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Ampicillin Sulbactam

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Ampicillin Sulbactam, Unasyn

  • See Also
  1. Aminopenicillin
  2. Ampicillin
  3. Amoxicillin
  4. Augmentin
  • Indications
  1. Skin and Soft Tissue Infection
  2. Genitourinary infections
  3. Pelvic Inflammatory Disease
  4. Pneumonia
  • Contraindications
  1. Penicillin Allergy
    1. Cephalexin and Cefaclor have similar side chains and risk of cross reactivity with Ampicillin
  • Dosing
  1. Adult (or child weight >40 kg)
    1. Typical 1.5 to 3 g IV or IM every 6 hours
    2. Some protocols start with 3 g IV or IM, followed by 1.5 g IV every 6 hours
  2. Child (weight <40 kg, dosing based on Ampicillin component)
    1. Mild to Moderate Infections: 100 to 150 mg/kg/day IV or IM divided every 6 hours
    2. Severe Infections: 200 to 400 mg/kg/day IV or IM divided every 6 hours
  3. Renal Dosing
    1. eGFR >30 ml/min: Dose every 6 to 8 hours
    2. eGFR 15 to 30 ml/min: Dose every 12 hours
    3. eGFR <15 ml/min: Dose every 24 hours
  • Mechanism
  1. See Aminopenicillin
  2. Sulbactam adds beta lactamase resistance to Ampicillin
  • Adverse Effects
  1. See Aminopenicillin
  2. See Penicillin
  3. Cholestatic Jaundice
  4. 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
  5. Diarrhea
    1. Most 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 Sulbactam (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=12eeb72a-403d-41be-bae4-4cb930862884
  • 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]