(am pi sill' in)
Ampicin (CAN), Apo-Ampi (CAN), Novo-Ampicillin (CAN), Nu-Ampi (CAN), Penbritin (CAN), Principen
Pregnancy Category B
Bactericidal action against sensitive organisms; inhibits synthesis of bacterial cell wall, causing cell death.
· Treatment of infections caused by susceptible strains of Shigella, Salmonella, E. coli, H. influenzae, P. mirabilis, N. gonorrhoeae, enterococci, gram-positive organisms (penicillin G–sensitive staphylococci, streptococci, pneumococci)
· Meningitis caused by Neisseria meningitidis
· Unlabeled use: Prophylaxis in cesarean section in certain high-risk patients
Contraindications and cautions
· Contraindicated with allergies to penicillins, cephalosporins, or other allergens.
· Use cautiously with renal disorders.
Capsules—250, 500 mg; powder for oral suspension—125 mg/5 mL, 250 mg/5 mL; powder for injection—250, 500 mg, 1, 2 g
Maximum recommended dosage: 8 mg/day; may be given IV, IM, or PO. Use parenteral routes for severe infections, and switch to oral route as soon as possible.
ADULTS AND PEDIATRIC PATIENTS
and soft-tissue infections:
> 40 kg: 250–500 mg IV or IM q 6 hr.
< 40 kg: 25–50 mg/kg/day IM or IV in equally divided doses at 6–8 hr intervals.
> 20 kg: 250 mg PO q 6 hr.
< 20 kg: 50 mg/kg/day PO in equally divided doses q 6–8 hr.
GI and GU
infections, including women with N. gonorrhoeae:
> 40 kg: 500 mg IM or IV q 6 hr.
< 40 kg: 50–100 mg/kg/day IM or IV in equally divided doses q 6–8 hr.
> 20 kg: 500 mg PO q 6 hr.
< 20 kg: 100 mg/kg/day PO in equally divided doses q 6–8 hr.
· Gonococcal infections: 500 mg q 6 hr for penicillin-sensitive organism or for patients > 45 kg, single dose of 3.5 g PO with 1 g probenecid.
· Bacterial meningitis: 150–200 mg/kg/day by continuous IV drip and then IM injections in equally divided doses q 3–4 hr.
· Septicemia: 150–200 mg/kg/day IV for at least 3 days, then IM q 3–4 hr.
· Prevention of bacterial endocarditis for GI or GU surgery or instrumentation: 2 g ampicillin IM or IV with gentamicin 1.5 mg/kg IM or IV within 30 minutes of starting procedure. Six hours later give 1 g ampicillin IM or IV or 1 g amoxicillin PO.
· Prevention of bacterial endocarditis for dental, oral, or upper respiratory procedures: 2 g ampicillin IM or IV within 30 minutes of procedure.
· STDs in pregnant women and patients allergic to tetracycline: 3.5 g ampicillin PO with 1 g probenecid.
· Prophylaxis in cesarean section: Single IV or IM dose of 25–100 mg/kg immediately after cord is clamped.
· Prevention of bacterial endocarditis for GI or GU surgery or instrumentation: 50 mg/kg ampicillin IM or IV with 1.5 mg/kg gentamicin IM or IV within 30 minutes of procedure. Six hours later give 25 mg/kg ampicillin IM or IV or 25 mg/kg amoxicillin PO.
· Prevention of bacterial endocarditis for dental, oral, or upper respiratory procedures: 50 mg/kg ampicillin IM or IV within 30 minutes of procedure.
Metabolism: T1/2: 1–2 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Unchanged in the urine
Preparation: Reconstitute with sterile or bacteriostatic water for injection; piggyback vials may be reconstituted with sodium chloride injection; use reconstituted solution within 1 hr. Do not mix in the same IV solution as other antibiotics. Use within 1 hr after preparation because potency may decrease significantly after that.
Infusion: Direct IV administration; give slowly over 3–5 min. Rapid administration can lead to seizures.
IV drip: Dilute as above before further dilution.
IV piggyback: Administer alone or further dilute with compatible solution.
Compatibility: Ampicillin is compatible with 0.9% sodium chloride, 5% dextrose in water, or 0.45% sodium chloride solution, 10% invert sugar water, M/6 sodium lactate solution, lactated Ringer's solution, sterile water for injection. Diluted solutions are stable for 2–8 hr; check manufacturer's inserts for specifics. Discard solution after allotted time period.
Incompatibility: Do not mix with lidocaine, verapamil, other antibiotics, dextrose solutions.
Y-site incompatibility: Do not give with epinephrine, hydralazine, ondansetron.
· CNS: Lethargy, hallucinations, seizures
· CV: CHF
· GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue, black "hairy" tongue, nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis, pseudomembranous colitis, nonspecific hepatitis
· GU: Nephritis
· Hematologic: Anemia, thrombocytopenia, leukopenia, neutropenia, prolonged bleeding time
· Hypersensitivity: Rash, fever, wheezing, anaphylaxis
· Local: Pain, phlebitis, thrombosis at injection site (parenteral)
· Other: Superinfections—oral and rectal moniliasis, vaginitis
· Increased ampicillin effect with probenecid
· Increased risk of rash with allopurinol
· Increased bleeding effect with heparin, oral anticoagulants
· Decreased effectiveness with tetracyclines, chloramphenicol
· Decreased efficacy of hormonal contraceptives, atenolol with ampicillin
· Oral ampicillin may be less effective with food; take on an empty stomach
· False-positive Coombs' test if given IV
· Decrease in plasma estrogen concentrations in pregnant women
· False-positive urine glucose tests if Clinitest, Benedict's solution, or Fehling's solution is used; enzymatic glucose oxidase methods (Clinistix, Tes-Tape) should be used to check urine glucose
· History: Allergies to penicillins, cephalosporins, or other allergens; renal disorders; lactation
· Physical: Culture infected area; skin color, lesion; R, adventitious sounds; bowel sounds; CBC, liver and renal function tests, serum electrolytes, hematocrit, urinalysis
· Culture infected area before treatment; reculture area if response is not as expected.
· Check IV site carefully for signs of thrombosis or drug reaction.
· Do not give IM injections in the same site; atrophy can occur. Monitor injection sites.
· Administer oral drug on an empty stomach, 1 hr before or 2 hr after meals with a full glass of water; do not give with fruit juice or soft drinks.
· Take this drug around-the-clock.
· Take the full course of therapy; do not stop taking the drug if you feel better.
· Take the oral drug on an empty stomach, 1 hr before or 2 hr after meals; the oral solution is stable for 7 days at room temperature or 14 days refrigerated.
· This antibiotic is specific to your problem and should not be used to self-treat other infections.
· You may experience these side effects: Nausea, vomiting, GI upset (eat frequent small meals), diarrhea.
· Report pain or discomfort at sites, unusual bleeding or bruising, mouth sores, rash, hives, fever, itching, severe diarrhea, difficulty breathing.
Adverse effects in Italic are most common; those in Bold are life-threatening.