Am Pic Ill Ins
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ampicillin (am pi sill' in)
ampicillin sodium Oral:
Ampicin (CAN), Apo-Ampi (CAN), Novo-Ampicillin (CAN), Nu-Ampi (CAN), Penbritin (CAN), Principen Pregnancy Category B Drug classes
Antibiotic Penicillin Therapeutic actions
Bactericidal action against sensitive organisms; inhibits synthesis of bacterial cell wall, causing cell death. Indications
• • •
Treatment of infections caused by susceptible strains of Shigella, Salmonella, E. coli, H. influenzae, P. mirabilis, N. gonorrhoeae, enterococci, gram-positive organisms (penicillin G–sensitive staphylococci, streptococci, pneumococci) Meningitis caused by Neisseria meningitidis Unlabeled use: Prophylaxis in cesarean section in certain high-risk patients
Contraindications and cautions
• •
Contraindicated with allergies to penicillins, cephalosporins, or other allergens. Use cautiously with renal disorders.
Available forms
Capsules—250, 500 mg; powder for oral suspension—125 mg/5 mL, 250 mg/5 mL; powder for injection—250, 500 mg, 1, 2 g Dosages
Maximum recommended dosage: 8 mg/day; may be given IV, IM, or PO. Use parenteral routes for severe infections, and switch to oral route as soon as possible. ADULTS AND PEDIATRIC PATIENTS
•
•
Respiratory and soft-tissue infections: > 40 kg: 250–500 mg IV or IM q 6 hr. < 40 kg: 25–50 mg/kg/day IM or IV in equally divided doses at 6–8 hr intervals. > 20 kg: 250 mg PO q 6 hr. < 20 kg: 50 mg/kg/day PO in equally divided doses q 6–8 hr. GI and GU infections, including women with N. gonorrhoeae: > 40 kg: 500 mg IM or IV q 6 hr. < 40 kg: 50–100 mg/kg/day IM or IV in equally divided doses q 6–8 hr. > 20 kg: 500 mg PO q 6 hr. < 20 kg: 100 mg/kg/day PO in equally divided doses q 6–8 hr.
• • •
Gonococcal infections: 500 mg q 6 hr for penicillin-sensitive organism or for patients > 45 kg, single dose of 3.5 g PO with 1 g probenecid. Bacterial meningitis: 150–200 mg/kg/day by continuous IV drip and then IM injections in equally divided doses q 3–4 hr. Septicemia: 150–200 mg/kg/day IV for at least 3 days, then IM q 3–4 hr.
ADULTS
•
• • •
Prevention of bacterial endocarditis for GI or GU surgery or instrumentation: 2 g ampicillin IM or IV with gentamicin 1.5 mg/kg IM or IV within 30 minutes of starting procedure. Six hours later give 1 g ampicillin IM or IV or 1 g amoxicillin PO. Prevention of bacterial endocarditis for dental, oral, or upper respiratory procedures: 2 g ampicillin IM or IV within 30 minutes of procedure. Sexually transmitted diseases in pregnant women and patients allergic to tetracycline: 3.5 g ampicillin PO with 1 g probenecid. Prophylaxis in cesarean section: Single IV or IM dose of 25–100 mg/kg immediately after cord is clamped.
PEDIATRIC PATIENTS
•
•
Prevention of bacterial endocarditis for GI or GU surgery or instrumentation: 50 mg/kg ampicillin IM or IV with 1.5 mg/kg gentamicin IM or IV within 30 minutes of procedure. Six hours later give 25 mg/kg ampicillin IM or IV or 25 mg/kg amoxicillin PO. Prevention of bacterial endocarditis for dental, oral, or upper respiratory procedures: 50 mg/kg ampicillin IM or IV within 30 minutes of procedure.
Pharmacokinetics Route Oral IM IV
Onset 30 min 15 min Immediate
Peak 2 hr 1 hr 5 min
Duration 6–8 hr 6–8 hr 6–8 hr
Metabolism: T1/2: 1–2 hr Distribution: Crosses placenta; enters breast milk Excretion: Unchanged in the urine IV facts
Preparation: Reconstitute with sterile or bacteriostatic water for injection; piggyback vials may be reconstituted with sodium chloride injection; use reconstituted solution within 1 hr. Do not mix in the same IV solution as other antibiotics. Use within 1 hr after preparation because potency may decrease significantly after that. Infusion: Direct IV administration; give slowly over 3–5 min. Rapid administration can lead to seizures. IV drip: Dilute as above before further dilution. IV piggyback: Administer alone or further dilute with compatible solution. Compatibility: Ampicillin is compatible with 0.9% sodium chloride, 5% dextrose in water, or 0.45% sodium chloride solution, 10% invert sugar water, M/6 sodium lactate solution, lactated Ringer's solution, sterile water for injection. Diluted solutions are stable
for 2–8 hr; check manufacturer's inserts for specifics. Discard solution after allotted time period. Incompatibility: Do not mix with lidocaine, verapamil, other antibiotics, dextrose solutions. Y-site incompatibility: Do not give with epinephrine, hydralazine, ondansetron. Adverse effects
• • • • • • • •
CNS: Lethargy, hallucinations, seizures CV: CHF GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue, black "hairy" tongue, nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis, pseudomembranous colitis, nonspecific hepatitis GU: Nephritis Hematologic: Anemia, thrombocytopenia, leukopenia, neutropenia, prolonged bleeding time Hypersensitivity: Rash, fever, wheezing, anaphylaxis Local: Pain, phlebitis, thrombosis at injection site (parenteral) Other: Superinfections—oral and rectal moniliasis, vaginitis
Interactions
Drug-drug • Increased ampicillin effect with probenecid • Increased risk of rash with allopurinol • Increased bleeding effect with heparin, oral anticoagulants • Decreased effectiveness with tetracyclines, chloramphenicol • Decreased efficacy of hormonal contraceptives, atenolol with ampicillin Drug-food • Oral ampicillin may be less effective with food; take on an empty stomach Drug-lab test • False-positive Coombs' test if given IV • Decrease in plasma estrogen concentrations in pregnant women • False-positive urine glucose tests if Clinitest, Benedict's solution, or Fehling's solution is used; enzymatic glucose oxidase methods (Clinistix, Tes-Tape) should be used to check urine glucose Nursing considerations Assessment
• •
History: Allergies to penicillins, cephalosporins, or other allergens; renal disorders; lactation Physical: Culture infected area; skin color, lesion; R, adventitious sounds; bowel sounds; CBC, liver and renal function tests, serum electrolytes, hematocrit, urinalysis
Interventions
• • • •
Culture infected area before treatment; reculture area if response is not as expected. Check IV site carefully for signs of thrombosis or drug reaction. Do not give IM injections in the same site; atrophy can occur. Monitor injection sites. Administer oral drug on an empty stomach, 1 hr before or 2 hr after meals with a full glass of water—no fruit juice or soft drinks.
Teaching points
• • • • • •
Take this drug around-the-clock. Take the full course of therapy; do not stop taking the drug if you feel better. Take the oral drug on an empty stomach, 1 hr before or 2 hr after meals; the oral solution is stable for 7 days at room temperature. This antibiotic is specific to your problem and should not be used to self-treat other infections. These side effects may occur: Nausea, vomiting, GI upset (eat small, frequent meals), diarrhea. Report pain or discomfort at sites, unusual bleeding or bruising, mouth sores, rash, hives, fever, itching, severe diarrhea, difficulty breathing.
Adverse effects in Italic are most common; those in Bold are life-threatening.
ampicillin sodium Oral:
Ampicin (CAN), Apo-Ampi (CAN), Novo-Ampicillin (CAN), Nu-Ampi (CAN), Penbritin (CAN), Principen Pregnancy Category B Drug classes
Antibiotic Penicillin Therapeutic actions
Bactericidal action against sensitive organisms; inhibits synthesis of bacterial cell wall, causing cell death. Indications
• • •
Treatment of infections caused by susceptible strains of Shigella, Salmonella, E. coli, H. influenzae, P. mirabilis, N. gonorrhoeae, enterococci, gram-positive organisms (penicillin G–sensitive staphylococci, streptococci, pneumococci) Meningitis caused by Neisseria meningitidis Unlabeled use: Prophylaxis in cesarean section in certain high-risk patients
Contraindications and cautions
• •
Contraindicated with allergies to penicillins, cephalosporins, or other allergens. Use cautiously with renal disorders.
Available forms
Capsules—250, 500 mg; powder for oral suspension—125 mg/5 mL, 250 mg/5 mL; powder for injection—250, 500 mg, 1, 2 g Dosages
Maximum recommended dosage: 8 mg/day; may be given IV, IM, or PO. Use parenteral routes for severe infections, and switch to oral route as soon as possible. ADULTS AND PEDIATRIC PATIENTS
•
•
Respiratory and soft-tissue infections: > 40 kg: 250–500 mg IV or IM q 6 hr. < 40 kg: 25–50 mg/kg/day IM or IV in equally divided doses at 6–8 hr intervals. > 20 kg: 250 mg PO q 6 hr. < 20 kg: 50 mg/kg/day PO in equally divided doses q 6–8 hr. GI and GU infections, including women with N. gonorrhoeae: > 40 kg: 500 mg IM or IV q 6 hr. < 40 kg: 50–100 mg/kg/day IM or IV in equally divided doses q 6–8 hr. > 20 kg: 500 mg PO q 6 hr. < 20 kg: 100 mg/kg/day PO in equally divided doses q 6–8 hr.
• • •
Gonococcal infections: 500 mg q 6 hr for penicillin-sensitive organism or for patients > 45 kg, single dose of 3.5 g PO with 1 g probenecid. Bacterial meningitis: 150–200 mg/kg/day by continuous IV drip and then IM injections in equally divided doses q 3–4 hr. Septicemia: 150–200 mg/kg/day IV for at least 3 days, then IM q 3–4 hr.
ADULTS
•
• • •
Prevention of bacterial endocarditis for GI or GU surgery or instrumentation: 2 g ampicillin IM or IV with gentamicin 1.5 mg/kg IM or IV within 30 minutes of starting procedure. Six hours later give 1 g ampicillin IM or IV or 1 g amoxicillin PO. Prevention of bacterial endocarditis for dental, oral, or upper respiratory procedures: 2 g ampicillin IM or IV within 30 minutes of procedure. Sexually transmitted diseases in pregnant women and patients allergic to tetracycline: 3.5 g ampicillin PO with 1 g probenecid. Prophylaxis in cesarean section: Single IV or IM dose of 25–100 mg/kg immediately after cord is clamped.
PEDIATRIC PATIENTS
•
•
Prevention of bacterial endocarditis for GI or GU surgery or instrumentation: 50 mg/kg ampicillin IM or IV with 1.5 mg/kg gentamicin IM or IV within 30 minutes of procedure. Six hours later give 25 mg/kg ampicillin IM or IV or 25 mg/kg amoxicillin PO. Prevention of bacterial endocarditis for dental, oral, or upper respiratory procedures: 50 mg/kg ampicillin IM or IV within 30 minutes of procedure.
Pharmacokinetics Route Oral IM IV
Onset 30 min 15 min Immediate
Peak 2 hr 1 hr 5 min
Duration 6–8 hr 6–8 hr 6–8 hr
Metabolism: T1/2: 1–2 hr Distribution: Crosses placenta; enters breast milk Excretion: Unchanged in the urine IV facts
Preparation: Reconstitute with sterile or bacteriostatic water for injection; piggyback vials may be reconstituted with sodium chloride injection; use reconstituted solution within 1 hr. Do not mix in the same IV solution as other antibiotics. Use within 1 hr after preparation because potency may decrease significantly after that. Infusion: Direct IV administration; give slowly over 3–5 min. Rapid administration can lead to seizures. IV drip: Dilute as above before further dilution. IV piggyback: Administer alone or further dilute with compatible solution. Compatibility: Ampicillin is compatible with 0.9% sodium chloride, 5% dextrose in water, or 0.45% sodium chloride solution, 10% invert sugar water, M/6 sodium lactate solution, lactated Ringer's solution, sterile water for injection. Diluted solutions are stable
for 2–8 hr; check manufacturer's inserts for specifics. Discard solution after allotted time period. Incompatibility: Do not mix with lidocaine, verapamil, other antibiotics, dextrose solutions. Y-site incompatibility: Do not give with epinephrine, hydralazine, ondansetron. Adverse effects
• • • • • • • •
CNS: Lethargy, hallucinations, seizures CV: CHF GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue, black "hairy" tongue, nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis, pseudomembranous colitis, nonspecific hepatitis GU: Nephritis Hematologic: Anemia, thrombocytopenia, leukopenia, neutropenia, prolonged bleeding time Hypersensitivity: Rash, fever, wheezing, anaphylaxis Local: Pain, phlebitis, thrombosis at injection site (parenteral) Other: Superinfections—oral and rectal moniliasis, vaginitis
Interactions
Drug-drug • Increased ampicillin effect with probenecid • Increased risk of rash with allopurinol • Increased bleeding effect with heparin, oral anticoagulants • Decreased effectiveness with tetracyclines, chloramphenicol • Decreased efficacy of hormonal contraceptives, atenolol with ampicillin Drug-food • Oral ampicillin may be less effective with food; take on an empty stomach Drug-lab test • False-positive Coombs' test if given IV • Decrease in plasma estrogen concentrations in pregnant women • False-positive urine glucose tests if Clinitest, Benedict's solution, or Fehling's solution is used; enzymatic glucose oxidase methods (Clinistix, Tes-Tape) should be used to check urine glucose Nursing considerations Assessment
• •
History: Allergies to penicillins, cephalosporins, or other allergens; renal disorders; lactation Physical: Culture infected area; skin color, lesion; R, adventitious sounds; bowel sounds; CBC, liver and renal function tests, serum electrolytes, hematocrit, urinalysis
Interventions
• • • •
Culture infected area before treatment; reculture area if response is not as expected. Check IV site carefully for signs of thrombosis or drug reaction. Do not give IM injections in the same site; atrophy can occur. Monitor injection sites. Administer oral drug on an empty stomach, 1 hr before or 2 hr after meals with a full glass of water—no fruit juice or soft drinks.
Teaching points
• • • • • •
Take this drug around-the-clock. Take the full course of therapy; do not stop taking the drug if you feel better. Take the oral drug on an empty stomach, 1 hr before or 2 hr after meals; the oral solution is stable for 7 days at room temperature. This antibiotic is specific to your problem and should not be used to self-treat other infections. These side effects may occur: Nausea, vomiting, GI upset (eat small, frequent meals), diarrhea. Report pain or discomfort at sites, unusual bleeding or bruising, mouth sores, rash, hives, fever, itching, severe diarrhea, difficulty breathing.
Adverse effects in Italic are most common; those in Bold are life-threatening.
