Amoxicillin: what is this antibiotic, shortage, what to do?

Rare are the French never to have taken amoxicillinactive substance antibiotic medication Clamoxyl® and Augmentin®. But today it can be hard to find in pharmacies. “Amoxicillinealone or in combination with clavulanic acid, is the subject of strong supply tensions in France for these antibiotics“ inform theMedicines Agency in November. The most affected forms are:

• Clamoxyl® (amoxicillin) and generics (dosages 125 mg/5ml, 250 mg/5 ml and 500 mg/5 ml);
• Augmentin® (amoxicillin/clavulanic acid) and generics (strength 100 mg/12.5 mg/ml).

These are the antibiotics more prescribed in children. Other oral forms, more intended for adults (tablets, capsules, etc.), are also the subject of tension. These tensions concern all of Europeas well as other international markets. “In this context, both the prescription and the wise use of these antibiotics are essential” insists the ANSM which reminds that “Antibiotics are ineffective against bronchiolitis, influenza, Covid-19, nasopharyngitis and the vast majority of angina and otitis”. The laboratories explain these tensions by the very significant increase in the consumption of antibiotics coupled with difficulties on the industrial production lines. During the pandemic of Covid-19, the demand for amoxicillin had fallen very sharply, leading to a reduction or even a stoppage of certain production lines, which have not regained their pre-pandemic production capacity. ANSM has asked laboratories to increase their production capacity.

Shortage of amoxicillin: what to do?

Faced with possible interruptions in amoxicillin deliveries, the duration of treatment is limited to 5 days in most common infectious pathologies (bacterial angina, otitis, pneumonia, etc.). It may be prescribed to treat bacterial infections only.

► Due to difficulties in the supply of amoxicillin, it is possible that the pharmacy will contact your doctor to define another effective antibiotic or another form of amoxicillin adapted to your situation;

► If an antibiotic has been prescribed to treat angina, your pharmacist will check that a test to detect bacterial angina has been carried out by your doctor (TROD angina test). If not, he can contact your doctor to discuss it. If your child is over 10 years old, the pharmacist can carry out this test himself.

The more antibiotics you take, the more bacteria in your body (skin, gut) are likely to become resistant.

► If you have amoxicillin at home, do not take it without medical advice. Antibiotics can be responsible for side effects, such as allergies or diarrhoea. The bacteria can adapt and survive in the presence of antibiotics. Thus, the more antibiotics you take, the more the bacteria present in your body (skin, intestine) are likely to become resistant. Antibiotic-resistant bacteria can cause hard-to-cure infections and you can also pass them on to your loved ones.

Definition: what is amoxicillin?

Amoxicillin is a beta-lactam antibiotic. Sometimes associated withclavulanic acid (Augmentin®), it is often prescribed in case ofbacterial infections. This treatment is only available on medical prescription.

In what drugs?

The drugs that contain it are: Amoxicillin®, Clamoxyl®, Augmentin®.

What are the effects of Amoxicillin?

As it is an antibiotic, it acts by killing or preventing the multiplication of the bacteria in question. “Some of them manage to inhibit the effectiveness of Amoxicillin (resistance) by secreting enzymes that inactivate it. Hence the amoxicillin and clavulanic acid duo, a combination that cancels the action of these enzymes and potentiates its action on certain resistant bacteria.“, explains Dr. Monique Quillard.

What are the indications for amoxicillin?

Amoxicillin is used in the management of many bacterial infections, provided that the bacterium in question is sensitive to it:

• Bronchitis only if bacterial cause confirmed
• Digestive and/or biliary infections
• Urinary tract infections only if bacterial cause confirmed
• Upper gynecological infections and male infections
• ENT infections (otitis, sinusitis, angina) only if bacterial cause confirmed
• Stomatological infections
• Urogenital infections
• Lyme disease
• Acute pneumonias
• Sepsis
• Endocarditis
• Helicobacter pylori infection

What are the indications for amoxicillin in case of otitis?

In case of acute purulent otitis media in infants and childrenthe doctor can initiate antibiotic therapy:

• straight away, in infants under 6 months of age; or if complicated otitis (high fever, intense otalgia and otorrhea);
• if no improvement in 36-48 hours under antipyreticin infants over 6 months and children.

When not to take amoxicillin?

Antibiotics such as amoxicillin should not be prescribed in situations that do not require it (infections whose origin is overwhelmingly viral), namely :

• Nasopharyngitis, laryngitis;
• Congestive otitis, serous otitis and otitis of uncertain diagnosis;
• Bronchiolitis, acute bronchitis;
• Acute angina in adults:

► Unless you have performed a rapid diagnostic orientation test (TROD) for group A beta-hemolytic streptococcus (GAS), and the result is positive;

► If the Trod cannot be performed during the consultation, you can use a conditional dispensation order for antibiotics: write on the order “If Trod angina positive, within x calendar days”. Thus, the pharmacist will only deliver the antibiotic if the result of the Trod carried out at the pharmacy is positive;

• Acute angina in a child under 3 years old;
• Influenza and Covid-19;
• Febrile asthma attack;
• Suspicion of pneumonia without confirmatory examination (X-ray or ultrasound, serum CRP assay);
• Superficial skin infections (impetigo) and impetiginized dermatoses;
• Unexplained fever.

Dosage: how much amoxicillin maximum per day?

It varies according to the infection treated, its severity, the patient’s age, weight:

• Adult and child over 40 kg: 1 to 3 g per day, divided into 2 or 3 doses (i.e. 500 mg to 1 g every 8 hours or 750 mg to 1 g every 12 hours),
• Infant and child under 40 kg: the usual dose is 40 to 90 mg per kg and per day, divided into 2 or 3 doses. Or, for example, for a 20 kg child: 1 measuring spoon of oral suspension at 500 mg, morning and evening.

Does amoxicillin affect ovulation?

Taking this treatment does not affect fertilitydoes not upset the cycles and does not prevent you from getting pregnant.

Can you drink alcohol while taking amoxicillin?

There is no contraindication to alcohol consumption during antibiotic treatment with amoxicillin. However, this must be done with moderation.

What are the side effects of amoxicillin?

From Side effects of this asset, we can note:

• Of the digestive disorders : abdominal pain, diarrhea
• Of the allergic reactions
• Of the dizziness and seizures in rare cases

“Like all antibiotics, amoxicillin also destroys a large part of the intestinal flora. It is therefore relevant to take a course of probiotics following the antibiotic treatment.“, recommends Dr. Quillard.

What signs in case of allergy?

In case of allergy, taking it can cause skin reactions such as more or less extensive redness (urticaria), and, in the most serious cases, angioedema even a anaphylactic shock.

What are the contraindications of amoxicillin?

They are few:

• In case of‘renal failurethe dosage should be adjusted
• In case of oral anticoagulant therapy, an antibiotic from the cyclin family or a drug containing methotrexate, allopurinol or probenecid, interactions are possible. Inform your doctor before starting treatment with Amoxicillin
• In case of’known allergies to beta-lactams

Can pregnant women take amoxicillin?

“No adverse effects for the child to be born has not been established with this drug. It can be prescribed during pregnancy“, says Dr. Quillard.

Thanks to Dr. Monique Quillard, general practitioner.