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 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

Drugs>Antimicrobial Agents>
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Ampicillin

Paul A. Pham, Pharm.D. and John G. Bartlett, M.D.
09-20-2010

Zambia Specific Information

  • 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)

REFERENCES

Zambia Information Author: Paul A. Pham, Pharm. D.

INDICATIONS

FDA

  • 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
NON-FDA APPROVED USES

  • Bacterial Meningitis, Acute, Community-Acquired ()
  • Intra-abdominal Abscess (in combination with gentamicin and metronidazole)
  • Enterococcal Endocarditis (in combination with gentamicin)
  • Enterococcus
  • Enteric infections ()

FORMS

brand 
name
 
generic 
Mfg 
brand 
forms
 
cost* 
Ampicillinampicillin~Various generic manufacturers.IV
vial
250 mg, 2gm, 10gm
250 mg $4.19; 2 gm $16.75;  10 gm $107.77
      PO
susp
125/5mL (100mL)
$7.63 per bottle
      PO
tab
500mg
$<1-2
      PO
tab
250mg
$<1-2
      PO
susp
250mg/5mL (100 mL and 200 mL)
$7.63 (100mL); $12.96 (200mL)
     

     

     

     

*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.

USUAL ADULT DOSING

  • Oral: 250-500mg q6h
  • Parenteral (usual dosing): 1-2 Gm IV q4-6h
  • Endocarditis or meningitis: 2Gm IV q4h

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

1Gm-2Gm IV q4-6h.

DOSING FOR GLOMERULAR FILTRATION OF 10-50

1Gm-2Gm IV q6-8h, no dose adjustment needed for oral administration.

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

1Gm-2Gm IV q8-12h; no dose adjustment needed for oral administration.

DOSING IN HEMODIALYSIS

1Gm-2Gm IV q8-12h. On HD days, give post HD.

DOSING IN PERITONEAL DIALYSIS

250-2000 mg q12h.

DOSING IN HEMOFILTRATION

CVVH: 2gm q6-12h. CVVHD: 2gm q6h.

ADVERSE DRUG REACTIONS

COMMON

  • GI intolerance and diarrhea with PO therapy (more common than amoxicillin)
  • Rash (especially seen if given in setting of infectious mononucleosis and chronic lymphocytic leukemia)
OCCASIONAL

  • Hypersensitivity reaction
  • Maculopapular rash (not urticarial)
  • Drug fever
  • Jarisch-Herxheimer reaction with spirochetal infection.
  • Phlebitis at infusion sites and sterile abscesses at IM sites
RARE

  • 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

DRUG INTERACTIONS

  • 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.
  • 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).

SPECTRUM

Detailed Spectrum of Activity

RESISTANCE

  • 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.

PHARMACOLOGY

Pharmacology

COMMENTS

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.

Basis for Recommendations

  • 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.

REFERENCES

REFERENCED WITHIN THIS GUIDE


 
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