Ampicillin/Sulbactam: Difference between revisions
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==General== | ==General== | ||
*Type: Amino-[[Penicillins]] | *Type: Amino-[[Penicillins]] | ||
*Dosage Forms: | *Dosage Forms: powder for solution | ||
*Dosage Strengths: 1.5g, 3g, 15g | |||
*Routes of Administration: IM, IV | |||
*Common Trade Names: Unasyn | *Common Trade Names: Unasyn | ||
==Adult Dosing== | ==Adult Dosing== | ||
===General=== | ===General=== | ||
* | *1.5-3g IV/IM q6 hours | ||
*Max: 12g/day | *Max: 12g/day | ||
===[[Bite]] (for Pasteurella multocida Coverage)=== | ===[[Bite]] (for Pasteurella multocida Coverage)=== | ||
* | *1.5-3g IM/IV q6 hours | ||
===[[Orbital Cellulitis]]=== | ===[[Orbital Cellulitis]]=== | ||
* | *3g IM/IV q6 hours | ||
===[[Diabetic Foot]] Osteomyelitis<ref>Lipsky, 2004</ref>=== | ===[[Diabetic Foot]] Osteomyelitis<ref>Lipsky, 2004</ref>=== | ||
* | *3g IM/IV q6 hours | ||
===[[PID]]=== | ===[[PID]]=== | ||
* | *3g IM/IV q6 hours + [[doxycycline]] | ||
===[[Pneumonia]]=== | ===[[Pneumonia]]=== | ||
*Aspiration or CAP | *Aspiration or CAP | ||
** | **1.5-3g IM/IV q6 hours | ||
*Hospital-acquired: | *Hospital-acquired: 3g IM/IV q6 hours | ||
===[[UTI]], [[Pyelonephritis]]=== | ===[[UTI]], [[Pyelonephritis]]=== | ||
* | *3g IM/IV q6 hours x 14 days | ||
==Pediatric Dosing (<40kg)== | ==Pediatric Dosing (<40kg)== | ||
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===General<ref>Red Book, 2012</ref>=== | ===General<ref>Red Book, 2012</ref>=== | ||
* | *'''Mild-moderate''' | ||
**100-200mg ampicillin/kg/day IM/IV divided q6 hours | |||
***Max: 1000mg ampicillin | **First Dose: 25-50mg ampicillin/kg IM/IV x 1 (37.5-75mg Unasyn/kg IM/IV x 1) | ||
* | **Max: 1000mg ampicillin (1500mg Unasyn) | ||
*'''Severe''' | |||
***Meningitis | **200mg ampicillin/kg/day IM/IV divided q6 hours | ||
* | **First Dose: 50mg ampicillin/kg IM/IV x 1 (75mg Unasyn/kg IM/IV x 1) | ||
**Max: 2000mg ampicillin (3000mg Unasyn) | |||
===[[Meningitis]]=== | |||
*400mg ampicillin/kg/day IM/IV divided q6 hours | |||
*First Dose: 100mg ampicillin/kg IM/IV x 1 (150mg Unasyn/kg IM/IV x 1) | |||
*Max: 2000mg ampicillin (3000mg Unasyn) | |||
===[[Endocarditis]]=== | ===[[Endocarditis]]=== | ||
*200mg ampicillin/kg/day IM/IV divided q4-6 hours +/- [[gentamicin]] x 4-6 weeks | |||
===[[SSTI]]=== | ===[[SSTI]]=== | ||
*200mg ampicillin/kg/day IM/IV divided q6 hours | |||
==Special Populations== | ==Special Populations== | ||
*Pregnancy: | *[[Drugs in Pregnancy|Pregnancy]]: B | ||
*Lactation: | *Lactation: Use caution | ||
*Renal Dosing | *Renal Dosing | ||
**Adult | **Adult | ||
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==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
*Anaphylaxis | |||
===Common=== | ===Common=== | ||
*Headache | |||
*Itching | |||
*Nausea | |||
*Vomiting | |||
==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: One hour | ||
*Metabolism: | *Metabolism: | ||
*Excretion: | *Excretion: Renal (75% excreted in active form), Bile (very small amount)<ref>Campoli-Richards DM, Brogden RN. (1987). ". Sulbactam/ampicillin: a review of its antibacterial activity, pharmacokinetic properties, and therapeutic use". Drugs. 33 (6): 577–609. doi:10.2165/00003495-198733060-00003. PMID 3038500</ref> | ||
*Mechanism of Action: | *Mechanism of Action: Bactericidal (Binds to penicillin-binding proteins to block cell wall synthesis), coupled with β-lacatamase inhibitor | ||
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== | |||
{| class="wikitable" | |||
| align="center" style="background:#f0f0f0;"|'''Group''' | |||
| align="center" style="background:#f0f0f0;"|'''Organism''' | |||
| align="center" style="background:#f0f0f0;"|'''Sensitivity''' | |||
|- | |||
| Gram Positive||[[Strep. Group A, B, C, G]]||'''S''' | |||
|- | |||
| ||[[Strep. Pneumoniae]]||'''S''' | |||
|- | |||
| ||[[Viridans strep]]||I | |||
|- | |||
| ||Strep. anginosus gp||'''S''' | |||
|- | |||
| ||[[Enterococcus faecalis]]||'''S''' | |||
|- | |||
| ||[[Enterococcus faecium]]||'''S''' | |||
|- | |||
| ||[[MSSA]]||'''S''' | |||
|- | |||
| ||[[MRSA]]||R | |||
|- | |||
| ||[[CA-MRSA]]||R | |||
|- | |||
| ||[[Staph. Epidermidis]]||R | |||
|- | |||
| ||[[C. jeikeium]]||R | |||
|- | |||
| ||[[L. monocytogenes]]||'''S''' | |||
|- | |||
| Gram Negatives||[[N. gonorrhoeae]]||'''S''' | |||
|- | |||
| ||[[N. meningitidis]]||'''S''' | |||
|- | |||
| ||[[Moraxella catarrhalis]]||'''S''' | |||
|- | |||
| ||[[H. influenzae]]||'''S''' | |||
|- | |||
| ||[[E. coli]]||'''S''' | |||
|- | |||
| ||[[Klebsiella]] sp||'''S''' | |||
|- | |||
| ||E. coli/Klebsiella ESBL+||R | |||
|- | |||
| ||E coli/Klebsiella KPC+||R | |||
|- | |||
| ||[[Enterobacter]] sp, AmpC neg||R | |||
|- | |||
| ||[[Enterobacter]] sp, AmpC pos||R | |||
|- | |||
| ||[[Serratia]] sp||R | |||
|- | |||
| ||Serratia marcescens||X1 | |||
|- | |||
| ||[[Salmonella]] sp||'''S''' | |||
|- | |||
| ||[[Shigella]] sp||'''S''' | |||
|- | |||
| ||[[Proteus mirabilis]]||'''S''' | |||
|- | |||
| ||[[Proteus vulgaris]]||'''S''' | |||
|- | |||
| ||[[Providencia sp.]]||'''S''' | |||
|- | |||
| ||[[Morganella sp.]]||'''S''' | |||
|- | |||
| ||[[Citrobacter freundii]]||R | |||
|- | |||
| ||[[Citrobacter diversus]]||R | |||
|- | |||
| ||[[Citrobacter sp.]]||R | |||
|- | |||
| ||[[Aeromonas sp]]||'''S''' | |||
|- | |||
| ||[[Acinetobacter sp.]]||'''S''' | |||
|- | |||
| ||[[Pseudomonas aeruginosa]]||R | |||
|- | |||
| ||[[Burkholderia cepacia]]||R | |||
|- | |||
| ||[[Stenotrophomonas maltophilia]]||R | |||
|- | |||
| ||[[Yersinia enterocolitica]]||I | |||
|- | |||
| ||[[Francisella tularensis]]||X1 | |||
|- | |||
| ||[[Brucella sp.]]||X1 | |||
|- | |||
| ||[[Legionella sp.]]||R | |||
|- | |||
| ||[[Pasteurella multocida]]||'''S''' | |||
|- | |||
| ||[[Haemophilus ducreyi]]||'''S''' | |||
|- | |||
| ||[[Vibrio vulnificus]]||X1 | |||
|- | |||
| Misc||[[Chlamydophila sp]]||R | |||
|- | |||
| ||[[Mycoplasm pneumoniae]]||R | |||
|- | |||
| ||[[Rickettsia sp]]||X1 | |||
|- | |||
| ||[[Mycobacterium avium]]||X1 | |||
|- | |||
| Anaerobes||[[Actinomyces]]||'''S''' | |||
|- | |||
| ||[[Bacteroides fragilis]]||'''S''' | |||
|- | |||
| ||[[Prevotella melaninogenica]]||'''S''' | |||
|- | |||
| ||[[Clostridium difficile]]||X2 | |||
|- | |||
| ||[[Clostridium (not difficile)]]||'''S''' | |||
|- | |||
| ||[[Fusobacterium necrophorum]]||'''S''' | |||
|- | |||
| ||[[Peptostreptococcus sp.]]||'''S''' | |||
|} | |||
===Key=== | |||
{{Template:Antibacterial Spectra Key}} | |||
==See Also== | ==See Also== | ||
*[[Antibiotics (Main)]] | *[[Antibiotics (Main)]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Pharmacology]] |
Latest revision as of 21:21, 25 October 2017
General
- Type: Amino-Penicillins
- Dosage Forms: powder for solution
- Dosage Strengths: 1.5g, 3g, 15g
- Routes of Administration: IM, IV
- Common Trade Names: Unasyn
Adult Dosing
General
- 1.5-3g IV/IM q6 hours
- Max: 12g/day
Bite (for Pasteurella multocida Coverage)
- 1.5-3g IM/IV q6 hours
Orbital Cellulitis
- 3g IM/IV q6 hours
Diabetic Foot Osteomyelitis[1]
- 3g IM/IV q6 hours
PID
- 3g IM/IV q6 hours + doxycycline
Pneumonia
- Aspiration or CAP
- 1.5-3g IM/IV q6 hours
- Hospital-acquired: 3g IM/IV q6 hours
UTI, Pyelonephritis
- 3g IM/IV q6 hours x 14 days
Pediatric Dosing (<40kg)
Unasyn (ampicillin/sulbactam) is formulated at a 2:1 ratio (3g vial = 2g ampicillin + 1g sulbactam)
General[2]
- Mild-moderate
- 100-200mg ampicillin/kg/day IM/IV divided q6 hours
- First Dose: 25-50mg ampicillin/kg IM/IV x 1 (37.5-75mg Unasyn/kg IM/IV x 1)
- Max: 1000mg ampicillin (1500mg Unasyn)
- Severe
- 200mg ampicillin/kg/day IM/IV divided q6 hours
- First Dose: 50mg ampicillin/kg IM/IV x 1 (75mg Unasyn/kg IM/IV x 1)
- Max: 2000mg ampicillin (3000mg Unasyn)
Meningitis
- 400mg ampicillin/kg/day IM/IV divided q6 hours
- First Dose: 100mg ampicillin/kg IM/IV x 1 (150mg Unasyn/kg IM/IV x 1)
- Max: 2000mg ampicillin (3000mg Unasyn)
Endocarditis
- 200mg ampicillin/kg/day IM/IV divided q4-6 hours +/- gentamicin x 4-6 weeks
SSTI
- 200mg ampicillin/kg/day IM/IV divided q6 hours
Special Populations
- Pregnancy: B
- Lactation: Use caution
- Renal Dosing
- Adult
- Pediatric
- Hepatic Dosing
- Adult
- Pediatric
Contraindications
- Allergy to class/drug
Adverse Reactions
Serious
- Anaphylaxis
Common
- Headache
- Itching
- Nausea
- Vomiting
Pharmacology
- Half-life: One hour
- Metabolism:
- Excretion: Renal (75% excreted in active form), Bile (very small amount)[3]
- Mechanism of Action: Bactericidal (Binds to penicillin-binding proteins to block cell wall synthesis), coupled with β-lacatamase inhibitor
Antibiotic Sensitivities[4]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia
See Also
References
- ↑ Lipsky, 2004
- ↑ Red Book, 2012
- ↑ Campoli-Richards DM, Brogden RN. (1987). ". Sulbactam/ampicillin: a review of its antibacterial activity, pharmacokinetic properties, and therapeutic use". Drugs. 33 (6): 577–609. doi:10.2165/00003495-198733060-00003. PMID 3038500
- ↑ Sanford Guide to Antimicrobial Therapy 2014