Yes

Antibiotic, Penicillin

Dental: Alternate antibiotic for the prevention of bacterial endocarditis in patients undergoing dental procedures. It is used in those patients unable to take oral medications

Medical: Treatment of susceptible bacterial infections (nonbeta-lactamase-producing organisms); susceptible bacterial infections caused by streptococci, pneumococci, nonpenicillinase-producing staphylococci, Listeria, meningococci; some strains of H. influenzae, Salmonella, Shigella, E. coli, Enterobacter, and Klebsiella

B

Known hypersensitivity to ampicillin or other penicillins

Dosage adjustment may be necessary in patients with renal impairment; a low incidence of cross-allergy with other beta-lactams exists; high percentage of patients with infectious mononucleosis have developed rash during therapy with ampicillin. Appearance of a rash should be carefully evaluated to differentiate a nonallergic ampicillin rash from a hypersensitivity reaction. Ampicillin rash occurs in 5% to 10% of children receiving ampicillin and is a generalized dull red, maculopapular rash, generally appearing 3-14 days after the start of therapy. It normally begins on the trunk and spreads over most of the body. It may be most intense at pressure areas, elbows, and knees.

>10%: Local: Pain at injection site

1% to 10%:

Dermatologic: Rash (appearance of a rash should be carefully evaluated to differentiate, if possible; nonallergic ampicillin rash from hypersensitivity reaction; incidence is higher in patients with viral infections, Salmonella infections, lymphocytic leukemia, or patients that have hyperuricemia)

Gastrointestinal: Diarrhea, vomiting, oral candidiasis, abdominal cramps

Miscellaneous: Allergic reaction (includes serum sickness, urticaria, angioedema, bronchospasm, hypotension, etc)

<1%: Penicillin encephalopathy, seizures (with large I.V. doses or patients with renal dysfunction), anemia, hemolytic anemia, thrombocytopenia, thrombocytopenic purpura, eosinophilia, leukopenia, granulocytopenia, decreased lymphocytes, interstitial nephritis (rare)

Symptoms of penicillin overdose include neuromuscular hypersensitivity (agitation, hallucinations, asterixis, encephalopathy, confusion, and seizures) and electrolyte imbalance with potassium or sodium salts, especially in renal failure

Hemodialysis may be helpful to aid in the removal of the drug from the blood, otherwise most treatment is supportive or symptom directed

Decreased effect: Efficacy of oral contraceptives may be reduced

Increased effect: Disulfiram, probenecid may increase penicillin levels, increased effect of anticoagulants

Increased toxicity: Allopurinol theoretically has an additive potential for amoxicillin (ampicillin) rash

Oral suspension is stable for 7 days at room temperature or for 14 days under refrigeration; solutions for I.M. or direct I.V. should be used within 1 hour; solutions for I.V. infusion will be inactivated by dextrose at room temperature; if dextrose-containing solutions are to be used, the resultant solution will only be stable for 2 hours versus 8 hours in the 0.9% sodium chloride injection. D₅W has limited stability.

Stability of parenteral admixture in NS at room temperature (25°C): 8 hours

Stability of parenteral admixture in NS at refrigeration temperature (4°C): 2 days

Standard diluent: 500 mg/50 mL NS; 1 g/50 mL NS; 2 g/100 mL NS

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin binding proteins (PBPs); which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

Absorption: Oral: 50%

Distribution: Distributes into bile; penetration into CSF occurs with inflamed meninges only, good only with inflammation (exceeds usual MICs)

Normal meninges: Nil

Inflamed meninges: 5-10

Protein binding: 15% to 25%

Half-life:

Neonates: 2-7 days: 4 hours; 8-14 days: 2.8 hours; 15-30 days: 1.7 hours

Children and Adults: 1-1.8 hours

Anuria/end-stage renal disease: 7-20 hours

Time to peak: Oral: Within 1-2 hours

Elimination: ~90% of the drug excreted unchanged in the urine within 24 hours

Neonates: I.M., I.V.:

Postnatal age less than or equal to 7 days:

less than or equal to 2000 g: Meningitis: 50 mg/kg/dose every 12 hours; other infections: 25 mg/kg/dose every 12 hours

>2000 g: Meningitis: 50 mg/kg/dose every 8 hours; other infections: 25 mg/kg/dose every 8 hours

Postnatal age >7 days:

<1200 g: Meningitis: 50 mg/kg/dose every 12 hours; other infections: 25 mg/kg/dose every 12 hours

1200-2000 g: Meningitis: 50 mg/kg/dose every 8 hours; other infections: 25 mg/kg/dose every 8 hours

>2000 g: Meningitis: 50 mg/kg/dose every 6 hours; other infections: 25 mg/kg/dose every 6 hours

Infants and Children: I.M., I.V.: 100-400 mg/kg/day in doses divided every 4-6 hours

Meningitis: 200 mg/kg/day in doses divided every 4-6 hours; maximum dose: 12 g/day

Children: Oral: 50-100 mg/kg/day in doses divided every 6 hours; maximum dose: 2-3 g/day

Adults:

Oral: 250-500 mg every 6 hours

I.M.: 500 mg to 1.5 g every 4-6 hours

I.V.: 500 mg to 3 g every 4-6 hours; maximum dose: 12 g/day

Sepsis/meningitis: 150-250 mg/kg/24 hours divided every 3-4 hours

Dosing interval in renal impairment:

Cl_cr 30-50 mL/minute: Administer every 6-8 hours

Cl_cr 10-30 mL/minute: Administer every 8-12 hours

Cl_cr <10 mL/minute: Administer every 12 hours

Hemodialysis: Moderately dialyzable (20% to 50%); administer dose after dialysis

Peritoneal dialysis: Moderately dialyzable (20% to 50%)

Administer 250 mg every 12 hours

Continuous arteriovenous or venovenous hemofiltration (CAVH) effects: Dose as for Cl_cr 10-50 mL/minute; ~50 mg of ampicillin per liter of filtrate is removed

Food: Decreases drug absorption rate; decreases drug serum concentration. Take on an empty stomach 1 hour before or 2 hours after meals.

With prolonged therapy monitor renal, hepatic, and hematologic function periodically; observe signs and symptoms of anaphylaxis during first dose

May interfere with urinary glucose tests using cupric sulfate (Benedict's solution, Clinitest®); may inactivate aminoglycosides in vitro

Large I.V. doses may rarely produce encephalopathy; penicillins have been reported to cause apprehension, illusions, agitation, insomnia, depersonalization, and encephalopathy

Rarely may cause bone marrow suppression; use caution with clozapine and carbamazepine

No information available to require special precautions

Prolonged use of penicillins may lead to development of oral candidiasis

Take entire prescription, even if you are feeling better. Take at equal intervals around-the-clock; preferably on an empty stomach with a full glass of water (1 hour before or 2 hours after meals). Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). You may experience nausea or vomiting (small frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help). If diabetic, drug may cause false tests with Clinitest® urine glucose monitoring; use of glucose oxidase methods (Clinistix®) or serum glucose monitoring is preferable. This drug may interfere with oral contraceptives; an alternate form of birth control should be used. Report rash; unusual diarrhea; unusual vaginal discharge, itching, burning, or pain; mouth sores; unresolved vomiting or constipation; fever or chills; unusual bruising or bleeding; or if condition being treated worsens or does not improve by the time prescription is completed.

Ampicillin and gentamicin should not be mixed in the same I.V. tubing or administered concurrently

Capsule, as anhydrous: 250 mg, 500 mg

Capsule, as trihydrate: 250 mg, 500 mg

Powder for injection, as sodium: 125 mg, 250 mg, 500 mg, 1 g, 2 g, 10 g

Powder for oral suspension, as trihydrate: 125 mg/5 mL (5 mL unit dose, 80 mL, 100 mL, 150 mL, 200 mL); 250 mg/5 mL (5 mL unit dose, 80 mL, 100 mL, 150 mL, 200 mL); 500 mg/5 mL (5 mL unit dose, 100 mL)

Powder for oral suspension, drops, as trihydrate: 100 mg/mL (20 mL)

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Brown RD, Campoli-Richards DM, "Antimicrobial Therapy in Neonates, Infants, and Children," Clin Pharmacokinet, 1989, 17(Suppl 1):105-15.

Dajani AS, Taubert KA, Wilson W, et al, "Prevention of Bacterial Endocarditis Recommendations by the American Heart Association," JAMA 1997, 277(22):1794-801.

Donowitz GR and Mandell GL, "Beta-Lactam Antibiotics," N Engl J Med, 1988, 318(7):419-26 and 318(8):490-500.

Tenenbein M, Cohen S, and Sitar DS, "Whole Bowel Irrigation as a Decontamination Procedure After Acute Drug Overdose," Arch Intern Med, 1987, 147(5):905-7.

Triggs EJ, Johnson JM, and Learoyd B, "Absorption and Disposition of Ampicillin in the Elderly," Eur J Clin Pharmacol, 1980, 18(2):195-8.

Wright AJ, "The Penicillins," Mayo Clin Proc, 1999, 74(3):290-307.