What is Levocin (amoxicillin) medication?

What is Levocin (Amoxicillin)?

Levocin is a brand name for amoxicillin, a semisynthetic penicillin-class antibacterial agent with broad-spectrum bactericidal activity against many Gram-positive and Gram-negative microorganisms. 1

Chemical Composition and Formulation

• Amoxicillin is chemically described as (2S,5R,6R)-6-[(R)-(-)-2-amino-2-(p-hydroxyphenyl)acetamido]-3-3-dimethyl-7-oxo-4-thia-1-azabicyclo[3.2.0]heptane-2-carboxylic acid trihydrate, with molecular formula C₁₆H₁₉N₃O₅S·3H₂O and molecular weight of 419.45 1

• Available as oral suspension in 125 mg/5 mL and 250 mg/5 mL concentrations 1

Mechanism of Action and Spectrum

• Amoxicillin is generally considered the most active of all oral β-lactams against streptococci, including pneumococci, due to its intrinsic activity and excellent bioavailability 2

• It demonstrates bactericidal activity by inhibiting bacterial cell wall synthesis 1

• The drug has fair to good intrinsic activity against β-lactamase-negative strains of Haemophilus influenzae, though it is 20 to 50 times less potent than third-generation cephalosporins against this organism 2

Clinical Indications

Amoxicillin is FDA-approved for treatment of infections in both adults and pediatric patients, including: 1

• Upper respiratory tract infections of the ear, nose, and throat 1
• Genitourinary tract infections 1
• Skin and skin structure infections 1
• Lower respiratory tract infections 1
• Helicobacter pylori infection and duodenal ulcer disease (adults only) 1

Dosing Regimens

Adults

• Standard dosing: 750 to 1,750 mg/day in divided doses every 8 to 12 hours 1
• High-dose amoxicillin is defined as 4 g/day for adults, which may be necessary to eradicate S. pneumoniae with high minimum inhibitory concentrations (MICs) 2

Pediatric Patients

• Children over 3 months: 20 to 45 mg/kg/day in divided doses every 8 to 12 hours 1
• High-dose pediatric regimen: 90 mg/kg per day for children, particularly important for penicillin-resistant S. pneumoniae 2
• Neonates and infants ≤3 months: maximum 30 mg/kg/day divided every 12 hours 1

Special Populations

• Dosage reduction required in patients with severe renal impairment (GFR <30 mL/min) 1

Guideline-Recommended Uses

Amoxicillin (with or without clavulanate) is recommended as first-choice therapy for multiple infections according to WHO and IDSA guidelines: 2

• Mild skin and soft tissue infections: Amoxicillin-clavulanic acid is listed as first choice 2
• Animal bites: Oral amoxicillin-clavulanic acid is the preferred oral treatment 2
• Impetigo: Amoxicillin-clavulanic acid is among recommended oral options 2
• Diabetic wound infections (mild): Amoxicillin-clavulanic acid is recommended 2
• COPD exacerbations: Amoxicillin with or without clavulanic acid is recommended as first-choice 2
• Acute bacterial rhinosinusitis: High-dose amoxicillin or amoxicillin-clavulanate is recommended for initial therapy 2

Pharmacokinetic Advantages

• Serum levels of amoxicillin increase linearly with dose (gastrointestinal absorption is not a limiting factor), and the difference in adverse effects between lower and higher doses is negligible 2

• Oral bioavailability approaches 100% 1

• Approximately 20% protein-bound in blood serum 1

• Primarily eliminated unchanged in urine (approximately 80%) through glomerular filtration and tubular secretion 1

Important Clinical Considerations

Contraindications

• History of serious hypersensitivity reaction (e.g., anaphylaxis or Stevens-Johnson syndrome) to amoxicillin or other beta-lactams 1

Common Adverse Reactions

• The most common adverse reactions (>1%) are diarrhea, rash, vomiting, and nausea 1

Drug Interactions

• Coadministration with probenecid is not recommended 1
• Concomitant use with oral anticoagulants may increase prothrombin time prolongation 1
• Coadministration with allopurinol increases risk of rash 1
• May reduce efficacy of oral contraceptives 1

Resistance Considerations

• Resistance to penicillin in S. pneumoniae is relative and may be overcome by using higher doses of amoxicillin 2
• When amoxicillin is selected for patients at risk for drug-resistant S. pneumoniae (recent antimicrobial use, immunodeficiency, frequent exposure to children in day care), the high-dose regimen should be used 2