Amoxicillin

Alternative Medicine
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Also indexed as:

Amoxil, Polymox, Trimox, Wymox

About amoxicillin

Amoxicillin is a member of the penicillin family of antibiotics. Amoxicillin is used to treat bacterial infections, including infections of the middle ear. The combination of amoxicillin/clavulanate (Augmentin®) is an extended-spectrum antibiotic used to treat bacterial infections resistant to amoxicillin alone.

Overview

Try these helpful products which may be beneficial if taken with this medicine

  • Bromelain
  • Taking 2,400 GDU (3,600 MCU) of bromelain at the same time as amoxicillin may increase the absorption of the drug leading to higher blood levels and greater effectiveness
  • Vitamin K
  • To avoid depletion of vitamin K, which might cause blood clotting problems, try taking 100 mcg of the nutrient each day, or eating more leafy green vegetables while taking the drug
  • Probiotics
  • Taking probiotics such as Saccharomyces, Lactobacillus, and Bifidobacterium species might prevent common consequences of amoxicillin therapy, such as diarrhea and yeast infections

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full article for more information on interactions with vitamins, herbs, and foods.

Herbs

Summary of Interactions for Amoxicillin

Depletion or interference Vitamin K *
Adverse interaction None known
Side effect reduction/prevention Bifidobacterium longum*
Lactobacillus acidophilus*
Lactobacillus casei*
Saccharomyces boulardii*
Saccharomyces cerevisiae*
Probiotics
Vitamin K *
Supportive interaction Saccharomyces boulardii*
Bromelain
Reduced drug absorption/bioavailability None known

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Supplements

Bromelain

When taken with amoxicillin, bromelain was shown to increase absorption of amoxicillin in humans.1 When 80 mg of bromelain was taken together with amoxicillin and tetracycline, blood levels of both drugs increased, though how bromelain acts on drug metabolism remains unknown.2 An older report found bromelain also increased the actions of other antibiotics, including penicillin, chloramphenicol, and erythromycin, in treating a variety of infections. In that trial, 22 out of 23 people who had previously not responded to these antibiotics did so after adding bromelain taken four times per day.3

Doctors will sometimes prescribe enough bromelain to equal 2,400 gelatin dissolving units (listed as GDU on labels) per day. This amount would equal approximately 3,600 MCU (milk clotting units), another common measure of bromelain activity.

Probiotics

A common side effect of antibiotics is diarrhea, which may be caused by the elimination of beneficial bacteria normally found in the colon. A nonpathogenic yeast known as Saccharomyces boulardii has been shown in two double-blind studies to decrease frequency of diarrhea in people taking amoxicillin as well as other penicillin-type drugs compared to placebo.4, 5 There were overall few people in these studies using amoxicillin specifically, so there is no definitive proof that Saccharomyces boulardii will be beneficial for everyone when it is combined with amoxicillin. The studies used 1 gram of Saccharomyces boulardii per day.

A separate double-blind study found that taking a combination of Lactobacillus acidophilus and Lactobacillus bulgaricus, two normal gut bacteria, with amoxicillin did not protect children from developing diarrhea.6 The authors of the study point out some problems such as the parents' inability to consistently define diarrhea. However, at this time, it is unknown if lactobacillus products will reduce diarrhea due to amoxicillin.

Controlled studies have shown that taking other probiotic microorganisms-such as Lactobacillus casei or Bifidobacterium longum -also helps prevent antibiotic-induced diarrhea.7

The diarrhea experienced by some people who take antibiotics also might be due to an overgrowth of the bacterium Clostridium difficile, which causes a disease known as pseudomembranous colitis. Controlled studies have shown that supplementation with harmless yeast-such as Saccharomyces boulardii 8 or Saccharomyces cerevisiae (baker's or brewer's yeast)9 -helps prevent recurrence of this infection. In one study, taking 500 mg of Saccharomyces boulardii twice daily enhanced the effectiveness of the antibiotic vancomycin in preventing recurrent clostridium infection.10 Therefore, people taking antibiotics who later develop diarrhea might benefit from supplementing with saccharomyces organisms.

Treatment with antibiotics also commonly leads to an overgrowth of yeast (Candida albicans) in the vagina (candida vaginitis ) and the intestines (sometimes referred to as "dysbiosis"). Controlled studies have shown that Lactobacillus acidophilus might prevent candida vaginitis.11

Vitamin K

Several cases of excessive bleeding have been reported in people who take antibiotics.12, 13, 14, 15 This side effect may be the result of reduced vitamin K activity and/or reduced vitamin K production by bacteria in the colon. One study showed that people who had taken broad-spectrum antibiotics had lower liver concentrations of vitamin K2 (menaquinone), though vitamin K1 (phylloquinone) levels remained normal.16 Several antibiotics appear to exert a strong effect on vitamin K activity, while others may not have any effect. Therefore, one should refer to a specific antibiotic for information on whether it interacts with vitamin K. Doctors of natural medicine sometimes recommend vitamin K supplementation to people taking antibiotics. Additional research is needed to determine whether the amount of vitamin K1 found in some multivitamins is sufficient to prevent antibiotic-induced bleeding. Moreover, most multivitamins do not contain vitamin K.

References

  1. Tinozzi S, Venegoni A. Effect of bromelain on serum and tissue levels of amoxicillin. Drugs Exp Clin Res 1978;4:39-44.
  2. Luerti M, Vignali M. Influence of bromelain on penetration of antibiotics in uterus, salpinx and ovary. Drugs Exp Clin Res 1978;4:45-8.
  3. Neubauer RA. A plant protease for potentiation of and possible replacement of antibiotics. Exp Med Surg 1961;19:143-60.
  4. Surawicz CM, Elmer GW, Speelman P, et al. Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: A prospective study. Gastroenterol 1989;96:981-8.
  5. McFarland LV, Surawicz CM, Greenberg RN, et al. Prevention of beta-lactam-associated diarrhea by Saccharomyces boulardii compared with placebo. Am J Gastroenterol 1995;90:439-48.
  6. Tankanow RM, Ross MB, Ertel IJ, et al. A double-blind, placebo-controlled study of the efficacy of Lactinex in the prophylaxis of amoxicillin-induced diarrhea. DICP Ann Pharmacother 1990;24:382-4.
  7. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].
  8. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].
  9. Schellenberg D, Bonington A, Champion CM, et al. Treatment of Clostridium difficile diarrhoea with brewer's yeast. Lancet 1994;343:171-2.
  10. Surawicz CM, Elmer GW, Speelman P, et al. Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: A prospective study. Gastroenterol 1989;96:981-8.
  11. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].
  12. Suzuki K, Fukushima T, Meguro K, et al. Intracranial hemorrhage in an infant owing to vitamin K deficiency despite prophylaxis. Childs Nerv Syst 1999;15:292-4.
  13. Huilgol VR, Markus SL, Vakil NB. Antibiotic-induced iatrogenic hemobilia. Am J Gastroenterol 1997;92:706-7.
  14. Bandrowsky T, Vorono AA, Borris TJ, Marcantoni HW. Amoxicllin-related postextraction bleeding in an anticoagulated patient with tranexamic acid rinses. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:610-2.
  15. Kaiser CW, McAuliffe JD, Barth RJ, Lynch JA. Hypoprothrombinemia and hemorrhage in a surgical patient treated with cefotetan. Arch Surg 1991;126:524-5.
  16. Conly J, Stein K. Reduction of vitamin K2 concentration in human liver associated with the use of broad spectrum antimicrobials. Clin Invest Med 1994;17:531-9.

Last Review: 01-21-2009

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires August 2010.


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Topic Contents
 Overview
 Herbs
 Interactions with Supplements
 References