Ampicillin

Indications

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.

CrCl (ml/min)	Dosage Recommendation
<10	Dose reduction or increase in dose interval.

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.

CrCl (ml/min)	Dosage Recommendation
<10	Dose reduction or increase in dose interval.

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.

CrCl (ml/min)	Dosage Recommendation
<10	Dose reduction or increase in dose interval.

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.

CrCl (ml/min)	Dosage Recommendation
<10	Dose reduction or increase in dose interval.

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.

CrCl (ml/min)	Dosage Recommendation
<10	Dose reduction or increase in dose interval.

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.

CrCl (ml/min)	Dosage Recommendation
<10	Dose reduction or increase in dose interval.

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.

CrCl (ml/min)	Dosage Recommendation
<10	Dose reduction or increase in dose interval.

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.

CrCl (ml/min)	Dosage Recommendation
<10	Dose reduction or increase in dose interval.

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.

CrCl (ml/min)	Dosage Recommendation
<10	Dose reduction or increase in dose interval.

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.

CrCl (ml/min)	Dosage Recommendation
<10	Dose reduction or increase in dose interval.

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.

CrCl (ml/min)	Dosage Recommendation
<10	Dose reduction or increase in dose interval.

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.

CrCl (ml/min)	Dosage Recommendation
<10	Dose reduction or increase in dose interval.

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.

CrCl (ml/min)	Dosage Recommendation
<10	Dose reduction or increase in dose interval.

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.

CrCl (ml/min)	Dosage Recommendation
<10	Dose reduction or increase in dose interval.

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.

CrCl (ml/min)	Dosage Recommendation
<10	Dose reduction or increase in dose interval.

Reconstitution: Reconstitute according to manufacturer's instructions. See lit.
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.

Contraindications

Hypersensitivity; infectious mononucleosis.

Warnings / Precautions

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

Adverse Reactions

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.

Overdose Reactions

Discontinue medication, treat symptomatically, and institute supportive measures as required.

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.
See Below for More ampicillin Drug Interactions

Food Interactions

Reduced absorption with food.

Mechanism of Actions

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.

Administration

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

Storage Conditions

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. Intravenous (IV) and intramuscular (IM) solutions should be used within 1 hour 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.

ATC Classification

J01CA01 - ampicillin ; Belongs to the class of penicillins with extended spectrum. Used in the systemic treatment of infections.
S01AA19 - ampicillin ; Belongs to the class of antibiotics. Used in the treatment of eye infections.