth-promotional agents since 2003. Moreover, several organizations (including the World Health Organization, the National Academy of Sciences , and the U.S. Food and Drug Administration ) have advocated restricting the amount of antibiotic use in food animal production. However, commonly there are delays in regulatory and legislative actions to limit
7680-445: The United States found their average cost to be about $ 42.67, while amoxicillin was sold for $ 12.14 on average. Pharmaceutical manufacturers make amoxicillin in tri hydrate form, for oral use available as capsules , regular, chewable and dispersible tablets , syrup and pediatric suspension for oral use, and as the sodium salt for intravenous administration. An extended-release is available. The intravenous form of amoxicillin
7800-660: The United States, the question of emergence of antibiotic-resistant bacterial strains due to use of antibiotics in livestock was raised by the US Food and Drug Administration (FDA) in 1977. In March 2012, the United States District Court for the Southern District of New York, ruling in an action brought by the Natural Resources Defense Council and others, ordered the FDA to revoke approvals for
7920-449: The acid in the stomach can aid the healing of duodenal ulcers and reduce the pain from indigestion and heartburn . However, stomach acids are needed to digest proteins, vitamin B 12 , calcium, and other nutrients, and too little stomach acid causes the condition hypochlorhydria . The PPIs are given in an inactive form, which is neutrally charged ( lipophilic ) and readily crosses cell membranes into intracellular compartments (like
8040-565: The activity of antibacterials depends frequently on its concentration, in vitro characterization of antibacterial activity commonly includes the determination of the minimum inhibitory concentration and minimum bactericidal concentration of an antibacterial. To predict clinical outcome, the antimicrobial activity of an antibacterial is usually combined with its pharmacokinetic profile, and several pharmacological parameters are used as markers of drug efficacy. In important infectious diseases, including tuberculosis, combination therapy (i.e.,
8160-438: The administration of a broad-spectrum antibiotic based on the signs and symptoms presented and is initiated pending laboratory results that can take several days. When the responsible pathogenic microorganism is already known or has been identified, definitive therapy can be started. This will usually involve the use of a narrow-spectrum antibiotic. The choice of antibiotic given will also be based on its cost. Identification
8280-425: The adverse effects can be fatal due to anaphylaxis . Use of the amoxicillin/clavulanic acid combination for more than one week has caused a drug-induced immunoallergic-type hepatitis in some patients. Young children having ingested acute overdoses of amoxicillin manifested lethargy , vomiting, and renal dysfunction . There is poor reporting of adverse effects of amoxicillin from clinical trials. For this reason,
8400-485: The antagonism observed between some bacteria, it would offer perhaps the greatest hopes for therapeutics". In 1874, physician Sir William Roberts noted that cultures of the mould Penicillium glaucum that is used in the making of some types of blue cheese did not display bacterial contamination. In 1895 Vincenzo Tiberio , Italian physician, published a paper on the antibacterial power of some extracts of mold. In 1897, doctoral student Ernest Duchesne submitted
8520-423: The bacteria. Protein synthesis inhibitors ( macrolides , lincosamides , and tetracyclines ) are usually bacteriostatic , inhibiting further growth (with the exception of bactericidal aminoglycosides ). Further categorization is based on their target specificity. "Narrow-spectrum" antibiotics target specific types of bacteria, such as gram-negative or gram-positive , whereas broad-spectrum antibiotics affect
8640-437: The blood. Women with menstrual irregularities may be at higher risk of failure and should be advised to use backup contraception during antibiotic treatment and for one week after its completion. If patient-specific risk factors for reduced oral contraceptive efficacy are suspected, backup contraception is recommended. In cases where antibiotics have been suggested to affect the efficiency of birth control pills, such as for
8760-568: The broad-spectrum antibiotic rifampicin , these cases may be due to an increase in the activities of hepatic liver enzymes' causing increased breakdown of the pill's active ingredients. Effects on the intestinal flora , which might result in reduced absorption of estrogens in the colon, have also been suggested, but such suggestions have been inconclusive and controversial. Clinicians have recommended that extra contraceptive measures be applied during therapies using antibiotics that are suspected to interact with oral contraceptives . More studies on
8880-438: The concurrent application of two or more antibiotics) has been used to delay or prevent the emergence of resistance. In acute bacterial infections, antibiotics as part of combination therapy are prescribed for their synergistic effects to improve treatment outcome as the combined effect of both antibiotics is better than their individual effect. Fosfomycin has the highest number of synergistic combinations among antibiotics and
9000-479: The data is weak and several confounding factors have been identified. Low levels of magnesium can be found in people on PPI therapy and these can be reversed when they are switched to H 2 -receptor antagonist medications. High dose or long-term use of PPIs carries an increased risk of bone fractures which was not found with short-term, low dose use; the FDA included a warning regarding this on PPI drug labels in 2010. In infants, acid suppression therapy
9120-497: The early 20th century, treatments for infections were based primarily on medicinal folklore . Mixtures with antimicrobial properties that were used in treatments of infections were described over 2,000 years ago. Many ancient cultures, including the ancient Egyptians and ancient Greeks , used specially selected mold and plant materials to treat infections . Nubian mummies studied in the 1990s were found to contain significant levels of tetracycline . The beer brewed at that time
9240-587: The first systemically active antibacterial drug, Prontosil , was developed by a research team led by Gerhard Domagk in 1932 or 1933 at the Bayer Laboratories of the IG Farben conglomerate in Germany. However, the effectiveness and easy access to antibiotics have also led to their overuse and some bacteria have evolved resistance to them. Antimicrobial resistance (AMR), a naturally occurring process,
9360-399: The first bacteria to be discovered were rod-shaped. Antibiotics are used to treat or prevent bacterial infections, and sometimes protozoan infections . ( Metronidazole is effective against a number of parasitic diseases ). When an infection is suspected of being responsible for an illness but the responsible pathogen has not been identified, an empiric therapy is adopted. This involves
9480-514: The first synthetic antibacterial organoarsenic compound salvarsan , now called arsphenamine. This heralded the era of antibacterial treatment that was begun with the discovery of a series of arsenic-derived synthetic antibiotics by both Alfred Bertheim and Ehrlich in 1907. Ehrlich and Bertheim had experimented with various chemicals derived from dyes to treat trypanosomiasis in mice and spirochaeta infection in rabbits. While their early compounds were too toxic, Ehrlich and Sahachiro Hata ,
9600-444: The form of biodegradation of pharmaceuticals, such as sulfamethazine-degrading soil bacteria introduced to sulfamethazine through medicated pig feces. The survival of bacteria often results from an inheritable resistance, but the growth of resistance to antibacterials also occurs through horizontal gene transfer . Horizontal transfer is more likely to happen in locations of frequent antibiotic use. Antibacterial resistance may impose
9720-923: The genetic makeup of bacterial strains. For example, an antibiotic target may be absent from the bacterial genome . Acquired resistance results from a mutation in the bacterial chromosome or the acquisition of extra-chromosomal DNA. Antibacterial-producing bacteria have evolved resistance mechanisms that have been shown to be similar to, and may have been transferred to, antibacterial-resistant strains. The spread of antibacterial resistance often occurs through vertical transmission of mutations during growth and by genetic recombination of DNA by horizontal genetic exchange . For instance, antibacterial resistance genes can be exchanged between different bacterial strains or species via plasmids that carry these resistance genes. Plasmids that carry several different resistance genes can confer resistance to multiple antibacterials. Cross-resistance to several antibacterials may also occur when
9840-465: The half-life of PPIs is about 1 hour (9 hours for tenatoprazole ), but the duration of acid inhibition is 48 hours because of irreversible binding to the H,K-ATPase. All the PPIs except tenatoprazole are rapidly metabolized in the liver by CYP enzymes (mostly by CYP2C19 and 3A4). Dissociation of the inhibitory complex is probably due to the effect of the endogenous antioxidant glutathione which leads to
9960-441: The highest consumption with a rate of 64.4. Burundi had the lowest at 4.4. Amoxicillin and amoxicillin/clavulanic acid were the most frequently consumed. Antibiotics are screened for any negative effects before their approval for clinical use, and are usually considered safe and well tolerated. However, some antibiotics have been associated with a wide extent of adverse side effects ranging from mild to very severe depending on
10080-501: The incidence of esophageal adenocarcinoma in Barrett's oesophagus, they do not change the length affected. In addition, research in the UK has suggested that PPIs are not effective at treating persistent throat symptoms. PPIs are often used longer than necessary. In about half of people who are hospitalized or seen at a primary care clinic there is no documented reason for their long-term use of PPIs. Some researchers believe that, given
10200-425: The lack of causality, have led to this association being questioned. It is recommended that long-term PPIs should be used judiciously after considering individual's risk–benefit profile, particularly among those with history of H. pylori infection, and that further, well-designed, prospective studies are needed. Long-term use of PPIs is associated with the development of benign polyps from fundic glands (which
10320-401: The late 1880s. Ehrlich noted certain dyes would colour human, animal, or bacterial cells, whereas others did not. He then proposed the idea that it might be possible to create chemicals that would act as a selective drug that would bind to and kill bacteria without harming the human host. After screening hundreds of dyes against various organisms, in 1907, he discovered a medicinally useful drug,
10440-828: The little evidence of long-term effectiveness, the cost of the medication and the potential for harm means that clinicians should consider stopping PPIs in many people. In general, proton pump inhibitors are well tolerated, and the incidence of short-term adverse effects is relatively low. The range and occurrence of adverse effects are similar for all of the PPIs, though they have been reported more frequently with omeprazole . This may be due to its longer availability and, hence, clinical experience. Common adverse effects include headache , nausea , diarrhea , abdominal pain , fatigue , and dizziness . Infrequent adverse effects include rash , itch , flatulence , constipation , anxiety , and depression . Also infrequently, PPI use may be associated with occurrence of myopathies , including
10560-409: The location of infection, and the pharmacokinetic and pharmacodynamic properties of the antibacterial. The bactericidal activity of antibacterials may depend on the bacterial growth phase, and it often requires ongoing metabolic activity and division of bacterial cells. These findings are based on laboratory studies, and in clinical settings have also been shown to eliminate bacterial infection. Since
10680-516: The occurrence of stroke. There are many different routes of administration for antibiotic treatment. Antibiotics are usually taken by mouth . In more severe cases, particularly deep-seated systemic infections , antibiotics can be given intravenously or by injection. Where the site of infection is easily accessed, antibiotics may be given topically in the form of eye drops onto the conjunctiva for conjunctivitis or ear drops for ear infections and acute cases of swimmer's ear . Topical use
10800-535: The parents are unable or unwilling to accept hospitalization of the child. Amoxicillin in combination with gentamicin is recommended for the treatment of infants with signs of other severe infections when hospitalization is not an option. It is also used to prevent bacterial endocarditis and as a pain-reliever in high-risk people having dental work done, to prevent Streptococcus pneumoniae and other encapsulated bacterial infections in those without spleens , such as people with sickle-cell disease , and for both
10920-403: The parietal cell canaliculus) with acidic environments. In an acid environment, the inactive drug is protonated and rearranges into its active form. As described above, the active form will covalently and irreversibly bind to the gastric proton pump, deactivating it. In H. pylori eradication , PPIs help by increasing the stomach pH, causing the bacterium to shift out of its coccoid form which
11040-707: The patient's weight and history of prior use. Other forms of misuse include failure to take the entire prescribed course of the antibiotic, incorrect dosage and administration, or failure to rest for sufficient recovery. Inappropriate antibiotic treatment, for example, is their prescription to treat viral infections such as the common cold . One study on respiratory tract infections found "physicians were more likely to prescribe antibiotics to patients who appeared to expect them". Multifactorial interventions aimed at both physicians and patients can reduce inappropriate prescription of antibiotics. The lack of rapid point of care diagnostic tests, particularly in resource-limited settings
11160-511: The possibility of tendon damage from the administration of a quinolone antibiotic with a systemic corticosteroid . Some antibiotics may also damage the mitochondrion , a bacteria-derived organelle found in eukaryotic, including human, cells. Mitochondrial damage cause oxidative stress in cells and has been suggested as a mechanism for side effects from fluoroquinolones . They are also known to affect chloroplasts . There are few well-controlled studies on whether antibiotic use increases
11280-447: The possible interactions between antibiotics and birth control pills (oral contraceptives) are required as well as careful assessment of patient-specific risk factors for potential oral contractive pill failure prior to dismissing the need for backup contraception. Interactions between alcohol and certain antibiotics may occur and may cause side effects and decreased effectiveness of antibiotic therapy. While moderate alcohol consumption
11400-450: The prevention and the treatment of anthrax . The United Kingdom recommends against its use for infectious endocarditis prophylaxis. These recommendations do not appear to have changed the rates of infection for infectious endocarditis. Amoxicillin is susceptible to degradation by β-lactamase -producing bacteria, which are resistant to most β-lactam antibiotics, such as penicillin . For this reason, it may be combined with clavulanic acid ,
11520-489: The proposed associations, due to study design and small estimates of effect size. As of March 2017, benefits outweighed risks when PPIs are used appropriately, but when used inappropriately, modest risks become important. They recommend that PPIs should be used at the lowest effective dose in people with a proven indication, but discourage dose escalation and continued chronic therapy in people unresponsive to initial empiric therapy. With regard to iron and vitamin B 12 ,
11640-512: The release of omeprazole sulfide and reactivation of the enzyme. Medically used proton pump inhibitors: There is no clear evidence that one proton pump inhibitor works better than another. PPIs were developed in the 1980s, with omeprazole being launched in 1988. Most of these medications are benzimidazole derivatives, related to omeprazole, but imidazopyridine derivatives such as tenatoprazole have also been developed. Potassium-competitive inhibitors such as revaprazan reversibly block
11760-536: The risk of oral contraceptive failure. The majority of studies indicate antibiotics do not interfere with birth control pills , such as clinical studies that suggest the failure rate of contraceptive pills caused by antibiotics is very low (about 1%). Situations that may increase the risk of oral contraceptive failure include non-compliance (missing taking the pill), vomiting, or diarrhea. Gastrointestinal disorders or interpatient variability in oral contraceptive absorption affecting ethinylestradiol serum levels in
11880-825: The risk of SBP and is associated with the development of clinical decompensation and liver-related death during long-term follow-up. There is evidence that PPI use alters the composition of the bacterial populations inhabiting the gut , the gut microbiota . Although the mechanisms by which PPIs cause these changes are yet to be determined, they may have a role in the increased risk of bacterial infections with PPI use. These infections can include Helicobacter pylori due to this species not favouring an acid environment, leading to an increased risk of ulcers and gastric cancer risk in genetically susceptible patients. PPI use in people who have received attempted H. pylori eradication may also be associated with an increased risk of gastric cancer. The validity and robustness of this finding, with
12000-790: The risk of surgical site infections. However, there are certain general causes for concern with topical administration of antibiotics. Some systemic absorption of the antibiotic may occur; the quantity of antibiotic applied is difficult to accurately dose, and there is also the possibility of local hypersensitivity reactions or contact dermatitis occurring. It is recommended to administer antibiotics as soon as possible, especially in life-threatening infections. Many emergency departments stock antibiotics for this purpose. Antibiotic consumption varies widely between countries. The WHO report on surveillance of antibiotic consumption published in 2018 analysed 2015 data from 65 countries. As measured in defined daily doses per 1,000 inhabitants per day. Mongolia had
12120-640: The same effect of killing or preventing the growth of microorganisms, and both are included in antimicrobial chemotherapy . "Antibacterials" include bactericides , bacteriostatics , antibacterial soaps , and chemical disinfectants , whereas antibiotics are an important class of antibacterials used more specifically in medicine and sometimes in livestock feed . Antibiotics have been used since ancient times. Many civilizations used topical application of moldy bread, with many references to its beneficial effects arising from ancient Egypt, Nubia , China , Serbia , Greece, and Rome. The first person to directly document
12240-457: The serious reaction rhabdomyolysis . Long-term use of PPIs requires assessment of the balance of the benefits and risks of the therapy. As of March 2017, various adverse outcomes have been associated with long-term PPI use in several primary reports, but reviews assess the overall quality of evidence in these studies as "low" or "very low". They describe inadequate evidence to establish causal relationships between PPI therapy and many of
12360-428: The severity and frequency of adverse effects from amoxicillin is probably higher than reported from clinical trials. Between 3 and 10% of children taking amoxicillin (or ampicillin ) show a late-developing (>72 hours after beginning medication and having never taken penicillin-like medication previously) rash, which is sometimes referred to as the "amoxicillin rash". The rash can also occur in adults and may rarely be
12480-555: The small benefit gained by amoxicillin may be overridden by the adverse effects. Amoxicillin is considered the first-line empirical treatment for most cases of uncomplicated bacterial sinusitis in children and adults when culture data is unavailable. Amoxicillin is recommended as the preferred first-line treatment for community-acquired pneumonia in adults by the National Institute for Health and Care Excellence , either alone (mild to moderate severity disease) or in combination with
12600-494: The species composition in the intestinal flora , resulting, for example, in overgrowth of pathogenic bacteria, such as Clostridioides difficile . Taking probiotics during the course of antibiotic treatment can help prevent antibiotic-associated diarrhea. Antibacterials can also affect the vaginal flora , and may lead to overgrowth of yeast species of the genus Candida in the vulvo-vaginal area. Additional side effects can result from interaction with other drugs, such as
12720-402: The species of bacteria. In general, combinations of a bacteriostatic antibiotic and bactericidal antibiotic are antagonistic. In addition to combining one antibiotic with another, antibiotics are sometimes co-administered with resistance-modifying agents. For example, β-lactam antibiotics may be used in combination with β-lactamase inhibitors , such as clavulanic acid or sulbactam , when
12840-502: The term antibiotic —literally "opposing life", from the Greek roots ἀντι anti , "against" and βίος bios , "life"—is broadly used to refer to any substance used against microbes , but in the usual medical usage, antibiotics (such as penicillin ) are those produced naturally (by one microorganism fighting another), whereas non-antibiotic antibacterials (such as sulfonamides and antiseptics ) are fully synthetic . However, both classes have
12960-442: The type of antibiotic used, the microbes targeted, and the individual patient. Side effects may reflect the pharmacological or toxicological properties of the antibiotic or may involve hypersensitivity or allergic reactions. Adverse effects range from fever and nausea to major allergic reactions, including photodermatitis and anaphylaxis . Common side effects of oral antibiotics include diarrhea , resulting from disruption of
13080-493: The use of antibiotics in livestock, which violated FDA regulations. Studies have shown that common misconceptions about the effectiveness and necessity of antibiotics to treat common mild illnesses contribute to their overuse. Other forms of antibiotic-associated harm include anaphylaxis , drug toxicity most notably kidney and liver damage, and super-infections with resistant organisms. Antibiotics are also known to affect mitochondrial function, and this may contribute to
13200-460: The use of antibiotics, attributable partly to resistance against such regulation by industries using or selling antibiotics, and to the time required for research to test causal links between their use and resistance to them. Two federal bills (S.742 and H.R. 2562 ) aimed at phasing out nontherapeutic use of antibiotics in US food animals were proposed, but have not passed. These bills were endorsed by public health and medical organizations, including
13320-445: The use of molds to treat infections was John Parkinson (1567–1650). Antibiotics revolutionized medicine in the 20th century. Synthetic antibiotic chemotherapy as a science and development of antibacterials began in Germany with Paul Ehrlich in the late 1880s. Alexander Fleming (1881–1955) discovered modern day penicillin in 1928, the widespread use of which proved significantly beneficial during wartime. The first sulfonamide and
13440-495: The world. Amoxicillin is also sometimes used as an antibiotic for animals . The use of amoxicillin for animals intended for human consumption ( chickens , cattle , and swine for example) has been approved. Stimulants: Phenylethanolamine Antibiotic An antibiotic is a type of antimicrobial substance active against bacteria . It is the most important type of antibacterial agent for fighting bacterial infections , and antibiotic medications are widely used in
13560-477: Was conjectured to have been the source. The use of antibiotics in modern medicine began with the discovery of synthetic antibiotics derived from dyes. Various Essential oils have been shown to have anti-microbial properties. Along with this, the plants from which these oils have been derived from can be used as niche anti-microbial agents. Synthetic antibiotic chemotherapy as a science and development of antibacterials began in Germany with Paul Ehrlich in
13680-522: Was developed by a research team led by Gerhard Domagk in 1932 or 1933 at the Bayer Laboratories of the IG Farben conglomerate in Germany, for which Domagk received the 1939 Nobel Prize in Physiology or Medicine. Sulfanilamide, the active drug of Prontosil, was not patentable as it had already been in use in the dye industry for some years. Prontosil had a relatively broad effect against Gram-positive cocci , but not against enterobacteria . Research
13800-431: Was first used in 1942 by Selman Waksman and his collaborators in journal articles to describe any substance produced by a microorganism that is antagonistic to the growth of other microorganisms in high dilution. This definition excluded substances that kill bacteria but that are not produced by microorganisms (such as gastric juices and hydrogen peroxide ). It also excluded synthetic antibacterial compounds such as
13920-423: Was identified in the United States resistant to colistin , "the last line of defence" antibiotic . In recent years, even anaerobic bacteria, historically considered less concerning in terms of resistance, have demonstrated high rates of antibiotic resistance, particularly Bacteroides , for which resistance rates to penicillin have been reported to exceed 90%. Per The ICU Book , "The first rule of antibiotics
14040-507: Was introduced by the French bacteriologist Jean Paul Vuillemin as a descriptive name of the phenomenon exhibited by these early antibacterial drugs. Antibiosis was first described in 1877 in bacteria when Louis Pasteur and Robert Koch observed that an airborne bacillus could inhibit the growth of Bacillus anthracis . These drugs were later renamed antibiotics by Selman Waksman , an American microbiologist, in 1947. The term antibiotic
14160-434: Was stimulated apace by its success. The discovery and development of this sulfonamide drug opened the era of antibacterials. Observations about the growth of some microorganisms inhibiting the growth of other microorganisms have been reported since the late 19th century. These observations of antibiosis between microorganisms led to the discovery of natural antibacterials. Louis Pasteur observed, "if we could intervene in
14280-758: Was the 26th most commonly prescribed medication in the United States, with more than 20 million prescriptions. Amoxicillin is used in the treatment of a number of infections, including acute otitis media , streptococcal pharyngitis , pneumonia , skin infections , urinary tract infections , Salmonella infections, Lyme disease , and chlamydia infections. Children with acute otitis media who are younger than six months of age are generally treated with amoxicillin or other antibiotics. Although most children with acute otitis media who are older than two years old do not benefit from treatment with amoxicillin or other antibiotics, such treatment may be helpful in children younger than two years old with acute otitis media that
14400-560: Was used to treat syphilis in the first half of the 20th century. In 1908, Ehrlich received the Nobel Prize in Physiology or Medicine for his contributions to immunology . Hata was nominated for the Nobel Prize in Chemistry in 1911 and for the Nobel Prize in Physiology or Medicine in 1912 and 1913. The first sulfonamide and the first systemically active antibacterial drug, Prontosil ,
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