Amoxicillin

PD Dialyzability: Very likely

Pharmacokinetic Parameters [1] [2]

	Amoxicillin
Molecular Weight (Da)	364
Plasma Protein Binding (%)	15 - 25
Volume of Distribution (L/Kg)	0.26
Hepatic Metabolism	< 30%, CYP2C19
Excreted Unchanged (%)	50-70
Half-Life; Normal Renal Function (hours)	0.9-2.3
Half-Life; ESRD (hours)	5-20

Indication Specific Dosing (PD Type unspecified):

• Dental prophylaxis - 2g PO single dose, 2 hours before dental procedure [6]
• Exit-site and tunnel infections - 250-500mg PO BID [7]
• Peritonitis treatment - refer to Table 5 of ISPD Peritonitis Recommendations: 2016 Update [8]

CAPD Dosing: [3] [4] [5]

• 250mg PO Q12H

CCPD Dosing:

• No literature identified. Extrapolate dosing from CAPD dosing recommendations.

Literature Summary:

Title	Patient	Intervention	Outcome	Note
Pseudomonas paucimobilis peritonitis in patients treated by peritoneal dialysis. [9]	CAPD 33 year-old woman re-admitted with abdominal pain	empiric IP antibiotics narrowed to IP ampicillin and then PO amoxicillin 3g PO daily x 5 days prior to discharge	Treatment failure with high dose PO Amoxicillin Dialysate cultured at 1 week post-discharge positive for P. paucimobilis	No ADR reported
Pregnancy in a patient with autosomal-dominant polycystic kidney disease and congenital hepatic fibrosis. [10]	CAPD 32 year-old pregnant woman Polycystic kidney disease congenital hepatic fibrosis intrauterine death at ~30 weeks	Amoxicillin 1g IV QID initiated at onset of fever	Patient delivered a stillborn boy Fever normalized within a day Renal function recovered, off dialysis	Total treatment duration unspecified No ADR reported
Bacteraemia and sinusitis due to flavimonas oryzihabitans infection. [11]	CAPD 51 year-old woman Purulent nasal discharge, right facial pain, low grade fever	Amoxicillin 2g PO daily x 2 weeks	Treatment failure due to resistance Amoxicillin discontinued and switched to other agents based on culture and sensitivity results Successfully treated with ciprofloxacin 500mg PO BID x 2 weeks	No ADR reported
Exit-site infection caused by Actinomyces odontolyticus in a CAPD patient. [12]	CAPD 56 year-old woman Recurrent catheter exit site infections (Pseudomonas aeruginosa, Enterococcus species, and Escherichia coli.)	Pen G IV x 1 month, then amoxicillin PO x 1 month Dosing regimens described in article:Pen G IV 10-20 MU/day; Amoxicillin PO 1.5g/day (no mention of renal dose adjustment or if divided doses given)	Treatment success Symptom-free at follow-up visits (data up to 12 months)	The citation referenced indicated Pen G IV total daily dose of 10-20 MU is to be divided and given every 6 hours. [13] No ADR reported
Successful pregnancy complicated by peritonitis in a 35-year-old CAPD patient. [14]	CAPD 35 year-old pregnant woman Amniotic leak with positive vaginal culture (E. coli) three weeks prior to delivery	Amoxicillin 500mg po QID until delivery	Successful delivery via C-section E coli peritonitis developed 5 days postpartum which was successfully treated	Only able to access abstract
Response to triple treatment with omeprazole, amoxicillin, and clarithromycin for Helicobacter pylori infections in continuous ambulatory peritoneal dialysis patients. [15]	20 CAPD patients and 124 otherwise-healthy patients with dyspepsia were assessed for H. pylori infections. 11 CAPD patients were treated with triple therapy.	Omeprazole 20 mg PO BID for 30 days, amoxicillin 500 mg PO TID for 15 days, and clarithromycin 500 mg PO TID for 15 days.	Successful H. pylori eradication in all CAPD patients	Only able to access abstract

References

[1]	Wishart DS, Knox C, Guo AC, Shrivastava S, Hassanali M, Stothard P, et al. DrugBank: a comprehensive resource for in silico drug discovery and exploration. Nucleic Acids Res. 2006 Jan 1;34(Database issue):D668-672.

[2]	American Pharmacists Association. Drug information handbook: a comprehensive resource for all clinicians and healthcare professionals. Hudson, Ohio; [Washington, D.C.: Lexi-Comp ; American Pharmacists Association; 2012.

[3]	Aronoff GR, editor. Drug prescribing in renal failure: dosing guidelines for adults and children. 5. ed. Philadelphia, Pa: American College of Physicians; 2007.

[4]	Adjusting oral antibiotics to estimated creatinine clearance [Internet]. Vancouver: Vancouver Coastal Health. Clinical Services Unit Pharmaceutical Sciences Vancouver Acute.; 2013 [cited 1 December 2015].

[5]	Gilbert B, Robbins P, Livornese LL. Use of Antibacterial Agents in Renal Failure. Medical Clinics of North America. 2011 Jul;95(4):677–702.

[6]	Piraino B, Bernardini J, Brown E, Figueiredo A, Johnson DW, Lye W-C, et al. ISPD Position Statement on Reducing the Risks of Peritoneal Dialysis-Related Infections. Peritoneal Dialysis International. 2011 Nov 1;31(6):614–30.

[7]	Szeto C-C, Li PK-T, Johnson DW, Bernardini J, Dong J, Figueiredo AE, et al. ISPD Catheter-Related Infection Recommendations: 2017 Update. Perit Dial Int. 2017 Mar 1;37(2):141–54.

[8]	Li PK-T, Szeto CC, Piraino B, Arteaga J de, Fan S, Figueiredo AE, et al. ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment. Perit Dial Int. 2016 Sep 1;36(5):481–508.

[9]	Glupczynski Y, Hansen W, Dratwa M, Tielemans C, Wens R, Collart F, et al. Pseudomonas paucimobilis peritonitis in patients treated by peritoneal dialysis. J Clin Microbiol. 1984 Dec;20(6):1225–6.

[10]	Klinkert J, Koopman MG, Wolf H. Pregnancy in a patient with autosomal-dominant polycystic kidney disease and congenital hepatic fibrosis. Eur J Obstet Gynecol Reprod Biol. 1998 Jan;76(1):45–7.

[11]	Lejbkowicz F, Belavsky L, Kudinsky R, Gery R. Bacteraemia and sinusitis due to Flavimonas oryzihabitans infection. Scand J Infect Dis. 2003;35(6–7):411–4.

[12]	Siu YP, Tong MKH, Lee MKF, Leung KT, Kwan TH. Exit-site infection caused by Actinomyces odontolyticus in a CAPD patient. Perit Dial Int. 2004 Dec;24(6):602–3.

[13]	Smego RA, Foglia G. Actinomycosis. Clin Infect Dis. 1998 Jun;26(6):1255-1261; quiz 1262-1263.

[14]	Tison A, Lozowy C, Benjamin A, Usher R, Prichard S. Successful pregnancy complicated by peritonitis in a 35- year old CAPD patient. Perit Dial Int. 1996;16 Suppl 1:S489-491.

[15]	Suleymanlar I, Tuncer M, Tugrul Sezer M, Ertugrul C, Sarikaya M, Fevzi Ersoy F, et al. Response to triple treatment with omeprazole, amoxicillin, and clarithromycin for Helicobacter pylori infections in continuous ambulatory peritoneal dialysis patients. Adv Perit Dial. 1999;15:79–81.