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ampicillin

ampicillin













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ampicillin
 Inhibits bacterial cell wall mucopeptide synthesis.


ampicillin +Sulbactam 
 Sulbactam inhibits plasmid-medicated beta-lactamase enzymes commonly found in microorganisms resistant to ampicillin.


ampicillin  Indications 


Treatment of respiratory, GI, and GU tract and
soft tissue infections, bacterial meningitis and enterococcal endocarditis,
 septicemia and gonococcal infections caused by susceptible microorganisms.
Prophylaxis in Cesarean section in certain high risk patients.


ampicillin +Sulbactam Indications
 Treatment of infections of skin and skin structure, intra-abdominal and gynecologic infections caused by susceptible microorganisms, and mixed infections caused by ampicillin-susceptible organisms and beta-lactamase–producing organisms


ampicillin  Contraindications
  Hypersensitivity to penicillins, cephalosporins or imipenem.
 Oral form not used to treat severe pneumonia,
 empyema, bacteremia, pericarditis, meningitis, and
purulent or septic arthritis during acute stage.


ampicillin +Sulbactam Contraindications
Hypersensitivity to penicillins, cephalosporins or imipenem.
 
ampicillin  Route/Dosage
Enterococcal Endocarditis
Adults IV 12 g/day either continuously or in equally divided doses q 4 hr plus mg/kg IM or IV gentamicin q 8 hr for 4 to 6 wk.
Respiratory Tract and Soft Tissue Infections
Adults and children at least 40 kg IV/IM 250 to 500 mg q 6 hr. Children less than 40 kg IV/IM 25 to 50 mg/kg/day in equally divided doses q 6 to 8 hr. Adults and children more than 20 kg PO 250 mg q 6 hr. Children 20 kg or less PO 50 mg/kg/day in equally divided dose q 6 to 8 hr.
Bacterial Meningitis
Adults and children Initial treatment is usually IV followed by IM 150 to 200 mg/kg/day in equally divided doses q 3 to 4 hr.
Septicemia
Adults and children IV 150 to 200 mg/kg/day for at least 3 days followed by IM q 3 to 4 hr.
GI and GU infections (other than N. gonorrhea)
Adults and children more than 20 kg PO 500 mg q 6 hr; use larger doses for severe or chronic infections, if needed. Children 20 kg or less PO 100 mg/kg/day in equally divided doses q 6 hr.
GI and GU infections (N. gonorrhea)
Adults PO 3.5 g administered simultaneously with 1 g probenecid. Adults and children at least 40 kg IV/IM 500 mg q 6 hr. Children less than 40 kg IV/IM 50 mg/kg/day in equally divided doses q 6 to 8 hr.
Urethritis caused by N. gonorrhea
Adult males IV/IM Two 500 mg doses at an interval of 8 to 12 hr. Dose may be repeated if necessary. In complicated gonorrheal urethritis, intensive therapy is recommended.
 

ampicillin +Sulbactam Route/Dosage
ADULTS: IV/IM 1.5 to 3 g q 6 hr not to exceed 4 g/day sulbactam (1.5 g of product contains 0.5 g sulbactam). CHILDREN ³ 1 YEAR OLD (< 40 KG): IV 300 mg/kg/day (200 mg ampicillin/100 mg sulbactam) in divided doses q 6 hr. CHILDREN ³ 40 KG: IV Dose according to adult recommended doses; do not exceed total sulbactam dose of 4 g/day.


Interactions
Allopurinol: Increases potential for ampicillin-induced skin rash.
 Atenolol: Antihypertensive and antianginal effects may be impaired.
 Contraceptives, oral: May reduce efficacy of oral contraceptives.  
Tetracyclines: May impair bactericidal effects of ampicillin.
 Do not mix with aminoglycosides (eg, gentamicin).


Lab Test Interferences
 May cause false-positive urine glucose test results with Benedict's Solution,
 Fehling's Solution, or
 Clinitest tablets (enzyme-based tests, eg, Clinistix, Tes-tape, are recommended);
 false-positive direct Coombs' test result in certain patient groups; false-positive protein reactions with sulfosalicylic acid and boiling test, acetic acid test, biuret reaction and nitric acid test (the bromphenol blue test, Multistix, is recommended).
Adverse Reactions
CARDIOVASCULAR: Thrombophlebitis at injection site. CNS: Dizziness; fatigue; insomnia; reversible hyperactivity; neurotoxicity (eg, lethargy, neuromuscular irritability, hallucinations, convulsions, seizures). DERMATOLOGIC: Urticaria; maculopapular to exfoliative dermatitis; vesicular eruptions; erythema multiforme; skin rashes. EENT: Itchy eyes; laryngospasm; laryngeal edema. GI: Diarrhea; pseudomembranous colitis. GU: Interstitial nephritis (eg, oliguria, proteinuria, hematuria, hyaline casts, pyuria); nephropathy; increased BUN and creatinine; vaginitis. HEMATOLOGIC: Decreased Hgb, Hct, RBC, WBC, neutrophils, lymphocytes, platelets; increased lymphocytes, monocytes, basophils, eosinophils, and platelets. METABOLIC: Elevated serum alkaline phosphatase, glutamic oxaloacetic transaminase, ALT, AST, and LDH; reduced serum albumin and total proteins. OTHER: Pain at injection site; hyperthermia.
Precautions
Pregnancy: Category B.
 Lactation: Excreted in breast milk. Hypersensitivity: Reactions range from mild to life-threatening. Use cautiously in cephalosporin-sensitive patients because of possible cross-allergenicity.
Superinfection: May result in overgrowth of nonsusceptible bacterial or fungal organisms. Renal impairment: Use cautiously with altered dosing interval.


PATIENT CARE CONSIDERATIONS




Administration/Storage
  • Use liquid preparations for patients with swallowing difficulties. Follow manufacturer's instructions for reconstitution, and handle liquids carefully to prevent contact dermatitis.
  • Time doses at equal intervals to achieve optimal blood levels.
  • To achieve max benefit, administer 1 hr before or 2 hr after a meal.
  • Monitor renal function.
  • Shake liquid preparations well before using.
  • Administer IM and IV solutions within 1 hr of reconstitution.
  • Allow foaming to subside before administering IV preparations. Do not administer if discolored or cloudy. Use volumetric IV pump to regulate delivery over 10- to 15-min period. Do not mix with other IV medications.
  • Be sure certain chewable tablets are crushed or chewed before swallowing. Supply water following dose.
  • Refrigerate liquid preparations after reconstitution, and discard after 14 days. Discard after 7 days if not refrigerated.
  • Store tablets and capsules in dry, tightly closed container. 
  • Do not mix in same IV solution with aminoglycosides.
  • Administer IM and IV solutions within 1 hr of reconstitution.
  • Allow foaming to subside before administering IV preparations. Do not administer if discolored or cloudy. Use volumetric IV pump to regulate delivery over 10 to 15 min period.
  • Do not infuse with other IV medications.
  • Do not administer other antibiotics within 1 hr.
  • Do not routinely exceed 14 days of IV therapy in children. Safety and efficacy of IM administration have not been established.
  • Monitor renal function.
  • Rotate IM injection sites.
  • Keep refrigerated after reconstitution. Medication is stable for 2 hr at room temperature, 72 hr if refrigerated.
  •  
Assessment/Interventions
  • Obtain patient history, including drug history and any known allergies.
  • Review results of culture and sensitivity testing, as available.
  • Monitor patient's condition closely for several hours after administering the first dose even when there is no history of allergy. Notify health care provider of any signs or symptoms of hypersensitivity or anaphylactic reaction.
  • Monitor renal and GI function during therapy, and notify health care provider of severe GI distress.
  • Evaluate skin daily for presence of classic ampicillin rash, usually maculopapular, pruritic, and generalized.
  • Monitor for bleeding in patients receiving anticoagulant therapy.
OVERDOSAGE: SIGNS & SYMPTOMS

Hyperexcitability, convulsive seizures
Patient/Family Education
  • Instruct patient to time the doses evenly over a 24-hr period.
  • Inform patient that medication works best on an empty stomach, but may be taken with food if there is GI upset.
  • Tell patient to increase fluid intake to 2000 to 3000 mL/day, unless contraindicated.
  • Advise patient to refrigerate oral liquid preparations, and to discard unrefrigerated preparations that are more than 7 days old.
  • Inform patient to notify health care provider immediately if rash develops or if having difficulty breathing.
  • Warn diabetic patient that product may cause false-positive glucose urine test results, and identify alternative tests.
  • If therapy is changed because of allergic reaction, explain the significance of penicillin allergy and inform of potential sensitivity to cephalosporins. 
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    الموضوعات السابقة 
    http://werdoctors.blogspot.com/p/drug.html
    ________________________________________________________
    reference 
    a to z drug facts 
    bnf 61
    clinicans handbook of prescription drug 

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