Maxamox^®

MIMS Revision Date: 01 October 2024

1 Name of Medicine

Amoxicillin trihydrate.

2 Qualitative and Quantitative Composition

Each Maxamox tablet contains 1000 mg amoxicillin as the trihydrate.
Amoxicillin trihydrate is a white or almost white, crystalline powder.
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

Maxamox tablets are oval, biconvex, white to cream-coloured, scored on both sides.

4 Clinical Particulars

4.1 Therapeutic Indications

Maxamox is indicated in the treatment of acute exacerbation of chronic bronchitis.
Notes. Therapy should be guided by bacteriologic studies including sensitivity tests and by clinical response. Amoxicillin alone or in combination with another antibiotic may be used in an emergency where the causative agent has yet to be identified.
Maxamox 1000 mg tablets have not been shown to be bioequivalent to the 500 mg and 250 mg capsule formulations given in equivalent doses. Therefore, Maxamox 1000 mg tablets and other forms of amoxicillin are not considered interchangeable.
Infections caused by pathogens with established penicillin G susceptibility should preferentially be treated with penicillin G.

4.2 Dose and Method of Administration

Dosage. Adults. 1000 mg twice daily.
Treatment should be continued for a minimum of 48 to 72 hours beyond the time when patients become asymptomatic or evidence of bacterial eradication has been obtained.
Bacteriological and clinical appraisals may have to be continued for several months following cessation of treatment.
Method of administration. Maxamox may be taken without regard to food.
Dosage adjustment. Renal impairment. In renal impairment the excretion of the antibiotic will be delayed, and depending on the degree of impairment, it may be necessary to reduce the total daily dose.

4.3 Contraindications

Amoxicillin is a penicillin and should not be given to patients with a history of hypersensitivity to β-lactam antibiotics (e.g. penicillins, cephalosporins, carbapenem or monobactam). Potential cross allergy to other beta-lactams such as cephalosporins should be taken into account.
Known and suspected hypersensitivity to the active substance, to any of the penicillins or known hypersensitivity to any of the excipients.
Antibiotics have no place in trivial infections.

4.4 Special Warnings and Precautions for Use

Hypersensitivity reactions. Serious, and occasionally fatal, hypersensitivity reactions (including anaphylaxis, anaphylactoid, and severe cutaneous reactions) have been reported in patients receiving beta-lactam antibiotics. Hypersensitivity reactions can also progress to Kounis syndrome, a serious allergic reaction that can result in myocardial infarction (see Section 4.8 Adverse Effects (Undesirable Effects)). These reactions are more likely to occur in individuals with a history of penicillin hypersensitivity and in atopic individuals. Although anaphylaxis is more frequent following parenteral therapy, it has occurred in patients on oral therapy. Before commencing therapy with any penicillin careful enquiry should be made concerning previous hypersensitivity reactions to penicillins, cephalosporins or other allergens. If an allergic reaction occurs, appropriate therapy should be instituted and amoxicillin therapy should be discontinued.
Serious anaphylactic reactions require immediate emergency treatment with adrenaline. Oxygen, intravenous steroids and airways management, including intubation should be administered as indicated.
Special caution should be exercised in patients with allergic diatheses or bronchial asthma and hay fever.
Drug-induced enterocolitis syndrome (DIES) has been reported mainly in children receiving amoxicillin (see Section 4.8 Adverse Effects (Undesirable Effects)). DIES is an allergic reaction with the leading symptom of protracted vomiting (1-4 hours after administration of amoxicillin) in the absence of allergic skin or respiratory symptoms. Further symptoms could comprise abdominal pain, diarrhoea, hypotension or leucocytosis with neutrophilia. There have been severe cases including progression to shock.
Lymphatic leukaemia. Amoxicillin should be given with caution to patients with lymphatic leukaemia as they are susceptible to amoxicillin induced skin rashes.
Non-susceptible microorganisms. Amoxicillin is not suitable for the treatment of some types of infection unless the pathogen is already documented and known to be susceptible or there is a very high likelihood that the pathogen would be suitable for treatment with amoxicillin. This particularly applies when considering the treatment of patients with urinary tract infections and severe infections of the ear, nose and throat.
Amoxicillin, an aminopenicillin, is not the treatment of choice in patients presenting with sore throat or pharyngitis because of the possibility that the underlying cause is infectious mononucleosis, in the presence of which there is a high incidence of rash if amoxicillin is used.
Overgrowth of non-susceptible microorganisms. Prolonged use may occasionally result in overgrowth of non-susceptible organisms.
Antibiotic associated pseudomembranous colitis has been reported with many antibiotics including amoxicillin. A toxin produced by Clostridium difficile appears to be the primary cause. The severity of the colitis may range from mild to life threatening. Clostridium difficile associated diarrhoea (CDAD) has been reported with the use of nearly all antibacterial agents and may range in severity from mild diarrhoea to fatal colitis. It is important to consider this diagnosis in patients who develop diarrhoea or colitis in association with antibiotic use (this may occur up to several weeks after cessation of antibiotic therapy). If prolonged or significant diarrhoea occurs or the patient experiences abdominal cramps, treatment should be discontinued immediately and the patient investigated further. Mild cases usually respond to drug discontinuation alone. However, in moderate to severe cases appropriate therapy with a suitable oral antibacterial agent effective against Clostridium difficile should be considered. Fluids, electrolytes and protein replacement should be provided when indicated. Drugs which delay peristalsis e.g. opiates and diphenoxylate with atropine (Lomotil) may prolong and/or worsen the condition and should not be used.
Convulsions. Convulsions may occur in patients with impaired renal function or in those receiving high doses or in patients with predisposing factors (e.g. history of seizures, treated epilepsy or meningeal disorders (see Section 4.8 Adverse Effects (Undesirable Effects)).
Anticoagulants. Abnormal prolongation of prothrombin time (increased INR) has been reported rarely in patients receiving amoxicillin and oral anticoagulants. Appropriate monitoring should be undertaken when anticoagulants are prescribed concurrently. Adjustments in the dose of oral anticoagulants may be necessary to maintain the desired level of anticoagulation.
Patients should be told about the potential occurrence of allergic reactions and instructed to report them.
If allergic reactions occur, the drug should be discontinued and the usual treatment with adrenaline, antihistamines and corticosteroids should be instituted, as necessary.
Prolonged therapy. As with any potent drug, periodic assessment of renal, hepatic and haematopoietic function should be made during prolonged therapy.
The possibility of superinfection with mycotic or bacterial pathogens should be kept in mind. If superinfection occurs (usually involving Aerobacter, Pseudomonas or Candida) discontinue the drug and/or institute appropriate therapy. Elevated liver enzymes and changes in blood counts have been reported.
Jarisch-Herxheimer reaction. The Jarisch-Herxheimer reaction has been seen following amoxicillin treatment of Lyme disease. It results directly from the bactericidal activity of amoxicillin on the causative bacteria of Lyme disease, the spirochaete Borrelia burgdorferi. Patients should be reassured that this is a common and usually self-limiting consequence of antibiotic treatment of Lyme disease.
Crystalluria. In patients with reduced urine output, crystalluria has been observed very rarely, predominantly with parenteral therapy. During the administration of high doses of amoxicillin, it is advisable to maintain adequate fluid intake and urinary output in order to reduce the possibility of amoxicillin crystalluria.
In patients with bladder catheters, a regular check of patency should be maintained (see Section 4.8 Adverse Effects (Undesirable Effects); Section 4.9 Overdose). At high doses, adequate fluid intake and urinary output must be maintained to minimise the possibility of amoxicillin crystalluria.
Urinary tract infections. Following single dose therapy of acute lower urinary tract infections, the urine should be cultured. A positive culture may be evidence of a complicated or upper urinary tract infection and call for longer or larger course of therapy.
Skin reactions. The occurrence of a generalized erythema with fever and pustules at the beginning of treatment should make suspect a generalized acute exanthematic pustulosis; this necessitates the interruption of therapy and contraindicated any further administration of amoxicillin.
Use in renal impairment. Dosage should be adjusted in patients with renal impairment (see Section 4.2 Dose and Method of Administration; Section 4.4 Special Warnings and Precautions for Use, Convulsions).
Use in the elderly. No data available.
Paediatric use. Precaution should be taken in premature children and during neonatal period: renal, hepatic and haematological functions should be monitored.
Effects on laboratory tests. Oral administration of amoxicillin will result in high urine concentrations of amoxicillin. Since high urine concentrations of amoxicillin may result in false positive reactions when testing for the presence of glucose in urine using Clinitest, Benedict's solution or Fehling's solution, it is recommended that glucose tests based on enzyme based glucose oxidase reactions (such as Clinistix, or Testape) be used.

4.5 Interactions with Other Medicines and Other Forms of Interactions

Allopurinol. The concurrent administration of allopurinol and ampicillin may promote the occurrence of skin rashes. The underlying mechanism is still poorly understood. Similar reactions can be expected with amoxicillin.
The concomitant administration of probenecid produces sustained and higher plasma levels by reducing renal elimination of amoxicillin.
Digoxin. An increase in the absorption of digoxin is possible on concurrent administration with amoxicillin. A dose adjustment of digoxin may be necessary.
Anticoagulants. Concomitant administration of amoxicillin and anticoagulants from the coumarin class, may prolong the bleeding time. A dose adjustment of anticoagulants may be necessary (see Section 4.4 Special Warnings and Precautions for Use). If coadministration is necessary, the prothrombin time or international normalised ratio should be carefully monitored with the addition or withdrawal of amoxicillin.
A large number of cases showing an increase of oral anticoagulant activity has been reported in patients receiving antibiotics. The infectious and inflammatory context, age and the general status of the patient appear as risk factors. In these circumstances, it is difficult to know the part of the responsibility between the infectious disease and its treatment in the occurrence of INR disorders. However, some classes of antibiotics are more involved, notably fluoroquinolones, macrolides, cyclines, cotrimoxazole and some cephalosporins.
In the literature there are rare cases of increased international normalised ratio in patients maintained on acenocoumarol or warfarin and prescribed a course of amoxicillin. If coadministration is necessary, the prothrombin time or international normalised ratio should be carefully monitored with the addition or withdrawal of amoxicillin.
Methotrexate. Penicillins may reduce the excretion of methotrexate causing a potential increase in toxicity. Serum methotrexate levels should be closely monitored in patients who receive amoxicillin and methotrexate simultaneously (see Section 4.4 Special Warnings and Precautions for Use). Amoxicillin decreases the renal clearance of methotrexate, probably by competition at the common tubular secretion system.
Tetracyclines. Tetracyclines and other bacteriostatic drugs may interfere with the bactericidal effects of amoxicillin.
Probenecid. Concomitant use of probenecid is not recommended. Probenecid decreases the renal tubular secretion of amoxicillin. Concurrent use with amoxicillin may result in increased and prolonged blood levels of amoxicillin.
Oral administration of amoxicillin will result in high urine concentrations of amoxicillin. Since high urine concentrations of ampicillin may result in false positive reactions when testing for the presence of glucose in urine using Clinitest, Benedict's solution or Fehling's solution, it is recommended that glucose tests based on enzyme based glucose oxidase reactions (such as Clinistix or Testape) be used.
Caution is recommended when amoxicillin is given concomitantly with:
Oral hormonal contraceptives. In common with other antibiotics, amoxicillin may affect the gut flora, leading to lower oestrogen reabsorption and reduced efficacy of combined oral contraceptives. Administration of amoxicillin can transiently decrease the plasma level of oestrogens and progesterone, and may reduce the efficacy of oral contraceptives. It is therefore recommended to take supplemental nonhormonal contraceptive measures.
Other forms of interactions. Forced diuresis leads to a reduction in blood concentrations by increased elimination of amoxicillin.
Amoxicillin may decrease the amount of urinary estriol in pregnant women.
At high concentrations, amoxicillin may diminish the results of serum glycemia levels.
Amoxicillin may interfere with protein testing when colorimetric methods are used.

4.6 Fertility, Pregnancy and Lactation

Effects on fertility. There are no data on the effects of amoxicillin on fertility in humans. Reproductive studies in animals have shown no effects on fertility.
Following administration of ampicillin to pregnant women a transient decrease in plasma concentration of total conjugated oestriol, oestriol-glucuronide, conjugated oestrone and oestradiol has been noted. This effect may also occur with amoxicillin.
Use in pregnancy. (Category A)
Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the foetus having been observed.
Animal studies with amoxicillin have shown no teratogenic effects. The product has been in extensive clinical use since 1972 and its suitability in human pregnancy has been well documented in clinical studies.
Amoxicillin may be used in pregnancy when the potential benefits outweigh the potential risks associated with treatment.
Use in labour and delivery. Oral ampicillin class antibiotics are generally poorly absorbed during labour. Studies in guinea pigs have shown that intravenous administration of ampicillin decreased the uterine tone, frequency of contractions and duration of contractions. However, it is not known whether the use of amoxicillin in humans during labour or delivery has immediate or delayed adverse effects on the foetus, prolongs the duration of labour or increases the likelihood that forceps delivery or other obstetrical intervention or resuscitation of the newborn will be necessary.
Use in lactation. Ampicillin class antibiotics are excreted in breast milk and caution should be exercised when amoxicillin is administered to nursing mothers. So far no detrimental effects for the breastfed infant have been reported after taking amoxicillin. Amoxicillin can be used during breastfeeding. However, breastfeeding must be stopped if gastrointestinal disorders (diarrhoea, candidosis or skin rash) occur in the newborn.

4.7 Effects on Ability to Drive and Use Machines

No studies on the effects on the ability to drive and use machines have been performed. However, undesirable effects may occur (e.g. allergic reactions, dizziness, convulsions), which may influence the ability to drive and use machines (see Section 4.8 Adverse Effects (Undesirable Effects)).

4.8 Adverse Effects (Undesirable Effects)

Amoxicillin 1000 mg tablets twice daily and amoxicillin 500 mg capsules three times daily for ten days were compared in a study of 395 adult patients with acute exacerbations of chronic bronchitis. There were no significant differences on the incidence or severity of adverse events between the treatment groups.
The most commonly reported adverse drug reactions (ADRs) are diarrhoea, nausea and skin rash.
The incidence of adverse events reported at a frequency of > 1%, and possibly or probably drug related, is shown in Table 1.

As with other penicillins, it may be expected that untoward reactions will be essentially limited to sensitivity phenomena. They are more likely to occur in individuals who have previously demonstrated hypersensitivity to penicillins. The following adverse reactions have been reported as associated with the use of amoxicillin.
Cardiac disorders. Kounis syndrome: not known.
Gastrointestinal. Nausea, vomiting, diarrhoea. Intestinal candidiasis, antibiotic associated colitis (including pseudomembranous colitis and haemorrhagic colitis), superficial discoloration of the teeth (especially with the suspension) have been reported rarely (see Section 4.4 Special Warnings and Precautions for Use). Usually the discoloration can be removed by teeth brushing. If severe and persistent diarrhoea occurs, the very rare possibility of pseudomembranous colitis should be considered. The administration of antiperistaltic drug is contraindicated. Black hairy tongue and haemorrhagic colitis have been reported very rarely.
Drug-induced enterocolitis syndrome: not known (see Section 4.4 Special Warnings and Precautions for Use).
Hypersensitivity. Erythematous maculopapular rash, pruritus and urticaria have been reported occasionally. Rarely, skin reactions such as erythema multiforme exsudativum, acute generalised exanthematous pustulosis (AGEP), Lyell's syndrome, Stevens-Johnson syndrome, toxic epidermal necrolysis, Jarisch-Herxheimer reaction, bullous and exfoliative dermatitis, drug reaction with eosinophilia and systemic symptoms (DRESS), and symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) (baboon syndrome) have been reported. As with other antibiotics, severe allergic reactions including angioneurotic oedema, anaphylaxis, serum sickness, hypersensitivity vasculitis and interstitial nephritis (crystalluria) have been reported rarely.
Whenever such reactions occur, amoxicillin should be discontinued.
Note. Urticaria, other skin rashes and serum sickness-like reactions may be controlled with antihistamines and, if necessary, systemic corticosteroids.
Anaphylaxis is the most serious reaction experienced (see Section 4.4 Special Warnings and Precautions for Use).
Hepatic. A moderate rise in AST and/or ALT has occasionally been noted, but the significance of this finding is unknown. As with other beta-lactam antibiotics, hepatitis and cholestatic jaundice have been reported rarely.
Renal. Crystalluria (including acute renal injury) has been reported rarely (see Section 4.9 Overdose).
Skin and subcutaneous tissue disorders. Linear IgA disease: not known.
Haemic and lymphatic systems. Reactions such as anaemia, thrombocytopenia, thrombocytopenic purpura, eosinophilia and leucopenia (including severe neutropenia or agranulocytosis) have been reported during therapy with other penicillins. These reactions are usually reversible on discontinuation of therapy and are believed to be hypersensitivity phenomena. Prolongation of bleeding time and prothrombin time have also been reported rarely.
Renal and urinary tract disorders. Interstitial nephritis, crystalluria (see Section 4.9 Overdose) have been reported very rarely.
Central nervous system effects. CNS effects have been seen rarely. They include hyperkinesia, dizziness and convulsions. Convulsions may occur in patients with impaired renal function or in those receiving high doses.
Infections and infestations. Mucocutaneous candidiasis have been reported very rarely.
Miscellaneous. Superficial tooth discolouration has been reported very rarely in children. Good oral hygiene may help to prevent tooth discolouration as it can usually be removed by brushing.
As the blood brain barrier becomes more permeable in meningitis, toxic symptoms may be precipitated by lower levels of amoxicillin in patients with meningitis.
Reporting suspected adverse effects. Reporting suspected adverse reactions after registration of the medicinal product is important. It allows continued monitoring of the benefit-risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions at www.tga.gov.au/reporting-problems.

4.9 Overdose

Signs of overdosage of amoxicillin would predominantly be gastrointestinal related. The symptoms may include abdominal or stomach cramps and pain, severe nausea, vomiting or diarrhoea. Amoxicillin crystalluria, in some cases leading to renal failure, has been observed (see Section 4.8 Adverse Effects (Undesirable Effects)). Treatment of penicillin overdosage should be symptomatic and supportive. Haemodialysis may aid in the removal of penicillins from the blood.
Please also see Section 4.4 Special Warnings and Precautions for Use; Section 4.8 Adverse Effects (Undesirable Effects).
For information on the management of overdose, contact the Poison Information Centre on 131126 (Australia).

5 Pharmacological Properties

5.1 Pharmacodynamic Properties

Mechanism of action. Microbiology. Amoxicillin trihydrate is a broad spectrum penicillin similar to ampicillin in its bactericidal action. It is believed to act through the inhibition of biosynthesis of cell wall mucopeptide. It is active against both Gram positive and Gram negative microorganisms. Amoxicillin is active in vitro against beta-lactamase negative strains of Proteus mirabilis, and Haemophilus influenzae. In vitro studies have also demonstrated activity against most strains of alpha and beta-haemolytic Streptococci, Streptococcus pneumoniae, and beta-lactamase negative strains of Staphylococci, Neisseria gonorrhoeae, Neisseria meningitidis and Enterococcus faecalis. However, some of the organisms are sensitive to amoxicillin only at concentrations achieved in the urine. Strains of gonococci which are relatively resistant to benzyl penicillin may also be resistant to amoxicillin. Amoxicillin is not effective against penicillinase producing bacteria, particularly resistant Staphylococci which now have a high prevalence. All strains of Pseudomonas, Klebsiella, Enterobacter, indole positive Proteus, Serratia marcescens, Citrobacter, penicillinase producing N. gonorrhoeae and penicillinase producing H. influenzae are also resistant. Escherichia coli isolates are becoming increasingly resistant to amoxicillin in vitro due to the presence of penicillinase producing strains. See Table 2.

Disc susceptibility testing. Dilution or diffusion techniques. Either quantitative (MIC) or breakpoint, should be used following a regularly updated, recognised and standardised method (e.g. NCCLS). Standardised susceptibility test procedures require the use of laboratory control microorganisms to control the technical aspects of the laboratory procedures.
A report of "susceptible" indicates that the pathogen is likely to be inhibited if the antimicrobial compound in the blood reaches the concentrations usually achievable. A report of "intermediate" indicates that the result should be considered equivocal, and if the microorganism is not fully susceptible to alternative, clinically feasible drugs, the test should be repeated. This category implies possible clinical applicability in body sites where the drug is physiologically concentrated or in situations where high dosage of drug can be used. This category also provides a buffer zone, which prevents small uncontrolled technical factors from causing major discrepancies in interpretation. A report of "resistant" indicates that the pathogen is not likely to be inhibited if the antimicrobial compound in the blood reaches the concentrations usually achievable; other therapy may be selected.
Note. The prevalence of resistance may vary geographically for selected species and local information on resistance is desirable, particularly when treating severe infections.
Clinical trials. Maxamox (1000 mg tablets bid) and amoxicillin (500 mg capsules tds) were compared in a multicentre, double blind, randomised study of 395 adult patients with acute exacerbations of chronic bronchitis. Patients were treated for 10 days and were assessed during therapy (days 3-5), after the end of therapy (days 12-15) and at follow-up (days 28-35).
The statistical analysis for each clinical efficacy parameter during therapy (pooling moderate/ severe severity and mucopurulent/ purulent sputum appearance) is shown in Table 3.
The primary endpoint of this study was the clinical success at the end of therapy. For clinically evaluable patients, the clinical success rate at the end of therapy was 156/175 (89.1%) in the Maxamox 1,000 mg bid group and 150/162 (92.6%) in the amoxicillin 500 mg tds group. The results (p value = 0.27; CI 95% = -0.96%, 2.7%) confirm the equivalence in clinical efficacy between the two treatment groups. Bacteriological success was a secondary endpoint in this study. A total of 219 patients were eligible for assessment of bacteriological success at the end of treatment. Bacteriological success was achieved for 85/109 (78%) of patients given Maxamox and 83/110 (75.5%) of patients given amoxicillin 500 mg tds.
Assessment at follow-up yielded a clinical recurrence rate of 13.4% in the bid group and 13.7% in the tds group. No statistically significant differences between the two treatment groups.

5.2 Pharmacokinetic Properties

Absorption. Amoxicillin is stable in the presence of gastric acid and is rapidly and well absorbed after oral administration, even in the presence of food. Peak serum levels are reached within one to two hours after ingestion.
Efficacy of β-lactam antibiotic is related to the time in which the concentration of antibiotic at the site of infection exceeds the minimal inhibitory concentration (MIC) of that antibiotic for the pathogen. Analysis of pharmacokinetic data from a single dose study of the amoxicillin 500 mg capsule and a single dose study of the amoxicillin 1 g film-coated tablet showed that the mean amoxicillin plasma concentrations were above the (MIC) for similar proportions of the dose interval for the MIC levels of 0.5, 1.0 and 2.0 microgram/mL. The time above the MIC for other MIC levels and the time above MIC at steady state were not assessed for either formulation and/or dose regimen of amoxicillin.
Data to establish the bioequivalence of the 1 x 1000 mg tablet with 2 x 500 mg capsules have not been submitted and as such, the products should not be directly substituted.
Distribution. Amoxicillin readily distributes in most body tissues and fluids with the exception of brain and spinal fluid except when the meninges are inflamed. Amoxicillin has been shown to diffuse into sputum and saliva.
Metabolism. Amoxicillin is excreted in the urine as unchanged drug and as penicilloic acid.
Excretion. It is excreted mainly via the urine where it exists in a high concentration. Concentrations in the bile vary and are dependent upon normal biliary function. Amoxicillin is eliminated with a half-life of 61.3 minutes with normal renal function and up to 16-20 hours in the absence of renal function. Approximately 75% of a 1 g dose is excreted in the urine within six hours with normal renal function. However, there is a proportional difference in the amount excreted following different doses, due to lack of linearity in the rate of absorption with higher doses. Elimination of amoxicillin can be delayed by concurrent administration of probenecid. Amoxicillin is only 17% protein bound in serum.

5.3 Preclinical Safety Data

Genotoxicity. No data available.
Carcinogenicity. No data available.

6 Pharmaceutical Particulars

6.1 List of Excipients

Magnesium stearate, povidone, sodium starch glycollate, cellulose-microcrystalline, titanium dioxide, talc-purified and hypromellose.

6.2 Incompatibilities

Incompatibilities were either not assessed or not identified as part of the registration of this medicine.
For information on interactions with other medicines and other forms of interactions, see Section 4.5.

6.3 Shelf Life

In Australia, information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG). The expiry date can be found on the packaging.

6.4 Special Precautions for Storage

Store below 25°C, protect from moisture.

6.5 Nature and Contents of Container

Maxamox are packed in blisters of 2 or 14 tablets.

6.6 Special Precautions for Disposal

In Australia, any unused medicine or waste material should be disposed of in accordance with local requirements.

6.7 Physicochemical Properties

Chemical structure. The chemical name of Maxamox is (2S,5R,6R)-6- [(R)-2-amino- 2-(4-hydroxyphenyl) acetamido]-3,3-dimethyl- 7-oxo-4-thia- 1-azabicyclo[3.2.0]heptane- 2-carboxylic acid trihydrate. Its molecular formula is C₁₆H₁₉N₃O₅S.3H₂O (Molecular weight: 419.4) and its structural formula is:

CAS number. 61336-70-7.
It is slightly soluble in water and in ethanol (96%), practically insoluble in chloroform, in ether and in fatty oils.

7 Medicine Schedule (Poisons Standard)

S4 - Prescription Only Medicine.

Date of First Approval

14 November 2001

Date of Revision

05 August 2024

Summary Table of Changes