Novo-Ampicillin , Principen
Ampicin , Penbritin
Classifications: antibiotic; aminopenicillin; Therapeutic:antibiotic
Pregnancy Category: B
250 mg, 500 mg capsules; 125 mg/5 mL, 250 mg/5 mL oral suspension; 125 mg, 250 mg, 500 mg, 1 gm, 2 gm vials
A broad-spectrum, semisynthetic aminopenicillin that is bactericidal but is inactivated by penicillinase (beta-lactamase).
Like other penicillins, ampicillin inhibits the final stage of bacterial cell wall synthesis by binding to specific penicillin-binding
proteins (PBPs) located inside the bacterial cell wall. This results in lysis and death of bacteria.
Effective against gram-positive bacteria as well as some gram negative.
Infections of GU, respiratory, and GI tracts and skin and soft tissues; also gonococcal infections, bacterial meningitis,
otitis media, sinusitis, and septicemia and for prophylaxis of bacterial endocarditis. Used parenterally only for moderately
severe to severe infections.
Hypersensitivity to penicillin derivatives; infectious mononucleosis.
History of hypersensitivity to cephalosporins; GI disorders; renal disease or impairment; pregnancy (category B) or lactation.
Route & Dosage
Adult: PO/IV/IM 250500 mg q6h
Child (under 40 kg): PO/IV 2550 mg/kg/d divided q68h
Neonate: IV/IM Up to 7 d and up to 2000 g, 50 mg/kg/d divided q12h; up to 7 d and >2000 g, 75 mg/kg/d divided q8h; >7 d, <1200 g, 50 mg/kg/d divided q12h; >7 d and 12002000 g, 75 mg/kg/d divided q8h; >7 d, >2000 g, 100 mg/kg/d divided q6h
Adult/Child: IV 150200 mg/kg/d divided q34h
Neonate: IV/IM Up to 7 d and up to 2000 g, 100 mg/kg/d divided q12h; up to 7 d and >2000 g, 150 mg/kg/d divided q8h; >7 d, <1200 g, 100 mg/kg/d divided 2h; >7 d and 12002000 g, 150 mg/kg/d divided q8h; >7 d, >2000 g, 200 mg/kg/d divided q6h
Adult: PO 3.5 g with 1 g probenecid times 1 IV/IM 500 mg q812h
Bacterial Endocarditis Prophylaxis
Adult: IV 2 g 30 min before procedure
Child: IV 50 mg/kg 30 min before procedure (max: 2 g)
Group B Strep Prophylaxis
Adult: IV 2 g, then 1 g q4h until delivery
Clcr 1030 mL/min: give q612h; <10 mL/min: give q12h
Dialysis: Dose should be given after dialysis
- Give with a full glass of water on an empty stomach (at least 1 h before or 2 h after meals) for maximum absorption. Food
hampers rate and extent of oral absorption.
- Reconstitute each vial by adding the indicated amount of sterile water for injection or bacteriostatic water for injection
(1.2 mL to 125 mg; 1 mL to 250 mg; 1.8 mL to 500 mg; 3.5 mL to 1 g; 6.8 mL to 2 g). All reconstituted vials yield 250 mg/mL
except the 125 mg vial which yields 125 mg/mL. Administer within 1 h of preparation.
- Withdraw the ordered dose and inject deep IM into a large muscle.
Verify correct IV concentration and rate of infusion with physician for administration to neonates, infants, and children.
PREPARE: Direct/Intermittent: ?? Reconstitute as follows with sterile water for injection: add 5 mL to 500 mg or fraction thereof; add 7.4 mL to 1 g; add
14.8 mL to 2 g. Final concentration must be ≤30 mg/mL; may be given direct
IV as prepared or further diluted in 50 mL or more of NS, D5W, D5/NS, D5W/0.45NaCl, or RL.??Stability of solution varies with diluent and concentration of solution. Solutions in NS are stable for up to 8 h at room
temperature; other solutions should be infused within 24 h of preparation. Give direct IV within 1 h of preparation.
??Wear disposable gloves when handling drug repeatedly; contact dermatitis occurs frequently in sensitized individuals.
ADMINISTER: Direct/Intermittent: ??Infuse 500 mg or less slowly over 35 min. Give 12 g over at least 15 min.??With solutions of 100 mL or more, set rate according to amount of solution, but no faster than direct IV rate.??Convulsions may be induced by too rapid administration.
INCOMPATIBILITIES Solution/additive: Do not add to a dextrose-containing solution unless entire dose is given within 1 h of preparation. Aztreonam, cefepime, hydrocortisone, prochlorperazine. Y-site: Amphotericin B, epinephrine, fenoldopam, fluconazole, hydralazine, lansoprazole, midazolam, nicardipine, ondansetron, sargramostim, TPN, verapamil, vinorelbine.
- Store capsules and unopened vials at 15°30° C (59°86° F) unless otherwise directed. Keep oral
preparations tightly covered.
Adverse Effects (≥1%)Body as a Whole:
Similar to those for penicillin G. Hypersensitivity (pruritus, urticaria, eosinophilia, hemolytic anemia, interstitial nephritis,
); superinfections. CNS:
Convulsive seizures with high doses. GI: Diarrhea,
nausea, vomiting, pseudomembranous colitis. Other:
Severe pain (following IM); phlebitis (following IV). Skin: Rash.
Diagnostic Test Interference
Elevated CPK levels may result from local skeletal muscle injury following IM injection. Urine glucose: high urine drug concentrations can result in false-positive test results with Clinitest or Benedict's [enzymatic glucose oxidase methods (e.g., Clinistix, Diastix, TesTape) are not affected]. AST may be elevated (significance not known).
increases incidence of rash. Effectiveness of the aminoglycosides
may be impaired in patients with severe end-stage renal
disease. Chloramphenicol, erythromycin,
may reduce bactericidal
effects of ampicillin; this interaction is primarily significant when low doses of ampicillin are
used. Ampicillin may interfere with the contraceptive action of oral contraceptives
). Female patients should be advised to consider nonhormonal contraception while on antibiotics. Food:
Food may decrease absorption of ampicillin, so it should be taken 1 h before or 2 h after meals.
Oral dose is 50% absorbed. Peak effect: 5 min IV, 1 h IM, 2 h PO. Duration:
68 h. Distribution:
Most body tissues; high CNS concentrations only with inflamed meninges; crosses the placenta. Metabolism:
Minimal hepatic metabolism. Elimination:
90% in urine; excreted into breast milk. Half-Life:
Assessment & Drug Effects
- Determine previous hypersensitivity reactions to penicillins, cephalosporins, and other allergens prior to therapy.
- Lab tests: Baseline C&S tests prior to initiation of therapy; start drug pending results. Baseline and periodic assessments
of renal, hepatic, and hematologic functions, particularly during prolonged or high-dose therapy.
- Note: Sodium content of drug must be considered in patients on sodium restriction.
- Inspect skin daily and instruct patient to do the same. The appearance of a rash should be carefully evaluated to differentiate
a nonallergenic ampicillin rash from a hypersensitivity reaction. Report rash promptly to physician.
- Note: Incidence of ampicillin rash is higher in patients with infectious mononucleosis or other viral infections, Salmonella infections, lymphocytic leukemia, or hyperuricemia or in patients taking allopurinol.
Patient & Family Education
- Note: Ampicillin rash is believed to be nonallergenic and therefore its appearance is not an absolute contraindication to future
- Report diarrhea to physician; do not self-medicate. Give a detailed report to the physician regarding onset, duration, character
of stools, associated symptoms, temperature and weight loss (if any) to help rule out the possibility of drug-induced, potentially
fatal pseudomembranous colitis (see Appendix F).
- Report S&S of superinfection (onset of black, hairy tongue; oral lesions or soreness; rectal or vaginal itching; vaginal
discharge; loose, foul-smelling stools; or unusual odor to urine).
- Notify physician if no improvement is noted within a few days after therapy is started.
- Take medication around the clock; continue taking medication until it is all gone (usually 10 d) unless otherwise directed
by physician or pharmacist.