Names and pronunciation
(am-pi-sill′in)
Source page 87
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Individual generic drug information
Extracted information for ampicillin only.
(am-pi-sill′in)
Source page 87
Func. class.: Antiinfective— broad-spectrum
Source page 87
Chem. class.: Aminopenicillin
Source page 87
ACTION: Interferes with cell wall rep- lication of susceptible organisms; the cell wall, rendered osmotically unstable, swells, bursts from osmotic pressure; lysis mediated by cell wall autolysins
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USES: Effective for gram-positive cocci (Staphylococcus aureus, Strep tococcus pyogenes, Streptococcus faecalis, Streptococcus pneumoniae), gram-negative cocci (Neisseria meningitidis), gram-negative bacilli (Haemophilus influenzae, Proteus mirabilis, Salmonella, Shigella, Liste ria monocytogenes), gram-positive bacilli; meningitis, GI/GU/respiratory infections, endocarditis, septicemia, otitis media, skin infection, bacterial endocarditis
Source page 87
Extracted information for ampicillin only.
CONTRAINDICATIONS: Hyper- sensitivity to penicillins, antimicrobial resistance Precautions: Pregnancy, breastfeeding, neonates, hypersensitivity to cephalospo- rins, renal disease, mononucleosis
Source page 87
SIDE EFFECTS CNS: Seizures (high doses) GI: Nausea, vomiting, diarrhea, CDAD, stomatitis HEMA: Anemia, bone marrow depres- granulocytopenia, leukopenia, sion, eosinophilia INTEG: Rash, urticaria MISC: Anaphylaxis, serum sickness
Source pages 88, 89
INTERACTIONS Increase: bleeding—oral anticoagulants, monitor INR/PT Increase: ampicillin concentrations— probenecid, used for this action Increase: ampicillin-induced skin rash—allopurinol, monitor for rash Decrease: ampicillin level—H2 antago- nists, proton pump inhibitors, separate by 2 hr Drug/Lab Test Increase: eosinophils, ALT, AST Decrease: conjugated estrogens during pregnancy, HB, WBC, platelets False positive: urine glucose, direct Coomb’s test Interference: urine glucose (Clinitest, Benedict’s reagent, cupric SO4)
Source page 89
Extracted information for ampicillin only.
DOSAGE AND ROUTES Systemic infections • Adult and child ≥40 kg: PO 250-500 mg q6hr; IV/IM 2-8 g/day in divided doses q4-6hr • Child <40 kg: PO 50-100 mg/kg/day in divided doses q6-8hr; IV/IM 100-150 mg/kg/day in divided doses q6hr Bacterial meningitis • Adult and adolescent: IM/IV 150- 200 mg/kg/day in divided doses q3-4 hr; IDSA dose IV 2 g q4hr • Infant and child: IM/IV 150-200 mg/ kg/day in divided doses q3-4hr; IDSA dose IV 200-400 mg/kg/day in divided doses q6hr • Neonate >7 days and >2000 g: IM/IV 200 mg/kg/day in divided doses q6hr; IDSA dose; IV 200 mg/kg/day in divided doses q6-8hr Prevention of bacterial endocarditis • Adult: IM/IV 2 g 30 min prior to procedure • Child: IM/IV 50 mg/kg 30 min prior to procedure, max 2 g GI/GU infections other than N. gonorrhoeae • Adult and child >20 kg: PO 500 mg q6hr, may use larger dose for more seri- ous infections • Child <40 kg: PO 50 mg/kg/day in divided doses q6-8hr Renal disease • Adult and child: CCr 10-50 mL/min extend to q6-12hr; CCr <10 mL/min ex- tend to q12-16hr
Source pages 87, 88
Available forms: Powder for injection 125, 250, 500 mg, 1, 2, 10 g/vial; cap- sules 250, 500 mg; powder for oral sus- pension 125, 250 mg/5 mL
Source page 88
Administer: • Check allergies before using; obtain C&S before using; begin before results are received PO route • Give in even doses around the clock, store caps in tight container, store after reconstituting in refrigerator up to 2 wk, 1 wk room temperature • Tablets may be crushed or capsules opened and mixed with water • On empty stomach with plenty of wa- ter for best absorption (1-2 hr before meals or 2-3 hr after meals) • Shake suspension well before each dose; store after reconstituting in refrig- erator up to 2 wk, 1 wk room temperature IM route • Reconstitute by adding 0.9-1.2 mL/125-mg vial; 0.9-1.9 mL/250-mg vial; 1.2-1.8 mL/500-mg vial; 2.4-7.4 mL/1-g vial; 6.8 mL/2-g vial IV route IV direct • After diluting with sterile water 0.9-1.2 mL/125-mg product, administer over 3-5 min (up to 500 mg), 10-15 min (>500 mg) Intermittent IV INFUSION route • May be diluted in 50 mL or more of D5W, D5 0.45% NaCl to a concentration of 30 mg/mL or less; IV solution is stable for 1 hr; give at prescribed rate, do not give in same tubing as aminoglycosides, separate by ≥1 hr Y-site compatibilities: Acyclovir, alem- tuzumab, alprostadil, amifostine, amino- caproic acid, anidulafungin, argatroban, atenolol, azithromycin, bivalirudin, bleo- mycin, CARBOplatin, carmustine, CISpla- tin, clarithromycin, cyclophosphamide, cytarabine, DACTINomycin, DAPTOmy- cin, DAUNOrubicin liposome, dexme- detomidine, dexrazoxane, DOCEtaxel, doxacurium, doxapram, DOXOrubicin liposome, eptifibatide, etoposide, etopo- side phosphate, filgrastim, fludarabine, fluorouracil, foscarnet, gallium, gatiflox- acin, gemcitabine, gemtuzumab, granise- tron, hetastarch, ifosfamide, irinotecan, lepirudin, leucovorin, levoFLOXacin, line- zolid, mannitol, mechlorethamine, mel- phalan, methotrexate, metroNIDAZOLE, milrinone, octreotide, ofloxacin, oxalipla- tin, PACLitaxel, palonosetron, pamidro- nate, pancuronium, pantoprazole, PEMEtrexed, penicillin G potassium, per- phenazine, potassium acetate, propofol, remifentanil, riTUXimab, rocuronium, sodium acetate, teniposide, thiotepa, tige- cycline, tirofiban, TNA, trastuzumab, vecuronium, vinBLAStine, vinCRIStine, vitamin B/C, voriconazole, zoledronic acid
Source page 88
Extracted information for ampicillin only.
Assess: • Infection: characteristics of wound, sputum; urine, stool, earache, fever WBC baseline, periodically; C&S before product therapy, product may be taken as soon as culture is taken • Hepatic studies: AST, ALT • Blood studies: WBC, RBC, HB, Hct, bleeding time • CDAD: bowel pattern before/during treatment • Skin eruptions after administration of penicillin to 1 wk after discontinuing product; identify allergies before using • Respiratory status: rate, character, A wheezing, tightness in chest • Anaphylaxis: rash, itching, dyspnea, facial swelling; stop product, notify prescriber, have emergency equipment available
Source page 89
Evaluate: • Therapeutic response: absence of fe- ver, draining wounds, resolution of infec- tion
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CLINICAL CONSIDERATIONS
Source page 89
Patient and caregiver information: • To take oral ampicillin on empty stomach with full glass of water; to use alternative contraception • All aspects of product therapy: to complete entire course of medication to ensure organism death (10-14 days); that culture may be taken after com- pleted course of medication • To report sore throat, fever, fatigue, di- arrhea (may indicate superinfection); to report rash, other signs of allergy • That product must be taken in equal intervals around the clock to maintain blood levels • To wear or carry emergency ID if al- lergic to penicillins • CDAD: diarrhea with blood or pus; no- tify prescriber • Pregnancy/breastfeeding: Identify if pregnancy is planned or suspected or if breastfeeding; to use additional contra- ception if using oral contraception, effect may be decreased TREATMENT OF ANAPHY- LAXIS: Withdraw product, maintain airway; administer EPINEPHrine, aminophyl line, O2, IV corticosteroids
Source page 89
Extracted information for ampicillin only.
PHARMACOKINETICS Half-life 50-110 min; excreted in urine, bile, breast milk; crosses placenta; removed by dialysis PO: Peak 2 hr, duration 6-8 hr IM: Peak 1 hr, duration 6-8 hr IV: Peak rapid, duration 6-8 hr
Source page 89
Filter the extracted dose blocks for this individual drug.
Systemic infections
• Adult and child ≥40 kg: PO 250-500 mg q6hr; IV/IM 2-8 g/day in divided doses q4-6hr
Candidate age grouping · source pages 87, 88
Systemic infections
• Child <40 kg: PO 50-100 mg/kg/day in divided doses q6-8hr; IV/IM 100-150 mg/kg/day in divided doses q6hr Bacterial meningitis
Candidate age grouping · source pages 87, 88
Systemic infections
• Infant and child: IM/IV 150-200 mg/ kg/day in divided doses q3-4hr; IDSA dose IV 200-400 mg/kg/day in divided doses q6hr
Candidate age grouping · source pages 87, 88
Systemic infections
• Child: IM/IV 50 mg/kg 30 min prior to procedure, max 2 g GI/GU infections other than N. gonorrhoeae
Candidate age grouping · source pages 87, 88
Systemic infections
• Adult and child >20 kg: PO 500 mg q6hr, may use larger dose for more seri- ous infections
Candidate age grouping · source pages 87, 88
Systemic infections
• Child <40 kg: PO 50 mg/kg/day in divided doses q6-8hr Renal disease
Candidate age grouping · source pages 87, 88
Systemic infections
• Adult and child: CCr 10-50 mL/min extend to q6-12hr; CCr <10 mL/min ex- tend to q12-16hr
Candidate age grouping · source pages 87, 88