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View Full Version : How long for amoxicillin to kick in?


C3
12-15-2003, 02:23 PM
I've got strep. I went to the doctor on Saturday and started on amoxicillin three times a day. On Sunday, I started running a fever. Today I'm still running a fever and my throat is worse...it's quite possibly the grossest thing I've ever seen. It's so swollen there's only a little space for the air to go through and it's covered in white pus.

Should the antibiotics be lessening my symptoms by now or am I being impatient? Should I go back to the doctor or stick it out for a couple more days?

In Conceivable
12-15-2003, 02:51 PM
IANAD but I have always started feeling better the day after getting antibiotics.

If I were you I would call your doctor and ask him.

stpauler
12-15-2003, 03:24 PM
IANAD, but I do get strep a lot. I mean a lot. For me, the effectiveness of the antibiotic on strep is dependant on a couple things. One of the most important ones is how soon you "caught" it. IOW, if you waited to get the throat cultures for awhile before you went to the Dr and were diagnosed. The longer that is, the longer the recovery time. If I wait a bit before I get the prescription, it usually takes a week before I'm feeling 80%. Also, it does get worse before it gets better for me.

Lots of fluids, lots of rest are the standard advice too. (Did your Dr recommend taking Tylenol?) I always toss out my toothbrush as well as I've been told by my Dr. that it could cause strep again.

FWIW, whenever I get strep throat (which incidentally, I have right now) I ask for a "z-pack" which is Zithromax (azithromycin). It's 6 pills for 5 days. (2 the first day and one the subsequent four days), it's effectiveness is the same for me but it's a lot easier to remember one pill with or without food than 3 pills a day for 10 days.

Best thing to do is to call your Dr just for peace of mind.

Hope ya feel better!

Lissa
12-15-2003, 03:58 PM
I have a heart problem which requires me to take antibiotics before I go to the dentist.

Last time I went, I had forgotten to get my prescription. They gave me four amoxicillin tablets at the office, and told me I'd have to wait for one hour before they started working.

Thus, I'm assuming they only take an hour or so before they start doing their job.

Perhaps, in your case, they're not being particularly effective against your illness.

alice_in_wonderland
12-15-2003, 04:05 PM
C3 - quick question. (Don't be offended if the answer is "no.") Did you have anything alcoholic to drink this weekend? It is the season and all that - alcohol will pretty much wipe out the effectiveness of penecilin type drugs.

If not, perhaps a call to your Drs' office would be a good idea.

mrklutz
12-15-2003, 04:16 PM
IANAD either, but I do have chronic sinusitis. My neighbor stpauler has the right of it. If it developed into a big, nasty infection it can take a while before you get better. In fact, if the infection was bad, you will probably actually feel worse for 1 or 2 days after you take the antibiotics. The way it was explained to me is that the antibiotics are killing the bacteria that caused the infection, which in turn causes their itty bitty corpses to release all their toxins into your bloodstream. So if there are lots of bacteria, the amount of toxins dumped by their die-off can make your symptoms worse for a couple days.

If you don't start feeling better tomorrow, though, I'd call your doctor and/or nurse. (My clinic has a nurse's line which I have found to be extremely helpful when I have questions.)

C3
12-15-2003, 04:45 PM
Originally posted by mrklutz
IANAD either, but I do have chronic sinusitis. My neighbor stpauler has the right of it. If it developed into a big, nasty infection it can take a while before you get better. In fact, if the infection was bad, you will probably actually feel worse for 1 or 2 days after you take the antibiotics. The way it was explained to me is that the antibiotics are killing the bacteria that caused the infection, which in turn causes their itty bitty corpses to release all their toxins into your bloodstream. So if there are lots of bacteria, the amount of toxins dumped by their die-off can make your symptoms worse for a couple days.

If you don't start feeling better tomorrow, though, I'd call your doctor and/or nurse. (My clinic has a nurse's line which I have found to be extremely helpful when I have questions.)

I think you and stpauler have probably hit on the problem. I started getting symptoms Wednesday and didn't start the antibiotics until Saturday. Bacteria corpses.....mmmmmmm.

alice-in-wonderland, no, I didn't have any alcohol (and I'm not offended by your asking :) ) - believe me when I tell you that I feel like absolute doo-doo. I've managed to eat some chicken broth and some Coke today. I tried a sandwich last night, but swallowing isn't my favorite activity these days.

Thanks for your input, everyone. If the fever hasn't subsided by tomorrow (I'm taking Tylenol for that) I'll give the doctor a call.

KP
12-15-2003, 04:59 PM
After each oral dose of amoxicillin, peak serum amoxicillin concentrations are reached in 1-2 hours for capsules, film-coated tablets, chewable tablets, or oral suspension in both fasting and non-fasting adults. Elimination is primarily via the kidneys and is rapid, with a relatively short half-life of approximately 1 hour.

What does this mean to you? Well, with most drugs, the first dose starts at a zero plasmalevel, but doesn't fully go away before the next dose, so the next dose has a "step stool to stand on" and reaches a higher maximum blood level. Typically, it takes 5 or so doses before you approach your ultimate steady-state [i.e. the amount left in the blood by the next dose becomes fairly stable]

With amoxicillin, which is typically taken every 8 hours, all but 1-2% of each dose is excreted by the kidneys before the next dose. That's why we often precribe it with clavulanic acid (e.g. Augmentin(tm)) to slow down its excretion. Amoxicillin is a sucker punch to the bacterial population in the blood: it peaks fast and hard, but drops relatively rapidly. Fortunately, it has decent antibiotic effects against susceptible species even at fairly low concentrations. How many sucker punches until the enough of the buggers go down to make a difference? You can probably guess that answer is: it depends on how many you had, and how badly they have you on the ropes

However, blood levels don't tell the whole story. Your body can be seen as divided into compartments, and it takes time for the drug to pass into the other compartments, where they may actually accumulate (unlike the blood, which is constantly filtered by the kidneys). For tissue infections it may take days to reach steady tissue levels; for joint infections, it can take a week or more. The lymphatic system (swollen glands) drain the tissues, so it can take a while, too, despite a near direct boost from the blood with every dose (it can also depend on how well your lympahtics are draining - but that's something that's traditionally covered more in DO schools than my own MD training).

Patients usually start feeling better in a day or two. Tell you doctor if you aren't. Different strains have different sensitivity, and people with repeated exposures to a specific antibiotic (or people infected by them) may have a strain that is more resistant to that antibioltic. Usually even the exact species of the infection is just an educated guess, based on the exam and community prevalence (the quick strep tests are okay, but the definitive tests take days, and who wants to wait that long to begin treating?) Your doctor may revise their estimate, if they hear it's not working.

You may need a different antibiotic. With amoxicillin, a higher dosage usually isn't indicated, because the bioavailability (the amount that actually enters the blood) decreases significantly if you go much above the standard adult dose of 500mg. (i.e. if you take 250-500 mg, 74-92% will enter your blood, but if you take 1000mg, you may only absorb 50% so the actual amount entering your blood may not be much higher)

MLS
12-15-2003, 09:29 PM
Awesome post, KP. I've often wondered about exactly those issues. Thanks!

Qadgop the Mercotan
12-15-2003, 09:55 PM
Well, since penicillin resistance is still not that frequent with strep throat, the first thing I'd ask is: How sure are you of the diagnosis? Even if you score 4 out of 5 of these criteria here:
1. Tonsillar swelling and pus
2. Tender, anterior swollen neck lymph nodes
3. Cough absent
4. Fever present
5. Exposure to known sore throat contact
your chance of having strep is only 43%. Viruses, including the EB virus which causes mononucleosis, are more common culprits for sore throats.

Of course, if your rapid strep test or strep culture is positive for Group A beta-hemolytic strep (and NOT other types), then I'd say you've got it.

However, there is also a body of evidence that indicates for many patients the symptoms of strep improve at about the same rate whether or not the infection is treated. The main reason to treat strep is not to cure the sore throat, but to prevent the complications of strep, such as rheumatic fever, or kidney damage, or abscess formation.

But: If you're still running a fever and having trouble handling your secretions because of pain and swelling, something may not be right.

So talk to your doc first. Given the rise in drug resistance, even among such previously sensitive organisms like strep, other modalities may need to be employed.

Bottom line: Check with your doc.

QtM, MD

Dr_Paprika
12-15-2003, 10:05 PM
What Qadgop said.

And two other points.

1. Ten per cent of people always test positive for Group A strep on throat swabs. THis tends to run in families.

2. Z-packs are very popular around here. I almost always prescribe erythromycin instead, however. Though it has slightly more side effects and is not once a day, it is about 20% of the cost and is as effective an antibiotic. Many expensive medicines have little benefit over cheap reliables that have been around for years.

Qadgop the Mercotan
12-15-2003, 10:08 PM
Originally posted by Dr_Paprika
Many expensive medicines have little benefit over cheap reliables that have been around for years.
Preach it, Brother!

Declan
12-15-2003, 10:19 PM
Originally posted by KP
You may need a different antibiotic. With amoxicillin, a higher dosage usually isn't indicated, because the bioavailability (the amount that actually enters the blood) decreases significantly if you go much above the standard adult dose of 500mg. (i.e. if you take 250-500 mg, 74-92% will enter your blood, but if you take 1000mg, you may only absorb 50% so the actual amount entering your blood may not be much higher)

So whats the difference between amoxocillian, and tetracycline ?

The payload, or the time on target for the intial release ?

Declan

KarlGauss
12-16-2003, 12:04 AM
Originally posted by alice_in_wonderland
... alcohol will pretty much wipe out the effectiveness of penecilin type drugs.


I'm not sure I agree with you on that. Although I am always open to new ideas, I don't know of evidence to support that statement. At worst, some antibiotics* when taken with alcohol make you feel pretty rotten, but the antibiotic effect is not inhibited.

* eg. Flagyl (metronidazole), cephalosporins (cefamandole, cefotetan, moxalactam)

vivalostwages
12-16-2003, 01:19 AM
C3, have you had your tonsils removed yet? I only mention it because I used to get strep repeatedly until they were removed when I was 18.

Just a possibility.

spingears
12-16-2003, 08:05 AM
Originally posted by Lissa
I have a heart problem which requires me to take antibiotics before I go to the dentist.
Last time I went, I had forgotten to get my prescription. They gave me four amoxicillin tablets at the office, and told me I'd have to wait for one hour before they started working.
Thus, I'm assuming they only take an hour or so before they start doing their job.
Perhaps, in your case, they're not being particularly effective against your illness.

My orthopedic Dr. reccomends 4 capsules of amoxicillin prior to dental cleaning or other procedues because of a total hip replacement.


________________
"Beware of the Cog"

C3
12-16-2003, 12:00 PM
OK, I'm back from my second doctor's visit in four days. He gave me a z-pack, a decongestant (because I can hear almost nothing right now, although I have no congestion in my sinuses or chest), and a pain killer (tramadol). He told me to use Afrin (again, for the hearing issue) and to take Tylenol and Advil, alternating every three hours. I think the nurse was grossed out when she swabbed me for another strep test.

I've been drinking ice water to help with the pain and gargling with warm salt water. I bought two new toothbrushes - one for the remainder of this illness and the other for when I start feeling better.

I feel like complete and utter crap.

Qadgop, I'm scoring 5 out of 5 on your criteria and I've now had two positive strep tests (the quick kind). Also, there's a bit of a strep outbreak in the area, according to the doctor. I think I have it, but the doctor thinks I may also have some sort of virus on top of it. He did a CBC and muttered something about white blood count (???) and said that I could have a viral infection also.

vivalostwages, I still have my tonsils. Although I haven't had strep in years, I have had it many times in the past. As a kid, I had strep that turned into Scarlet Fever. During my first year teaching (I don't teach anymore), I had strep 7 times!!! That was almost ten years ago and I've managed to avoid it until now.

KP, that was an awesome post. I really learned a lot from that.

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