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Paul A. Pham, Pharm.D. and John G. Bartlett, M.D.
01-28-2010
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Available formulation in Zambia: Powder for injection: 500 mg; 1 g (as sodium salt) vial.
- Organisms usually resistant include Klebsiella, Proteus spp. other than P. mirabilis, Enterobacter, Serratia, Pseudomonas, Acinetobacter and the anaerobe group B.fragilis.
- Increased resistance observed with H. influenzae, N. gonorrhoeae, E. coli, Salmonella, and Shigella.
- Dose for Listeria meningitis: 2 gm IV q4h
- Dose fo enterococcal endocarditis: 2 gm IV q4h (in combination is gentamicin 1 mg/kg q8h)
Zambia Information Author: Paul A. Pham, Pharm. D.
- Streptococcal infections (Group A streptococcal pharyngitis, Group B streptococci)
- Otitis media (Haemophilus influenzae due to beta-lactamase negative strains)
- Diverticulitis (in combination with metronidazole)
- Gonorrhea (in combination with probenecid, however currently not recommended due to high failure rate)
- Enteric infections (Proteus mirabilis infections, salmonellosis, shigellosis)
- Urinary tract infections
- Bacterial vaginosis 8) Endocarditis 9) Meningitis 10) Respiratory tract infections 11) Septicemia
- Bacterial Meningitis, Acute, Community-Acquired ()
- Intra-abdominal Abscess (in combination with gentamicin and metronidazole)
- Enterococcal Endocarditis (in combination with gentamicin)
- Enterococcus
- Enteric infections ()
brand
name
| generic
| Mfg
| brand
forms
| cost*
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| Ampicillin | ampicillin | ~Various generic manufacturers. | IV
vial
250 mg, 2gm, 3gm, 10gm | $4; $9; $17; $67 |
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| PO
susp
125/5mL (100mL) | $5.04 per bottle |
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| PO
tab
500mg | $<1-2 |
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| PO
tab
250mg | $<1-2 |
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| PO
susp
250mg/5mL (100 mL and 200 mL) | $7.83 (100mL); $14.86 (200mL) |
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*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
- Oral: 250-500mg q6h
- Parenteral (usual dosing): 1-2 Gm IV q4-6h
- Endocarditis or meningitis: 2Gm IV q4h
1Gm-2Gm IV q4-6h.
1Gm-2Gm IV q6-8h, no dose adjustment needed for oral administration.
1Gm-2Gm IV q8-12h; no dose adjustment needed for oral administration.
1Gm-2Gm IV q8-12h. On HD days, give post HD.
250-2000 mg q12h.
CVVH: 2gm q6-12h. CVVHD: 2gm q6h.
- GI intolerance and diarrhea with PO therapy (more common than amoxicillin)
- Rash (especially seen if given in setting of infectious mononucleosis)
- Hypersensitivity reaction
- Maculopapular rash (not urticarial)
- Drug fever
- Jarisch-Herxheimer reaction with spirochetal infection.
- Phlebitis at infusion sites and sterile abscesses at IM sites
- Coombs' test positive, hemolytic anemia
- Leukopenia and thrombocytopenia
- CNS: seizures and twitching (especially with high doses in patients with renal failure)
- Interstitial nephritis
- LFTs elevation
- Allopurinol: incidence of skin rash increased to 14-22% when the two are co-administered compared to 6-8% with ampicillin when administered alone or 2% when allopurinol.
- Oral contraceptives: may decrease efficacy of OC. Use an additional form of contraception with co-administration of oral ampicillin.
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Tetracyclines: avoid concurrent administration. In two studies involving a total of 79 patients with pneumococcal meningitis treated with either penicillin plus tetracyclines or penicillin monotherapy resulted in a higher mortality rate (79-85%) in the combination therapy compared to penicillin monotherapy (30-33%) (Arch Intern Med 1951:88:489, Ann Intern Med 1961; 55:545). However there was not a difference in mortality between penicillin monotherapy and penicillin plus tetracycline in the treatment of pneumococcal pneumonia (Arch Intern Med 1953; 91:197).
- Resistant break points for S. pneumoniae: > .12 mcg/mL for S. pneumoniae meningitis, but >2 mcg/mL(PO) and > 8 mcg/mL (for IV) for S. pneumoniae pneumonia and non-meningeal infections.
- Break points for Enterobacteriaceae is 8 mcg/mL.
- Break points for Enterococci is 8 mcg/mL.
Oral and parenteral beta-lactam. Due to inferior absorption of ampicillin, oral amoxicillin has replaced oral ampicillin for all infections except shigellosis. IV ampicillin is the drug of choice for infections involving ampicillin-sensitive enterococci.
- Mandell LA, Wunderink RG, Anzueto A, et al.;
Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults.;
Clin Infect Dis;
2007; Vol.
44 Suppl 2; pp.
S27-72;
ISSN:
1537-6591;
PUBMED: 17278083
Rating:
Basis for recommendation
Comments:Cefotaxime,ceftriaxone, or IV ampicillin PLUS a macrolide is the preferred treatment regimen for CAP in non-ICU inpatients.
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