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Medical English
Amoxicillin 阿莫西林
Professor: Dr. Pat Chan
Clinical specialist
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Map of USA
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Map of USA in Chinese
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Minnesota
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Lakes
Healthy environment
Education
Good health care system
Famous hospital Mayo Clinic, U of Minnesota
Hospital…
Family life
Many famous companies ie 3M, Honeywell,
General Mills, Cargill, Best buy, Seagate and
many software companies
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Expectations
• Come to classes on time
• Attendance is important. If you need to miss a
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class, you must be responsible for that missing
lesson; send me an email why you miss the
class [email protected]
Class participation is part of the grading system
I will email PPT to your class leader for future
lectures
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Examination
• Will be held on September 26
• Learn pharmaceutical vocabularies
• Write a short description of a drug which you
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have chosen
2 pages long in English
Type your name and student numbers
You can not copy from other materials. You can
interpret the materials and use your own ideas
and words
Do not copy and paste
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vocabulary
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drug-resistant bacteria 细菌耐药性
effectiveness 成效
semisynthetic antibiotic半合成抗生素
Pharmacokinetics 药代动力学
drug-resistant bacteria 细菌耐药性
semisynthetic antibiotic半合成抗生素
broad spectrum of bactericidal activity 广谱抗菌
活性
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vocabulary
• gastric acid胃酸
• Stable稳定
• brain and spinal fluid 大脑 脊髓液
• meninges are inflamed 脑膜炎
• excreted unchanged in the urine 尿中排出
不变
• Half Life 半衰期
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Vocabulary
• Probenicid can delay amoxicillin’s excretion 丙
磺舒可延遲其排泄
• Average peak blood levels 平均血药浓程度 高峰
• excreted in the urine 在尿中排泄
• Pharmacology药理
• inhibition of biosynthesis of cell wall
mucopeptide 抑制细菌细胞壁
的生物合成
• active multiplication 积极增殖
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Medical terminology
• Escherichia coli大肠埃希氏菌( b-
lactamase negative only贝塔内酰胺酶
阴性株 )
• Haemophilus influenza( b-lactamase
negative only)嗜血杆菌
• Neisseria gonorrhoeae淋球菌
• Proteus mirabilis变形杆菌
• Helicobacter pylori幽门螺杆菌
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Medical terminology
• Aerobic gram positive microorganism需氧革兰氏
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阳性菌
Enterococcus faecalis 粪肠球菌
staphylococcus葡萄球菌(b-lactamase negative
strain) (贝塔内酰胺酶阴性株 )
Streptococcus pneumoniae 肺炎链球菌
Streptococcus (b-lactamase negative)
aerobic negative microorganism 好氧微生物负
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Medical terminology
• glomerular filtration rate腎小球濾過率
• B-lactamase B-内酰胺酶
• Susceptibility tests 药敏试验
• minimum inhibitory concentrations 最低抑
菌浓度
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Amoxicillin in USA is prescription
only
• This is to reduce the development of drugresistant bacteria 细菌耐药性
• maintain the effectiveness 成效 of
amoxicillin and other antibacterial drugs
• amoxicillin should be used only to treat
infections that are strongly suspected to
be caused by bacteria
• 强烈怀疑是由细菌引起的
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Description
Description:
• Formulations of amoxicillin contain amoxicillin, a
semisynthetic antibiotic半合成抗生素
• an analog 模拟 of ampicillin molecules
• a broad spectrum of bactericidal activity广谱抗菌
活性 against many gram – positive and gramnegative microorganisms针对革兰氏阳性和革兰
氏阴性细菌 .
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Clinical pharmacology & pharmacokinetics临
床药理学及药代动力学
• Amoxicillin is stable in the presence of
gastric acid阿莫西林在胃酸是稳定的
• rapidly absorbed after oral administration.
口服后迅速吸收
• Amoxicillin diffuses readily into body
tissues and fluids 扩散 人体组织和 体液
Except 除了 :
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Pharmacokinetics of amoxicillin
• Exception : of brain and spinal fluid 除了大脑 脊
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髓液
except when meninges are inflamed 脑膜炎
The half life of amoxicillin is 61.3 minutes
Most of the amoxicillin is excreted unchanged in
the urine 尿中排出不变
its excretion can be delayed by concurrent
administration of probenecid 丙磺舒可延遲
amoxicillin排泄
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Pharmacology药理
• Average peak blood levels平均 血药浓程度
高峰 1-2 hours after administration of 250
mg and 500 mg of amoxicillin capsules
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Pharmacokinetics 药代动力学
• Detectable serum levels are observed up to 8
hours after an orally administered dose of
amoxicillin.
• 口服药剂后检出阿莫西林血清水平观察
长达到8 hours。
• Approximately 60% of an orally administrated
dose of amoxicillin is excreted in the urine在尿中
排泄 within 6 to 8 hours
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Microbiology
• Amoxicillin is similar to ampicillin in its bactericidal action against
susceptible organisms during the stage of active multiplication积极
增殖 . It acts through the inhibition of biosynthesis of cell wall
mucopeptide 抑制细菌细胞壁
的生物合成
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Medical terminology
• Aerobic gram positive microorganism需氧革兰氏
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阳性菌
Enterococcus faecalis 粪肠球菌
staphylococcus葡萄球菌(b-lactamase negative
strain) (贝塔内酰胺酶阴性株 )
Streptococcus pneumoniae 肺炎链球菌
Streptococcus (b-lactamase negative)
aerobic negative microorganism 好氧微生物负
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Medical terminology
• Escherichia coli大肠埃希氏菌( b-
lactamase negative only贝塔内酰胺酶
阴性株 )
• Haemophilus influenza( b-lactamase
negative only)嗜血杆菌
• Neisseria gonorrhoeae淋球菌
• Proteus mirabilis变形杆菌
• Helicobacter pylori幽门螺杆菌
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Medical terminology
• glomerular filtration rate腎小球濾過率
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B-lactamase B-内酰胺酶 (an enzyme produced by some
bacteria causes the antibiotic to become ineffective)一些细
菌所产生的酶，导致抗生素变得无
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Amoxicillin has been shown to be active against most
strains of the following microorganisms
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Susceptibility tests 药敏试验
• The MIC ( minimum inhibitory concentrations)最低抑菌
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浓度 provide estimates of the susceptibility of bacteria
to antimicrobial compound
The MIC should be determined using a standard
procedure. Standardized procedures are based on
diluted method稀释法 .
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Minimum inhibitory concentration
(MIC)
Anti-infective agent dosing:
1. Need to be considered when administering antibiotics include
absorption
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吸收
volume of distribution 分佈容積
代谢
Excretion 排泄.
metabolism
These factors determine the dose of each drug and the time
interval of administration
To effectively clear a bacterial infection, serum levels of the
antibiotic need to be maintained above the minimum inhibitory
concentration (MIC) for a significant perioid.
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Indications and usage 使用指示
Amoxicillin is indicated in the treatment of infections due to susceptible
(Only B-lactamas-negative) strains of bacteria.
1. Infections of the ear, nose, and throat—due Streptococcus spp.
(alpha and beta hemolytic strains only), S. pneumoniae,
Staphylococcus spps. Or H. influenzae
2. Infections of the genitourinary tract泌尿生殖系统—due to E. Coli,
P. mirabils, or E. Faecalis
3. Infections of the skin and skin structure—due to Streptococcus
spp. ( alpha and Beta hemolytic strains only), Staphlococcus spp.,
or E. Coli
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Indication of use使用指示
4. Infections of the lower respiratory tract– due to
Streptococcus spp. ( alpha and beta hemolytic
strains only), S. pneumoniae, Staphylococcus
spp., or H. influenzae
5. Gonorrhea, acute uncomplicated (ano-genital肛
生殖器 and urethral 尿道infections)—due to
N. gonorrhoeae ( males and females)
6. H. pylori eradication消灭 to reduce the risk of
duodenal ulcer十二指溃疡 recurrence
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A word of warning:
• To reduce the development of drug-resistant
bacteria and maintain the effectiveness of
amoxicillin and other antibacterial drugs,
amoxicillin should be used only to treat or
prevent infections that are proven or strongly
suspected to be caused by susceptible bacteria.
When culture and susceptibility information are
available, they should be considered in selecting
or modifying antibacterial therapy. In the
absence of such data, the use of amoxicillin is
based on practical experience or local
epidemiology流行病学
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Contraindication禁忌
• A history of allergic reaction to any of the
penicillins is a contraindication
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Warnings
• Serious and occasionally fatal hypersensitivity (anaphylactic过敏的性
反应 ) reactions have been reported in patients on penicillin
therapy. Although anaphylaxis is more frequent following parenteral
therapy, it has occurred in patients on oral penicillins. These
reactions are more likely to occur in individuals with a history of
penicillin hypersensitivity. There have been reports of individuals
with a history of hypersensitivity to penicillins who have experienced
severe reaction to cephalosporins头孢菌素 (cefazolin头孢唑啉).
Before initiating amoxicillin therapy, careful inquiry should be made
concerning previous hypersensitivity reactions to penicillins, or
cephalosporins.
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warnings
• If an allergic reaction occurs, amoxicillin should
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be discontinued
Serious anaphylactic reactions require immediate
emergency treatment with epinephrine肾上腺素,
oxygen, intravenous steroids类固醇, and airway
management, including intubation气管插管
should also be administered as indicated
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Warnings
• Pseudomembranous colitis 伪膜性结肠炎 can developed by using
amoxicillin
• Pseudomembranous colitis, also known as antibiotic-
associated diarrhea (AAD), is an infection of the colon . It is
often associated with Clostridium Difficile bacteria 难辨梭状芽孢杆菌
• Amoxicillin can cause the normal flora在in the bowel腸道正常菌群to
change. This will result in more extensive growth of Clostridium
difficile. In addition, C. Difficile can produce toxins 毒 and result in
toxic megacolon 毒性巨結腸 .
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Warnings
• Pseudomembranous colitis is characterized
by offensive-smelling diarrhea, fever, and
abdominal pain.
• In severe cases, life-threatening
complications can develop, such as toxic
megacolon
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Picture of pseudomembranous
colitis caused by Clostridium
Difficile
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Dosage and administration
• Capsules, tablets and oral suspensions of amoxicillin may
be given without regard to meals. The 400 mg
suspension and the 875 mg tablet have been studies
only when administered at the start of a light meal.
However, food effect studies have not been performed
with the 200mg and 500 mg formulations
Neonates and infants aged < 12 weeks (<3 months)
Due to incompletely developed renal function affecting
elimination of amoxicilin in this age group, the
rrecommended upper dose of amoxicillin is 30
mg/kg/day divided every 12 hours
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Dosing and administration:
• The children’s dosage is intended for individuals whose weight is
less than 40 kg. Children weighing 40kg or more should be dosed
according to the adult recommendations
• After re-constitution 水来稀释 , the required amount of suspension
should be placed directly on the child’s tongue for swallowing.
Alternate means of administration are to add the required amount
of suspension to formula, milk, fruit juice, water, ginger ale, or cold
drinks. These preparations should then be taken immediately
• All patients with gonorrhea 淋病 should be evaluated for syphilis 梅
毒
• Large doses may be required for stubborn or severe infections
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Duration 为期
• In stubborn infections, therapy may be required for
several weeks
• In gonorrhea, treatment should be continued for a
minimum of 48-72 hours beyond the time that the
patient becomes asymptomatic or evidence of bacterial
eradication has been obtained
• It is recommended that at least 10 days treatment for
any infection caused by streptococcus pyogenes 化膿性
鏈球菌 to prevent the occurrence of acute rheumatic
fever 風濕熱
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Dosing recommendations for adults with impaired
renal function腎功能差
• Dosing with impaired renal function do not
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generally require a reduction in dose unless the
impairment is severe.
For patients with glomerular filtration rate腎小
球濾過率 of <30 ml/min should not receive
875 mg tablet (high dose)
Patients with glomerular filtration rate of 10-30
ml/min should receive 500mg or 250mg every
12 hours, depending on the severity of the
infection.
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腎功能差
• Patients with less than 10 ml/min GFR should
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receive 500mg or 250mg every 24 hours,
depending on the severity of the infection
Hemodialysis洗血 patients should receive 500mg
or 250mg q 24h, depending on the severity of
the infection. They should receive an additional
dose both during and at the end of dialysis
There are no dosing recommendations for
pediatric patients with impaired renal
function.
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Laboratory tests
• As with any potent drug, periodic assessment of renal,
hepatic, and blood tests should be made during
prolonged therapy
评估肾脏，肝脏和血液测试
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• Patients with gonorrhea 淋病
should have a
for syphilils 梅毒
serologic test 血清學檢測
• at the time of diagnosis 诊断
. Patients treated with amoxicillin should have a follow up
serologic test for syphilis 梅毒
after 3 months
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Carcinogenesis, mutagenesis, impariment of
fertility
致癌，致基因突变 ，损害生育能力
• No carcinogenesis and mutagenesis have been reported
or studied in human
• In a multi-generation reproduction study 多代繁殖研究 in
rats, no impairment of fertility or other adverse
reproductive effects were seen at dose up to 500mg/kg (
approximately 3 times the human dose in mg/m2
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Teratogenic effects 致畸胎
• Reproduction studies 繁殖研究 have been performed in
mice and rats
• no evidence 没有证据 of impaired fertility损害生育能力
or harm to the fetus due to amoxicillin 伤害到胎儿
• no adequate and well-controlled studies in pregnant
women. Because animal reproduction studies are not
always predictive of human response
• this drug should be used during pregnancy only if
clearly needed
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Nursing mother 哺乳的母亲
• Penicillins have been shown to excreted in
human milk.在人乳分泌
• Amoxicillin use by nursing mother may lead to
sensitization 促進 婴儿敏感 of infants
.
• Caution should be exercised when amoxicillin is
administered to a nursing mother
• 哺乳的母亲需要小心使用阿莫西林
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Pediatric use
• Because of the incompletely developed renal
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function in neonates 新生儿 and young
infants, the elimination of amoxicillin may be
delayed. 阿莫西林消除可能会迟
Dosing of amoxicillin should be modified in
pediatric patients 12 weeks or young
• 12周或年轻的患者应修改阿莫西林的
剂量
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Geriatric use 老人使用 amoxicillin
• Clinical data have shown that there are no
differences in response between elders
and younger patients
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老人使用 amoxicillin
• Amoxicillin is excreted by the kidney, and the
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risk of toxic reaction to this drug may be greater
in patients with impaired renal function
Because elderly patients are more likely to have
decreased renal function, care should be taken
in dose selection and it may useful to monitor
renal function
由于老年患者可能有肾功能下降，应减少剂量，
和监测肾功能
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Adverse reaction 不良反应
1. Gastrointestinal 胃肠道 : nausea, vomiting,
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diarrhea and hemorrhagic/
psuedomembranous colitis
恶心，呕吐，腹泻和出血性/伪膜性结肠炎
Hypersensitivity reactions: erythematous
maculopapular rashes紅色斑丘疹, erythema
multiforme 多形性紅斑,史蒂文斯約翰遜綜合徵 ,
Stevens-Johnson syndrome
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Adverse reaction
• Lymphatic systems淋巴系統 : Anemia,
including hemolytic anemia溶血性貧血
• thrombocytopenia 血小板減少症,
leukopenia白細胞減少症
• agranulocytosis 粒細胞缺乏症 have been
reported
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Adverse reactions
• Central nervous system中枢神经系统 :
agitation 躁動, anxiety, insomnia,
confusion焦虑，失眠，精神错乱
• convulsion抽搐 and dizziness头晕 have
been reported
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Overdose: 过量用药
• Discontinuation of amoxicillin
• If the overdose is recent, an attempt to emesis
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嘔吐 or other means of removing the drug from
the stomach may be performed.
。
Overdosage
of < 250mg/kg of amoxicillin are
not associated with significant clinical symptoms
and do not require gastric emptying
没有显着的临床症状
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• 没有必要清胃 。
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Over dose
• Crystalluria 結晶尿 from overdose of amoxicillin
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may lead to renal failure肾功能衰竭 .
Adequate fluid intake 足够的液体 and diuresis
利尿 to reduce the risk of amoxicillin
crystalluria.
以减少阿莫西林结晶风险
Amoxicillin may be removed by hemodialysis 血
液透析
阿莫西林可通过血液透析去除
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Patient information
• Amoxicillin may be taken every 8 hours or every
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12 hours, depending on the strength of the
product. 250 mg or 500mg may be given every
8 hours by mouth. Or 500mg to 875 mg twice a
day or
extended release tablets 缓释片 775 mg once
daily.
Amoxicillin does not treat virus infection病毒感染
( common cold) only bacterial infections细菌感
染.
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Patient information
• The medication should be taken exactly as
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directed. 用药应采取的指示
Not completing the full course of therapy may:
未完成全程服药
1. decrease the effectiveness of the treatment
2. increase the chance of resistant to amoxicillin
or other antibacterial drug in the future.
增加对阿莫西林耐药抗的机会
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Patient information
• Take amoxicillin with or without food. Take with food if it causes
upset stomach 导致胃部不适
• Chewable tablet 咀嚼片 : chew or crush well. Mix crushed tablet
with food. Do not swallow whole 不要吞下整个丸
• Extended release tablet 缓释片 : take with food. Swallow whole.
Do not chew or break
• Take a missed dose as soon as possible. If it is almost time for the
next dose. Skip the missed dose and return to your regular schedule
• Do not take a double dose or extra dose
• 不要服用两个或额外的剂量
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How should amoxicillin be stored应该如何储
存阿莫西林
• Store capsules or tablets at room temperature
• Protect capsules and tablets from moisture 湿气
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. Do not store in a bathroom or kitchen cabinet
Store liquid suspension at room temperature or
in a refrigerator冰箱 . Do not freeze. Throw
away any unused portion after 2 weeks
Talk with your physician or pharmacist if you are
starting any new medicine, including over the
counter supplements, medications, herbal or
vitamins 补充剂，药物，草药或维生素
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How does amoxicillin comes?
• Capsule胶囊 , oral :250mg, 500mg
• Powder oral粉剂 : 125mg/5ml (80ml, 100ml,
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150ml)
200mg/5ml (50ml, 75ml, 100ml, 150ml);
400mg/5ml (50ml, 75ml, 100ml)
Tablet: oral 500mg or 875mg
Tablet chewable, oral: 125mg, 200mg, 250mg,
400mg
Tablet extended release, oral: 775 mg
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Thank you!
• I hope you have learnt many medical
terminology and medical English from this
presentation
• This presentation is based on amoxicillin
drug insert by Sandoz company
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