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Ampicillin

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Ampicillin

  • See Also
  1. Aminopenicillin
  2. Amoxicillin
  3. Augmentin
  4. Unasyn
  • Indications
  1. Otitis Media
  2. Acute Bacterial Sinusitis
  3. Pneumonia
  4. Group A Streptococcal Pharyngitis
  5. Group B Streptococcus
  6. Meningitis
  7. Helicobacter Pylori
  8. Endocarditis Prophylaxis
  • Contraindications
  1. Penicillin Allergy
    1. Cephalexin and Cefaclor have similar side chains and risk of cross reactivity with Ampicillin
  • Dosing
  1. Adult (or child with weight >40 kg)
    1. Mild/Moderate Infections (typical dose): 1 to 2 g IV every 4 to 6 hours
    2. Severe Infections (Sepsis, Meningitis): 150 to 200 mg/kg/day IV divided every 4 hours
  2. Child (weight <40 kg)
    1. Mild/Moderate Infections (typical dose): 100 to 150 mg/kg/day IM or IV divided every 6 hours
    2. Severe Infections (Sepsis, Meningitis): 200 to 400 mg/kg/day IM or IV divided every 6 hours
    3. Newborns (weight >2 kg): 25 to 50 mg/kg IV every 8 hours until age >1 week, then every 6 hours
  3. Renal Dosing
    1. eGFR 30 to 50 ml/min: Dose every 6 to 8 hours
    2. eGFR 10 to 30 ml/min: Dose every 8 to 12 hours
    3. eGFR <10 ml/min: Dose every 12 to 24 hours (after Hemodialysis)
  • Mechanism
  1. See Aminopenicillin
  • Adverse Effects
  1. See Aminopenicillin
  2. See Penicillin
  3. Maculopapular rash
    1. Onset 5-7 days after initiating medication
    2. Typically not IgE mediated (non-allergic)
      1. No immediate allergy (e.g. Urticaria), systemic symptoms or mucous membrane involvement
    3. Typically safe to use Amoxicillin in future if non-allergic rash alone
      1. Consider IgE Skin Testing if unclear rash etiology
    4. References
      1. Orman and Hayes in Herbert (2017) EM:Rap 17(7): 7-8
  4. Diarrhea
    1. More common with Augmentin
    2. Modifications can decrease stools
      1. Dose exactly by kilogram for children
      2. Avoid food before dose
      3. Consider eating yogurt with each dose
  • Safety
  1. Pregnancy Category B
  2. Safe in Lactation
  • Resources
  1. Ampicillin (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0a66c5c3-63bf-46e3-835e-26b555ab6954
  • References
  1. (2008) Comparison of Amoxicillin Products, Presc Lett, #240425
  2. Miller (2002) J Midwifery Womens Health 47(6):426-34 +PMID: 12484664 [PubMed]
  3. Bush (2016) Cold Spring Harb Perspect Med 6(8):a025247 +PMID: 27329032 [PubMed]