Left your amoxicillin or Augmentin out of the refrigerator? It’s probably OK.

The Pediatric Insider

© 2014 Roy Benaroch, MD

We get these calls a few times a month—a family, despite dire warnings that their child’s antibiotic MUST be refrigerated, leaves it out on the counter overnight. Can we call in a new prescription?

Sure we can. But we probably don’t need to.

Many children’s antibiotics come in liquid suspensions. Little ground-up particles of medicine (along with flavorings and colorings and stabilizers and other goodies, collectively called “excipients”) are mixed by the pharmacist with water, and the bottle is shaken. Voila, you’ve got a suspension. But the water can break down some molecules especially if the water gets warm. So some of these suspensions are supposed to be kept in the ‘fridge, especially amoxicillin and amoxicillin/clavulanate (commonly called Augmentin.) That’s in the product insert: “keep refrigerated.” And it’s on a little sticker the pharmacist puts on the bottle. But is it really necessary?

Trust science to find out!

From The Journal of Applied Pharmaceutical Science, 2012, comes a study using state-of-the-art liquid chromotography to determine the potency of amoxicillin/clavulanate stored in three ways: refrigerated, stored in a cupboard at room temperature, and with the bottle submerged in water at room temperature (to minimize fluctuations in temperature.) Both the amoxicillin and clavulanate components of the medication kept all of their potency for at least five days. After that, there was a drop off in potency no matter how the samples were stored, though the refrigerated sample stayed the strongest. The amoxicillin portion of the medication lost about 17% of its potency in the fridge after 10 days, versus 25% of its potency in the cupboard. The clavulanate portion was a little bit more sensitive, losing about half of its potency at room temperature by day 7 to 10.

The study was done in Nigeria, where frequent power outages make consistent refrigeration problematic, and where limited resources make it more difficult to easily replace medications. But the results should be applicable here, too: under ordinary household circumstances, both amoxicillin and Augmentin are stable if left unrefrigerated for 5 days, maybe even longer for amoxicillin alone. They considered up to 84 degrees ordinary room temperature—again, this was in Nigeria. I imagine in typical cooler American homes these medications might last even longer sitting on the counter.

Some factors might further influence unrefrigerated shelf life. Light, especially direct sunlight, could potentially break down medications faster; and if the liquid gets really warm, left in a car, that’s going to ruin the medication pretty quickly. And this study only looked at two penicillin-based antibiotics (amoxicillin and Augmentin.) I can’t vouch for other medicines that are supposed to stay in the fridge. But it’s nice to know that for these common antibiotics, a few days at room temperature probably makes no difference.

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9 Comments on “Left your amoxicillin or Augmentin out of the refrigerator? It’s probably OK.”

  1. Ashley Says:

    Good to know! I’ve called you twice to do this before!

    Like

  2. Eleese Says:

    I just took some of this stuff, again, for sinus problems, here in north east Texas, again, in less than a few months time, because of all of the north east Texas pollen, and the pollution, coming out of Dallas, Texas, (why don’t you all clean up your damn pollution there, in Dallas, Texas, dear Dallas, Texas, because it blows north east, to Greenville, Texas, and other communities, nearby!) (we don’t want your damn big city pollution, coming out here, to Greenville, Texas, and other communities, nearby, because it’s unhealthy, for All of us out here, especially in the summer!) coming out our direction, here in way north east Texas, and it chokes me all up, and then I have to take these clog me up, antibiotics, which clog me up, and make me feel gross, a few day after I have taken them, or whatever. and then it gets me worrying, do I have cancer? am I going to die because I’m clogged up with gross antibiotics? yeah, I do worry about cancer, and if I am dying, after I get off of antibiotics, every time, because they clog me up, for like a week or so, after I get off of them! I think I just got off of my antibiotics, less than a month ago. I think it was about less than a month ago, anyways. do I have another health problem, too? do you all think, I might have another health problem, too? is it my heart burn? now I am worried, it might also be my hearth burn, along with the antibiotics, too!

    Like

  3. mjsmomma07 Says:

    How funny- I googled looking for an answer to this question, only to find my first “hit” was this post from the owner of our pediatric practice. Thanks, Dr. Roy!

    Like

  4. Saundra Senior Says:

    Great information! We realized it must be refrigerated during the weekend which made us panic. Now I’m relieved.

    Like

  5. Estella medina Says:

    Left Amoxicillin out overnight it’s last bottle room temp is 74 I need to give it all to her for the infection what shall I do scared to give it to her

    Like

  6. mary Says:

    this was very informative!! helps me do my job as a pharmacy tech better 🙂 🙂

    Like

  7. Amy Says:

    Wow! “We get these calls a few times a month—a family, despite dire warnings that their child’s antibiotic MUST be refrigerated, leaves it out on the counter overnight.” This sounds very condescending. I guess they do not have children and do everything perfectly even when it is bedtime and their kid doesn’t feel well and is very whiny and a younger sibling is crying wanting medicine too and you are just trying to give your kid their medicine so they feel better. I wish I could be so perfect.

    I do thank you for the information though.

    Like

  8. Joanna Hurley Says:

    Thank you for this post! I sent hubs to put away a bottle of augmentin and just discovered he left it out last night. Oops! Good to know one night is probably fine.

    Like

  9. lataya clarke Says:

    Thank u

    Like


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