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Ampicillin & Sulbactam:

ANTIBIOTICS & ANTIINFECTIVES

PENICILLINS - [ ANTIBIOTICS & ANTIINFECTIVES ]

Ampicillin is an aminopenicillin and is bactericidal for both gram-positive and gram negative organisms. The bacteria susceptible to this drug includes meningococci, Listeria. Monocytogenes, enetrococci. Strains of bacteria which were highly susceptible earlier but turned resistant now include N. gonorrhoeae, E. coli, Pseudomonas mirabilis, Salmonella and Shigella.1 Sulbactam is a Beta lactamase inhibitor which is combined with amipicillin to prevent its hydrolysis by class A Beta Lactamases. Concurrent administration of these two drugs markedly increases the spectrum of activity of the two drugs. 1 The combination is active against a variety of gram-positive bacteria including staphylococci, streptococci and gram negative bacteria inclusive of Hemophilus (2)

Ampicillin & Sulbactam combination is indicated for the treatment of infections due to susceptible strains of the susceptible microorganisms in the following conditions: Skin and skin structure infections Intra-abdominal infections Gynecological infections (2)

Individuals with history of hypersensitivity to any of the penicillins (2)

Pain at IM and IV injection site Thrombophlebitis of vein Diarrhoea Rash Rare adverse reactions include itching, nausea, vomiting, candidiasis, fatigue, malaise, headache, chest pain, flatulence, abdominal distension, glossitis, urine retention, dysuria, edema, facial swelling, erythema, chills, tightness in throat, substernal pain, epistaxis and mucosal bleeding. Increased ALT, AST, alkaline phosphatase, LDH Decrease hemoglobin and blood cell count Decreased serum albumin and total proteins. Increased BUN and creatinine. Presence of RBCs and hyaline casts in urine. Gastritis, stomatitis, black “hairy” tongue and pseudomembranous enterocolitis Hypersensitivity reactions Agranulocytosis (2)

Probenecid: Decreased renal tubular secretion of ampicillin and sulbactam Allopurinol: Increased incidence of rashes Aminoglycosides: In vitro inactivation of aminoglycoside by ampicillin (2)

Drug should be used during pregnancy only if specifically indicated Low concentrations of ampicillin and sulbactam are excreted in the milk and so caution is exercised while administering to nursing mothers Safety and effectiveness not established in pediatric population for intra-abdominal infections Less frequent dosing needed in patients of renal impairment guided by creatinine clearance (2)

The recommended adult dosage is 1.5 to 3 g not exceeding 4 g per day. The recommended daily dose for children more than 1 year of age is 300 mg per kg of body weight administered via intravenous infusion in equally divided doses every 6 hours. (2)

1.William A, Petri JR. Penicillins, Cephalosporins and other Beta Lactam Antibiotics. In: Brunton L, Chabner B, Knollmann B eds. Goodman & Gilman’s The Pharmacological basis of Therapeutics. 12th ed. China: McGraw Hill; 2011. P1477-1505. 2. Unasyn [Internet]. [cited 2013 Aug 27]. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/050608s040lbl.pdf.