II. Indications
- Skin and Soft Tissue Infection
- Genitourinary infections
- Pelvic Inflammatory Disease
- Pneumonia
III. Contraindications
-
Penicillin Allergy
- Cephalexin and Cefaclor have similar side chains and risk of cross reactivity with Ampicillin
IV. Dosing
- Adult (or child weight >40 kg)
- Typical 1.5 to 3 g IV or IM every 6 hours
- Some protocols start with 3 g IV or IM, followed by 1.5 g IV every 6 hours
- Child (weight <40 kg, dosing based on Ampicillin component)
- Mild to Moderate Infections: 100 to 150 mg/kg/day IV or IM divided every 6 hours
- Severe Infections: 200 to 400 mg/kg/day IV or IM divided every 6 hours
-
Renal Dosing
- eGFR >30 ml/min: Dose every 6 to 8 hours
- eGFR 15 to 30 ml/min: Dose every 12 hours
- eGFR <15 ml/min: Dose every 24 hours
V. Mechanism
- See Aminopenicillin
- Sulbactam adds beta lactamase resistance to Ampicillin
VI. Adverse Effects
- See Aminopenicillin
- See Penicillin
- Cholestatic Jaundice
- Maculopapular rash
- Onset 5-7 days after initiating medication
- Typically not IgE mediated (non-allergic)
- No immediate allergy (e.g. Urticaria), systemic symptoms or mucous membrane involvement
- Typically safe to use Amoxicillin in future if non-allergic rash alone
- Consider IgE Skin Testing if unclear rash etiology
- References
- Orman and Hayes in Herbert (2017) EM:Rap 17(7): 7-8
-
Diarrhea
- Most common with Augmentin
- Modifications can decrease stools
- Dose exactly by kilogram for children
- Avoid food before dose
- Consider eating yogurt with each dose
VII. Safety
- Pregnancy Category B
- Safe in Lactation
VIII. Resources
- Ampicillin Sulbactam (DailyMed)
IX. References
- (2008) Comparison of Amoxicillin Products, Presc Lett, #240425
- Miller (2002) J Midwifery Womens Health 47(6):426-34 +PMID: 12484664 [PubMed]
- Bush (2016) Cold Spring Harb Perspect Med 6(8):a025247 +PMID: 27329032 [PubMed]