Suspected Sepsis: 25mg/kg/dose IV
Severe Sepsis +/- Meningitis: 50mg/kg/dose IV

Postmenstrual Age (weeks)	Postnatal Age (days)	Dosing Interval (hr)
<29	0 to 28	12
	>28	8
30 to 36	0 to 14	12
	>14	8
37 to 44	0 to 7	12
	>7	8
>45	All	6

Indications

1. Empirical therapy for infants with risk factors for sepsis or suspected sepsis. Usually administered in combination with gentamicin, cefoxitin, cefotaxime, or netilmicin.
2. Specific therapy for Streptococcus agalactiae, Streptococcus faecalis, Listeria monocytogenes.

Contraindications

1. Hypersensitivity to penicillins/cephalosporins.

Precautions

1. Caution in preterm infants, especially extreme immaturity.
2. Caution in infants with liver, renal or gastrointestinal disease.

Clinical Pharmacology

Amoxycillin is a broad spectrum penicillin with antibacterial activity against certain gram negative and gram positive organisms.  It is in activated by penicillinases including those produced by Staphylococcus aureus, E.coli, Pseudomonas, Klebsiella, and Enterobacter. ⁶

Widely distributed at varying concentrations in human body tissues and fluids.  Very little passes into the CSF unless the meninges are inflamed.  Low binding to human plasma protein.  Half-life (adults) of 1 to 1.5 hours, which would be extended in the neonate. ⁷   Excreted mainly unchanged by the kidneys.

Possible Adverse Effects

1. Venous irritation, soft tissue injury at site of IV injection.
2. Pain, soft tissue injury at site of IM injection.
3. Gastrointestinal disturbance (nausea, vomiting, diarrhoea).
4. Maculopapular rash, non-specific rashes and skin eruptions.
5. Fever, pruritis, urticaria.
6. Seizures (encephalopathy with high doses greater than 400 mg/kg/day).

Special Considerations

1. May give concurrently with aminoglycoside therapy for synergistic effect. Administer separately as simultaneous administration may cause inactivation.
2. Reduce dose in suspected renal dysfunction.
3. Sodium content 2.6 mmol/g.