From the Guidelines
Amoxicillin can be used in patients with kidney disorders, but dose adjustments are often necessary, and it is recommended to consult a nephrologist before taking the medication. When considering the use of amoxicillin in patients with kidney disorders, it is essential to take into account the degree of renal impairment and the potential for drug accumulation 1.
- The American Heart Association recommends amoxicillin as a prophylactic antibiotic for patients with high risks of infection, including those with kidney disorders 1.
- For patients on hemodialysis, a dose of 2 g of amoxicillin orally 1 h before dental treatment is suggested, but this may need to be adjusted based on residual kidney function 1.
- It is crucial to avoid nephrotoxic drugs, such as aminoglycoside antibiotics and tetracyclines, in patients with kidney disorders 1.
- Patients with kidney disorders should be closely monitored for potential side effects, including nausea, diarrhea, or skin rashes, and report any unusual symptoms to their healthcare provider.
- Regular monitoring of kidney function may be recommended during treatment with amoxicillin to ensure safe use and minimize potential risks 1.
From the FDA Drug Label
This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Amoxicillin is primarily eliminated by the kidney and dosage adjustment is usually required in patients with severe renal impairment (GFR less than 30 mL/min).
Key Considerations:
- Amoxicillin is substantially excreted by the kidney.
- Patients with impaired renal function are at a greater risk of toxic reactions.
- Dosage adjustment is required in patients with severe renal impairment.
Clinical Decision: Amoxicillin can be used in patients with kidney disorder, but caution should be exercised and dosage adjustment may be necessary, especially in patients with severe renal impairment. It is essential to monitor renal function and adjust the dose accordingly to minimize the risk of toxic reactions 2.
From the Research
Amoxicillin and Kidney Disorder
- Amoxicillin is an antibiotic that may require dose adjustments in patients with impaired kidney function to avoid subtherapeutic concentrations 3.
- Current dose reductions recommended for amoxicillin in patients with impaired kidney function could lead to suboptimal treatments, especially when targeting less susceptible pathogens 3.
- The probability of target attainment (PTA) for amoxicillin is reduced with decreased kidney function, with a PTA of 92%, 62%, and 38% for a CKD-EPI of 10,20, and 30 mL/min/1.73 m2, respectively, versus 100% for the standard dose 3.
General Guidelines for Antibiotic Dosing in Kidney Disorder
- Antibiotic dosing in patients with renal insufficiency or receiving dialysis is a therapeutic challenge that requires consideration of the pharmacokinetics of the antibiotic 4.
- Practical guidelines for determining the appropriate dose and dosing interval in patients with impaired hepatic or renal dysfunction are available, but may not always be followed 4, 5.
- Dosage adjustment based on creatinine clearance may not be appropriate for patients receiving drugs that require active tubular secretion for urinary excretion, such as ampicillin and cephalexin 6.
Specific Considerations for Amoxicillin
- Amoxicillin clearance can be well predicted with body weight and CKD-EPI, which can inform dose adjustments in patients with impaired kidney function 3.
- For MICs ≤ 2 mg/L, the probability of target attainment (PTA) is > 90% in patients with impaired kidney function following both reduced and standard dose regimens of amoxicillin 3.
- Deferred renal dose reduction of wide therapeutic index antibiotics like amoxicillin could improve outcomes in patients with infectious diseases, particularly in the first 48 hours of therapy 7.