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Ampicillin information from DrugsUpdate  

See Available Brands of Ampicillin in India

P - Cautioned in pregnancy
L - Cautioned in lactation
LI - Lab*

Ampicillin is a beta-lactam antibiotic that has been used extensively to treat bacterial infections since 1961. Until the introduction of ampicillin by the British company, Beecham, penicillin therapies had only been effective against Gram-positive organisms such as Staphylococci and Streptococci. Ampicillin (originally branded as 'Penbritin') also demonstrated activity against Gram-negative organisms such as H. influenzae, coliforms and Proteus spp. Ampicillin was the first of a number of so-called broad spectrum penicillins subsequently introduced by Beecham. Ampicillin is part of the aminopenicillin family and is roughly equivalent to its successor,amoxicillin in terms of spectrum and level of activity[1]. It can sometimes result in non-allergic reactions that range in severity from a rash (e.g., patients with mononucleosis) to potentially lethal anaphylaxis. However, as with other penicillin drugs, it is relatively non-toxic and adverse effects of a serious nature are encountered only infrequent)

Pharmacodynamics

Pharmacokinetics

Ampicillin exerts bactericidal action on both gm+ve and gm-ve organisms. Its spectrum includes gm+ve organisms eg, S pneumoniae and other Streptococci, L monocytogenes and gm-ve bacteria eg, M catarrhalis, N gonorrhoea, N meningitidis, E coli, P mirabilis, Salmonella, Shigella, and H influenzae. Ampicillin exerts its action by inhibiting the synthesis of bacterial cell wall.
Absorption: Relatively well absorbed from the GI tract with peak plasma concentrations after 1-2 hr (oral); may be altered in the presence of food.
Distribution: Widely distributed into the ascitic, pleural and joint fluids (therapeutic concentrations), CSF (small amounts except when the meninges are inflamed), bile (high concentrations); crosses the placenta and enters the breast milk (small amounts). Protein-binding: 20%.
Metabolism: Converted to some extent to penicilloic acid; undergoes enterohepatic recycling.
Excretion: Via the urine by glomerular filtration and tubular secretion; via the faeces. May be removed by haemodialysis.

Ampicillin Indications / Ampicillin Uses

In listeriosis, susceptible infections, perinatal streptococcal infections, endocarditis, biliary tract infections, otitis media, bronchitis, peritonitis, gastroenteritis

Ampicillin Adverse Reactions / Ampicillin Side Effects

GI upset, nausea, vomiting, diarrhoea; blood dyscrasias; urticaria, exfoliative dermatitis, rash; fever, seizures; interstitial nephritis.
Potentially Fatal: Anaphylactic shock; pseudomembranous colitis; neuromuscular hypersensitivity; electrolyte imbalance.

Precautions

Information Not Available

Special Precautions

Renal failure; patients with lymphatic leukaemia or HIV infections; pregnancy and lactation

Other Drug Interactions

Simultaneous use with oral contraceptives may lead to increased risk of breakthrough bleeding and reduced efficacy of the contraceptive. Skin rash increased with allopurinol. Probenecid increases blood levels. Synergism with β-lactamase inhibitors, clavulanic acid or sulbactam, penicillinase-stable drugs eg, cloxacillin or flucloxacillin and aminoglycosides.
Potentially Fatal: Increases disulfiram and anticoagulant effects.

Other Interactions

Reduced absorption with food

Dosage

Oral Biliary tract infections
Adult: 250-500 mg every 6 hr.
Child: 50-100 mg/kg daily, given in equally divided doses every 6 hr. Max: 2-4 g/day.
Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.


Oral
Endocarditis
Adult: 250-500 mg every 6 hr.
Child: 50-100 mg/kg daily, given in equally divided doses every 6 hr. Max: 2-4 g/day.
Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.


Oral: Otitis media
Adult: 250-500 mg every 6 hr.
Child: 50-100 mg/kg daily, given in equally divided doses every 6 hr. Max: 2-4 g/day.
Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.


Oral: Peritonitis
Adult: 250-500 mg every 6 hr.
Child: 50-100 mg/kg daily, given in equally divided doses every 6 hr. Max: 2-4 g/day.
Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.


Oral:Bronchitis
Adult: 250-500 mg every 6 hr.
Child: 50-100 mg/kg daily, given in equally divided doses every 6 hr. Max: 2-4 g/day.
Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.


Oral: Perinatal streptococcal infections
Adult: 250-500 mg every 6 hr.
Child: 50-100 mg/kg daily, given in equally divided doses every 6 hr. Max: 2-4 g/day.
Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.


Oral: Gastroenteritis
Adult: 250-500 mg every 6 hr.
Child: 50-100 mg/kg daily, given in equally divided doses every 6 hr. Max: 2-4 g/day.
Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.
Oral: Listeriosis
Adult: 250-500 mg every 6 hr.
Child: 50-100 mg/kg daily, given in equally divided doses every 6 hr. Max: 2-4 g/day.
Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.

Oral: Susceptible infections
Adult: 250-500 mg every 6 hr.
Child: 50-100 mg/kg daily, given in equally divided doses every 6 hr. Max: 2-4 g/day.
Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.

Oral: Typhoid and paratyphoid fever
Adult: 1-2 g every 6 hr for 2 wk in acute infections and 4-12 wk in carriers.
Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.
Oral
Uncomplicated gonorrhoea
Adult: 2 g with 1 g of probenecid as a single dose, recommended to be repeated in female patients.
Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.

Intravenous: Intrapartum prophylaxis against group B Streptoccocal infection in neonates
Adult: Initially, 2 g via inj followed by 1 g every 4 hr until delivery.
Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.
Intravenous
Septicaemia Adult: 150-200 mg/kg daily. Initiate with IV admin for at least 3 days, then continue with IM inj every 3-4 hr. Continue treatment for at least 48-72 hr after the patient has become asymptomatic or when there is evidence of bacterial eradication. Recommended treatment duration for infections caused by group-A β-haemolytic streptococci: At least 10-days to prevent occurrence of acute rheumatic fever or acute glomerulonephritis.
Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.
Parenteral
Meningitis: Adult: 150-200 mg/kg daily in equally divided doses every 3-4 hr. May initiate with IV admin followed by IM injections.
Child: and infants: 150 mg/kg daily in divided doses. Neonates: <1 wk: 50 mg/kg every 12 hr; older neonates: 50 mg/kg every 8 hr. Max: 3 g/day. May initiate with IV admin followed by IM injections.
Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.

Parenteral: Susceptible infections
Adult: 250-500 mg every 6 hr, can be given via IM or slow IV inj over 3-5 minutes or infusion.
Child: 100-400 mg/kg daily in divided doses every 6 hr. Max: 12 g daily. Dose can be given via IM or slow IV inj over 3-5 minutes or infusion.
Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.
Injection
As supplement in systemic therapy for treatment of susceptible infections
Adult: For intrapleural or intraperitoneal injections: 500 mg daily, dissolved in 5-10 ml of water. For intra-articular inj: 500 mg daily, dissolved in up to 5 ml of water or a solution of 0.5% procaine HCl.
Child: ½ the adult dose.
Renal impairment: Patients undergoing haemodialysis should receive an additional dose after the session.

Reconstitution: Reconstitute according to manufacturer's instructions.
Incompatibility: Y-site incompatibility: Amphotericin B cholesteryl sulfate complex, ondansetron, sargramostim, verapamil, vinorelbine epinephrine, fluconazole, hydralazine, midazolam. Syringe incompatibility: Erythromycin lactobionate, gentamicin, lincomycin, metoclopramide, hydromorphone, kanamycin. Admixture incompatibility: Amikacin, hydralazine, prochlorperazine, chlorpromazine, dopamine, gentamicin.

Food(before/after)

Should be taken on an empty stomach. (Take on an empty stomach 1 hr before or 2 hr after meals.)

List of Contraindications

Ampicillin and Pregnancy

Caution when used during pregnancy.
Category B
Reproduction studies have been performed in laboratory animals at doses several times the human dose and have revealed no evidence of adverse effects due to Ampicillin. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

Ampicillin and Lactation

Caution when used in lactation.
Ampicillin is excreted in trace amounts in human milk. Therefore, caution should be exercised when Ampicillin-class antibiotics are administered to a nursing woman.

Ampicillin and Children

Information Not Available

Ampicillin and Geriatic

Information Not Available

Ampicillin and Other Contraindications

Hypersensitivity; infectious mononucleosis

Storage

Injection: Store at 20-25°C. For admin: Use freshly prepared solutions. IV and IM solutions should be used within 1 hr after preparation. Intravenous: Store at 20-25°C. For admin: Use freshly prepared solutions. IV and IM solutions should be used within 1 hr after preparation. Oral: Store at 20-25°C. Parenteral: Store at 20-25°C. For admin: Use freshly prepared solutions. IV and IM solutions should be used within 1 hr after preparation.

Lab interference

Injection: Store at 20-25°C. For admin: Use freshly prepared solutions. IV and IM solutions should be used within 1 hr after preparation. Intravenous: Store at 20-25°C. For admin: Use freshly prepared solutions. IV and IM solutions should be used within 1 hr after preparation. Oral: Store at 20-25°C. Parenteral: Store at 20-25°C. For admin: Use freshly prepared solutions. IV and IM solutions should be used within 1 hr after preparation.

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