From the Guidelines
Amoxicillin is the most comparable oral medication to ampicillin, with similar spectrums of activity against many gram-positive and some gram-negative bacteria. According to the guidelines provided by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America 1, amoxicillin is listed as a preferred oral therapy for several pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and Group A Streptococcus. The guidelines recommend amoxicillin dosing of 90 mg/kg/day in 2 doses or 45 mg/kg/day in 3 doses for children with Streptococcus pneumoniae infections 1.
Key Points
- Amoxicillin has better absorption from the gastrointestinal tract (about 75-90% absorbed) compared to oral ampicillin (35-50% absorbed) 1
- Amoxicillin can be taken with food, whereas ampicillin absorption is reduced by food
- Common adult dosing for amoxicillin is 250-500mg three times daily or 875mg twice daily, depending on the severity of infection
- For children, dosing is typically 20-90mg/kg/day divided into 2-3 doses
- Treatment duration varies by infection type, usually 7-14 days
- Amoxicillin-clavulanate (Augmentin) combines amoxicillin with a beta-lactamase inhibitor, making it effective against more resistant bacteria
Considerations
- Patients with penicillin allergy should avoid amoxicillin due to cross-reactivity
- Side effects of amoxicillin include diarrhea, nausea, and rash
- The guidelines recommend the shortest effective duration of treatment to minimize exposure to antimicrobials and minimize the selection for resistance 1
From the Research
Oral Medicine Comparable to Ampicillin
- Levofloxacin is a fluoroquinolone antibacterial agent with a broad spectrum of activity against Gram-positive and Gram-negative bacteria and atypical respiratory pathogens, and has been shown to be effective in the treatment of infections of the respiratory tract, genitourinary tract, skin and skin structures 2.
- Amoxicillin-clavulanic acid is a combination product that has been used as empiric therapy for many infections, but its use is often limited by gastrointestinal side effects, including Clostridium difficile infection 3.
- Other oral agents, such as cefpodoxime, cefditoren, and azithromycin, have been shown to have activity against certain Gram-positive and Gram-negative bacteria, but their effectiveness can vary depending on the specific infection and the presence of resistance 4.
- Vancomycin, doxycycline, and fusidic acid have been shown to be effective against certain non-spore-forming Gram-positive bacilli, including Corynebacterium species 5.
- Novel antibiotics, such as cefiderocol, a new cephalosporin, have been studied and show promising results against Pseudomonas aeruginosa, a common nosocomial pathogen 6.
Comparison to Ampicillin
- Levofloxacin has been shown to be as effective as amoxicillin-clavulanic acid in the treatment of certain infections, such as community-acquired pneumonia 2.
- Amoxicillin-clavulanic acid has been compared to other oral agents, such as cefpodoxime and cefditoren, and has been shown to have similar or better activity against certain bacteria 4.
- The choice of oral medicine comparable to ampicillin will depend on the specific infection, the presence of resistance, and the patient's individual needs and medical history.