Amoxicillin + Bromhexine

Oral
Lower respiratory tract infections, Upper respiratory tract infections

Penicillin allergy, lactation.

Pregnancy, renal and hepatic disease and history of peptic ulcer . Infectious mononucleosis.

Headache, nausea, dizziness, vomiting, diarrhoea, black hairy tongue, maculopapular rash, urticaria, eosinophilia, hemolytic anemia, thrombocytopenia.
Potentially Fatal: Anaphylaxis, pseudomembranous colitis, acute cytoloytic hepatitis and Stevens-Johnson syndrome.

Live oral typhoid vaccine should not be given 3 days before or 3 days after amoxicillin admin as immune response may be attenuated. Amoxicillin increases the anticoagulant response of coumarins. Amoxicillin may reduce OC pill absorption leading to breakthrough bleeding or pregnancy. Amoxicillin reduces the renal clearance of methotrexate and pemetrexate. Amoxicillin level significantly reduced when given with or 2 hr after acacia admin. Bromhexine enhances the penetration of amoxicillin into bronchial secretions.

Tannins in catha reduced amoxicillin absorption if amoxicillin is admin <2 hr after chewing catha.

Possible interference with urinary glucose tests using cupric sulfate. May increase degradation of aminoglycosides in vitro. Increase in ALT and AST.

Description:
Mechanism of Action: Amoxicillin inhibits the final transpeptidation of peptidoglycan synthesis in bacterial cell walls. Hence, cell wall synthesis is inhibited and results in bacterial lysis. Bromhexine is a mucolytic. It thins and liquifies the mucus and helps increased penetration of the antibiotic. The less viscous mucus is easily removed by ciliary movement and expectoration.
Pharmacokinetics:
Absorption: Amoxicillin: Rapidly and almost completely absorbed from the GI tract; peak plasma concentration (oral): 1-2 hr. Bromhexine: Bioavailability: 20% (oral); peak plasma concentration: 1 hr.
Distribution: Amoxicillin: Protein binding: 17-20 %; Widely distributed to body fluid and bone, CSF (small concentrations except when meninges are inflamed). Bromhexine: Highly protein-bound; Widely distributed.
Metabolism: Amoxicillin: Partially metabolised to penicilloic acid. Bromhexine: Extensively hepatically metabolized to ambroxol.
Excretion: Amoxicillin: Via urine: 60% as unchanged drug. Elimination half-life: Adults: 0.7-1.4hr, CrCl:<10 ml/min: 7-21 hr; infants & children: 1-2 hr.Bromhexine: Via urine: As mainly metabolites; elimination half-life (terminal): 13-40 hr.

Penicillins