Adult Dosing

Enterococcal Endocarditis

• 12 g/day IV continuously or in equally divided doses q4 hrs plus 1 mg/kg IV/IM gentamicin in divided doses q8 hrs x 4-6 wk

Endocarditis prophylaxis

• 2 g dose IV/IM 30 min before procedure

Respiratory Tract and Soft Tissue Infections

• Adults >40 kg: 250-500 mg IV/IM in divided doses q6 hrs

Bacterial Meningitis

• 1-2 g IV in divided doses q3-4 hrs
• Max: 14 g/day

Septicemia

• 150-200 mg/kg/day IV for at least 3 days followed by IM route q3-4 hrs

GI and GU infections (N. gonorrhoeae)

• Adults >40 kg: 500 mg IV/IM in divided doses q6 hrs

Pediatric Dosing

Endocarditis prophylaxis

• Children: 50 mg/kg IV/IM 30 min before procedure
• Max: 2 g/dose

Respiratory Tract and Soft Tissue Infections

Children

• <40 kg: 25-50 mg/kg/day IV/IM in equally divided doses q6-8 hrs
• >40 kg: 250-500 mg IV/IM q6 hrs

Neonates

• <7 days:
• <2 kg: 50-100 mg/kg/day IV/IM in divided doses q12 hrs
• >2 kg: 75-150 mg/kg/day IV/IM in divided doses q8 hrs

• >7 days
• <1.2 kg: 50-100 mg/kg/day IV/IM in divided doses q12 hrs
• 1.2-2 kg: 75-150 mg/kg/day IV/IM in divided doses q8 hrs
• >2 kg: 100-200 mg/kg/day IV/IM in divided doses q6 hrs

• Infants: 100-400 mg/kg/day IV/IM in divided doses q4-6 hrs
• Max: 12 g/day

Bacterial Meningitis

Neonates

• <7 days:
• <2 kg: 100 mg/kg/day IV/IM in divided doses q12 hrs
• >2 kg: 150 mg/kg/day IV/IM in divided doses q8 hrs

• >7 days
• <1.2 kg: 100 mg/kg/day IV/IM in divided doses q12 hrs
• 1.2-2 kg: 150 mg/kg/day IV/IM in divided doses q8 hrs
• >2 kg: 200 mg/kg/day IV/IM in divided doses q6 hrs

• Infants or Children: 200-400 mg/kg/day IV/IM in divided doses q4-6 hrs
• Max: 12 g/day

Septicemia

• Children: 150-200 mg/kg/day IV for at least 3 days followed by IM q3-4 hrs

GI and GU infections (N. gonorrhoeae)

Children

• <40 kg: 50 mg/kg/day IV/IM in divided doses q6-8 hrs
• >40 kg: 500 mg IV/IM in divided doses q6 hrs

Pediatrics Pneumonia [Non-FDA Approved]

• 100–200 mg/kg/24 hrs divided q6 hrs IM/IV; Max: 4 g q6 hrs

[Outline]

• Adult Dosing
• Pediatric Dosing

• Treatment of infections caused by susceptible strains of the designated organisms in the following conditions:
• Respiratory tract infections
• Bacterial meningitis
• Septicemia and endocarditis
• Urinary tract infections
• Gastrointestinal infections

• History of previous hypersensitivity reaction to any of the penicillins
• Hypersensitivity to any of the ingredients of the product

• N/A

Renal Dose Adjustment (Base on CrCl)

• 10-50 mL/min: q6-12 hrs
• <10 mL/min: q12-24 hrs

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• Serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported in patients on penicillin therapy more likely to occur in individuals with a history of penicillin hypersensitivity and/or a history of sensitivity to multiple allergens
• Detailed inquiry should be made regarding previous hypersensitivity responses to penicillins, cephalosporins, or other allergens
• Drug should be discontinued on occurrence of allergic reaction and appropriate therapy should be instituted
• Treatment with epinephrine and other emergency measures may be required in serious acute hypersensitivity reactions
• Prolonged use may result in fungal or bacterial superinfection, including C. difficile associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been reported to occur over two months after the administration of antibacterial agents
• Increased risk of the development of drug-resistant bacteria may occur if ampicillin is prescribed in the absence of proven or strongly suspected infections or as a prophylactic indication
• A high percentage of patients with infectious mononucleosis have developed skin rash during therapy. Therefore, the administration of ampicillin is not recommended in patients with mononucleosis
• Periodic assessment of organ system function, including renal, hepatic, and hematopoietic, should be made during prolonged therapy

Cautions: Use cautiously in

• Patients with mononucleosis
• Penicillin-sensitive patients
• Epstein Barr virus and acute cytomegalovirus infection
• Non-anaphylactic hypersensitivity to beta-lactams
• Renal impairment
• Acute lymphoblastic leukemia

Pregnancy Category:B

Breastfeeding: Safe; excreted in trace amounts in human milk.

• GI: Glossitis, stomatitis, black hairy tongue, nausea, vomiting, enterocolitis, pseudomembranous colitis, diarrhea, abdominal pain
• DERM: Skin rashes, urticaria, exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome
• HEMA: Anemia, thrombocytopenia, thrombocytopenic purpura, eosinophilia, leukopenia, agranulocytosis
• LABTESTS: Rise in serum glutamic oxaloacetic transaminase (SGOT), mild transitory SGOT elevations
• CNS: Seizures, dizziness, headache, confusion
• GU: Interstitial nephritis
• HYPERSENSITIVITY: Anaphylaxis
• MISC: Candidiasis, serum sickness-like reaction

• Anti-infective; destroys bacteria by inhibiting bacterial cell wall mucopeptide synthesis
• Metabolized by liver 10%
• Renally excreted; largely unchanged (75-90%)
• Half-life: 1-1.5 hrs, 9-19 hrs (severe renal impairment)

US Trade Name(s)

• Only generic available

US Availability

ampicillin sodium (generic)

• PWDR for INJ: 125 mg/vial
• PWDR for INJ: 250 mg/vial
• PWDR for INJ: 500 mg/vial
• PWDR for INJ: 1 g/vial
• PWDR for INJ: 2 g/vial
• PWDR for INJ: 10 g/vial

Canadian Trade Name(s)

• Only generic available

Canadian Availability

ampicillin sodium (generic)

• PWDR for INJ: 250 mg/vial
• PWDR for INJ: 500 mg/vial
• PWDR for INJ: 1 g/vial
• PWDR for INJ: 2 g/vial

UK Trade Name(s)

• Only generic available

UK Availability

ampicillin sodium (generic)

• PWDR for INJ: 500 mg/vial

Australian Trade Name(s)

• Ampicyn
• Austrapen
• lbimicyn

Australian Availability

Austrapen, lbimicyn

• PWDR for INJ: 500 mg/vial
• PWDR for INJ: 1 g/vial

Ampicyn

• PWDR for INJ: 1 g/vial

[Outline]

Antimicrobials

Antibiotics

Penicillins; Aminopenicillins

Infectious Disease

Antibiotics

Penicillins; Aminopenicillins