Names and pronunciation
Unasyn
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Drug reference
Unasyn
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Func. class.: Antiinfective—broad- spectrum
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Chem. class.: Aminopenicillin with β-lactamase inhibitor
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ACTION: Interferes with cell wall rep- lication of susceptible organisms; the cell wall, rendered osmotically unstable, swells, bursts from osmotic pressure; lysis due to cell wall autolytic enzymes; combination extends spectrum of activity by β-lactamase inhibition
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USES: Skin infections, intraabdominal infections, cellulitis, diabetic foot ulcer, nosocomial pneumonia, gynecologic infections; Acinetobacter sp., Actinomy ces sp., Bacillus anthracis, Bacteroides sp., Bifidobacterium sp., Bordetella pertussis, Borrelia burgdorferi, Bru cella sp., Clostridium sp., Corynebacte rium diphtheriae/xerosis, Eikenella corrodens, Enterococcus faecalis, Ery sipelothrix rhusiopathiae, Escherichia coli, Eubacterium sp., Fusobacterium sp., Gardnerella vaginalis, Haemophi lus influenzae (β-lactamase negative/ positive), Helicobacter pylori, Kleb siella sp., Lactobacillus sp., Leptospira sp., Listeria monocytogenes, Moraxella catarrhalis, Morganella mor ganii, Neisseria gonorrhoeae, Pas teurella multocida, Peptococcus sp., Peptostreptococcus sp., Porphyromo nas sp., Prevotella sp., Propionibacte rium sp., Proteus mirabilis, Proteus vulgaris, Providencia rettgeri, Provi dencia stuartii, Salmonella sp., Shi gella sp., Staphylococcus aureus (MSSA)/epidermidis/saprophyticus, Streptococcus agalactiae/dysgalactiae/ pneumoniae/pyogenes, Treponema pallidum, viridans streptococci
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CONTRAINDICATIONS: Hyper- sensitivity to penicillins, sulbactam Precautions: Pregnancy, breastfeeding, neonates, hypersensitivity to cephalo sporins/carbapenems, renal disease, mono nucleosis, viral infections, syphilis
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SIDE EFFECTS CNS: Coma, seizures (high dose) GI: Nausea, vomiting, diarrhea, abdom- inal pain, CDAD, hepatotoxicity HEMA: Anemia, bone marrow depression, granulocytopenia, leukopenia, eosinophilia INTEG: Injection site reactions, rash, urticaria MISC: Anaphylaxis, serum sickness, Stevens-Johnson syndrome
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INTERACTIONS Increase: bleeding risk—oral anticoagu- lants; check INR, PT Increase: ampicillin-induced skin rash—allopurinol, check for rash Increase: ampicillin level—probenecid Increase: methotrexate level—metho- trexate Decrease: contraception effect—oral con- traceptives, use additional contraception Drug/Lab Test False positive: urine glucose, urine protein
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DOSAGE AND ROUTES • Adult/adolescent/child ≥40 kg: IM/IV 1.5-3 g q6hr, max 4 g/day sulbactam • Child #40 kg: IV 150-300 mg/kg/day divided q6hr Renal disease • Adult ≥40 kg: IM/IV CCr 15-30 mL/ min dose q12hr; CCr 5-15 mL/min dose q24hr
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Available forms: Powder for injection 1.5 g (1 g ampicillin, 0.5 g sulbactam), 3 g (2 g ampicillin, 1 g sulbactam), 15 g (10 g ampicillin, 5 g sulbactam)
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Administer: IM route • Reconstitute by adding 3.2 mL sterile water/1.5-g vial; 6.4 mL/3-g vial, give deep in large muscle, aspirate • Do not use IM in child Direct IV route • After diluting 1.5 g/3.2 mL sterile wa- ter for injection or 3 g/6.4 mL (250 mg ampicillin/125 mg sulbactam), allow to stand until foaming stops; may give over 15 min, inject slowly Intermittent IV INFUSION route • Dilute further in 50 mL or more of D5W, NaCl; administer within 1 hr after reconstitution; give over 15-30 min, sepa- rate doses from aminoglycosides by ≥1 hr Y-site compatibilities: Alemtuzumab, amifostine, aminocaproic acid, anidulafun- gin, argatroban, atenolol, bivalirudin, bleo- mycin, CARBOplatin, carmustine, cefepime, CISplatin, codeine, cyclophosphamide, cytarabine, DAPTOmycin, DAUNOrubicin liposome, dexmedetomidine, DOCEtaxel, doxacurium, DOXOrubicin liposomal, eptifibatide, etoposide, fenoldopam, filgras- tim, fludarabine, fluorouracil, foscarnet, gallium, gatifloxacin, gemcitabine, granise- tron, hetastarch, irinotecan, levoFLOXacin, linezolid, methotrexate, metroNIDAZOLE, octreotide, oxaliplatin, PACLitaxel, palono- setron, pamidronate, pancuronium, panto- prazole, PEMEtrexed, remifentanil, riTUX- imab, rocuronium, tacrolimus, teniposide, thiotepa, tigecycline, tirofiban, TNA, TPN, trastuzumab, vecuronium, vinCRIStine, voriconazole, zoledronic acid
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Assess: • For previous sensitivity to penicillin or cephalosporins, cross-sensitivity is common • Infection: characteristics of wound, sputum; take temperature, WBC count, check allergies before using; C&S be- fore product therapy, product may be given as soon as culture is taken • CDAD: bowel pattern before, during treatment • Hepatic studies: AST, ALT if on long- term therapy or impaired liver function • Anaphylaxis: skin eruptions after ad- ministration of ampicillin to 1 wk after discontinuing product
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Evaluate: • Therapeutic response: absence of fe- ver, draining wounds; negative C&S
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report superinfection: vaginal itch- ing; loose, foul-smelling stools; black furry tongue • CDAD: to report immediately to health A care provider symptoms of fever, diarrhea with pus, blood, mucus; may occur up to 4 wk after treatment • To wear or carry emergency ID if al- lergic to penicillin products • Pregnancy/breastfeeding: If preg- nancy is planned or suspected; use addi- tional contraception if using oral contra- ceptives TREATMENT OF ANAPHY- LAXIS: Withdraw product, maintain airway; administer EPINEPHrine, ami nophylline, O2, IV corticosteroids
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PHARMACOKINETICS IV: Peak 5 min, IM 1 hr; half-life 50-110 min (ampicillin) 1-1.4 hr (sulbactam), 10%-50% metabolized in liver, 75%-85% of both products excreted in urine, excreted in breast milk, crosses placenta
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• Adult/adolescent/child ≥40 kg: IM/IV 1.5-3 g q6hr, max 4 g/day sulbactam
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• Adult ≥40 kg: IM/IV CCr 15-30 mL/ min dose q12hr; CCr 5-15 mL/min dose q24hr
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