Preparat: Amimox®, Amoclav, Amoxicillin 2care4, Amoxicillin Aurobindo, Amoxicillin Ebb, Amoxicillin Mylan, Amoxicillin Sandoz, Amoxicillin/Clavulanic acid 2care4, Amoxicillin/Clavulanic acid Actavis, Amoxicillin/Clavulanic acid Aurobindo, Amoxicillin/Clavulanic acid BB, Amoxicillin/Klavulansyra 2care4, Amoxicillin/Klavulansyra Ebb, Amoxil Vials for Injection 500 mg, Augmentin, Augmentin i.v., Betaklav, Bioclavid, Co-amoxiclav, DAP-amoxicillin, Imacillin®, Klaximol, Nexium® HP, Spektramox®
ATC kod: A02BD06, J01CA04, J01CR02, V01AA20
Substanser: amoxicillin, amoxicillinnatrium, amoxicillintrihydrat
En stor studie har visat att känsligheten för amoxicillin var lika hos E. coli-positiva urinprov från kvinnor och män. Vissa studier har rapporterat mer resistens mot amoxicillin hos pojkar/män medan andra studier inte har påvisat någon könsskillnad.
In a pharmacokinetic study (without significance calculations) in healthy volunteers (6 men, 6 women) amoxicillin mean half-life was shorter in men than in women (54 min vs. 73 min) after a single dose (500 mg). Higher concentration of amoxicillin was found in the men’s urine. However, no differences in exposure between men and women were shown .
A pharmacokinetic study (17 women) described significant changes in amoxicillin pharmacokinetics during pregnancy, in comparison to postpartum circumstances. Amoxicillin exposure was lower in the second and third trimesters of pregnancy than three months postpartum. On the contrary, creatinine clearance and amoxicillin renal clearance and secretion were higher during pregnancy. Plasma half-life of amoxicillin was shorter in the second and third trimesters than postpartum .
No sex differentiation in dosing has been recommended by the manufacturer .
Resistance patterns for pathogens often differ between populations. A Dutch study comparing resistance in urinary samples from 560 men with historic data from urinary samples from 917 women  found no difference between men and women in E.colisusceptibility to amoxicillin . In contrast to this a Portuguese retrospective analysis of urinary samples (120 691 (78%) from women and 34 898 (22%) from men) amoxicillin resistance was more common in male urinary samples positive for E. coliandP. mirabilis.
Another study of urinary E. coliisolates (2 274 men, 32 265 women) has described age- and sex-specific antibiotic susceptibility patterns for ampicillin, amoxicillin clavulanate, ciprofloxacin, nitrofurantoin and trimethoprim-sulfamethoxazole. Amoxicillin/clavulanic acid susceptibility was similar in men and women (56.9% vs. 67.3%). Age-specific susceptibilities differed between men and women for all antibiotics studies except trimethoprim-sulfamethoxazole. However, the magnitude of the observed differences was generally less than 5% and the authors suggest that they may not represent clinically meaningful differences .
The benefit of antibiotic prophylaxis in preventing infections after craniotomy has been evaluated based on surveillance data of infections after craniotomy (one including 4 878 men and women, the other study 3134 men, 3109 women) [9,10]. In both studies, patients received cloxacillin or amoxicillin-clavulanate. Results showed that antibiotic prophylaxis decreased infections rates  but did not prevent meningitis . Male sex was among risk factors for infection and meningitis.
Amoxicillin/clavulanic acid can induce idiosyncratic drug-induced liver injury (DILI). Clinical studies have reported a higher incidence of DILI in women with certain drugs such as nitrofurantoin, flucloxacillin, erythromycin and isoniazid . A study of amoxicillin/clavulanic acid induced DILI (35 men, 26 women) showed association with certain HLA I and II genotypes .
Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).
A retrospective study, including 1921 patients (794 men, 1122 women, lack of access to 5 medical records), found a greater occurrence of positive penicillin skin test result in female patients than in male patients with self-reported penicillin allergy. The risk was calculated from the whole set of 64 positive results (11 men, 53 women), including different penicillins .A retrospective cohort study, analyzing data for antibiotic prescriptions in outpatient care in Belgium, revealed that girls/women were prescribed amoxicillin to a greater extent than boys/men, compared to broad-spectrum antibiotics. Also, female physicians (general practitioners and pediatricians) prescribed more amoxicillin, compared with broader spectrum alternatives, than male colleagues .
Fler kvinnor än män hämtade ut läkemedel innehållande amoxicillin (ATC-kod J01CA04) på recept i Sverige år 2015, totalt 76 277 kvinnor och 66 376 män. Det motsvarar 16 respektive 14 personer per tusen invånare. Andelen som hämtat ut läkemedel var högst i åldersgrupperna 0-4 år och 70 år och äldre hos båda könen. I åldersgrupperna 0-4 år och 75 år och äldre var läkemedel innehållande amoxicillin i genomsnitt 1,4 gånger vanligare hos pojkar/män och i åldersgruppen 10-69 år i genomsnitt 1,5 gånger vanligare hos flickor/kvinnor .
Faktagranskat av: Mia von Euler
Godkänt av: Karin Schenck-Gustafsson