Two patients yesterday with neuropsychiatric symptoms responsive to amoxicillin. One patient claimed that Moxatag, a long acting drug, was more effective than traditional short acting amoxicillin. The other adamantly claimed the opposite.
The question about continuous therapy versus pulse therapy is controversial and unsettled.
At least one(Lyme)study showed that continuous exposure to drug, even at lower concentration was more effective(had better killing kinetics).
Test tube study.
Clinical support: Long acting Bicillin (penicillin) works very well despite low blood/tissue concentration of drug.
Amoxicillin reaches a peak blood level without hours and is rapidly excreted with preferential penetration to some tissues. In-vivo(you), tissue concentration may be higher than shown with in-vitro(test tubes). Don't know.
IV antibiotics with long half lifes - Rocephin and Zithromax can be very effective.
Oral antibiotics behave differntly in the body than IV for a number of reasons.
I currently prescribe amoxicillin as 500 mg, two twice daily. Perhaps one four times per day would work better. There are practical limitations: better adsorption on an empty stomach, scheduling doses.
My impression: continuous better than pulsed.
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