Dosing & Uses
Dosage Forms & Strengths
powder for solution
- 1.5g (ampicillin 1g/sulbactam 0.5g)
- 3g (ampicillin 2g/sulbactam 1g)
- 15g (ampicillin 10g/sulbactam 5g)
Gynecologic Infections
1.5 g (1 g ampicillin + 0.5 g sulbactam) to 3 g (2 g ampicillin + 1 g sulbactam) IV/IM q6hr; not to exceed 12 g/day
Intra-Abdominal Infections
1.5 g (1 g ampicillin + 0.5 g sulbactam) to 3 g (2 g ampicillin + 1 g sulbactam) IV/IM q6hr; not to exceed 12 g/day
Skin & Skin Structure Infections
1.5 g (1 g ampicillin + 0.5 g sulbactam) to 3 g (2 g ampicillin + 1 g sulbactam) IV/IM q6hr; not to exceed 12 g/day
Orbital Cellulitis
3 g (2 g ampicillin + 1 g sulbactam) IV q6hr
Pelvic Inflammatory Disease
3 g (2 g ampicillin + 1 g sulbactam) IV q6hr
Pneumonia
Aspiration or community acquired: 1.5 g (1 g ampicillin + 0.5 g sulbactam) to 3 g (2 g ampicillin + 1 g sulbactam) IV q6hr for 5 or more days
Hospital acquired: 3 g IV q6hr for 5 or more days
Urinary Tract Infections
Pyelonephritis: 3 g (2 g ampicillin + 1 g sulbactam) IV q6hr for 14 days
Acute Bacterial Rhinosinusitis (Off-label)
Severe infection requiring hospitalization
1.5 g (1 g ampicillin + 0.5 g sulbactam) to 3 g (2 g ampicillin + 1 g sulbactam) IV q6hr for 5-7 days
Endocarditis (Off-label)
Enterococcus infection resistant to penicillin/susceptible to aminoglycosides: 3 g (2 g ampicillin + 1 g sulbactam) IV q6hr for 6 weeks if not aminoglycoside resistant; >6 weeks if aminoglycoside resistant
HACEK infection: 3 g (2 g ampicillin + 1 g sulbactam) IV q6hr for 4 weeks
Dosing Modifications
Renal impairment
- CrCl 5-14 mL/min/1.73 m²: 1.5 g (1 g ampicillin + 0.5 g sulbactam) to 3 g (2 g ampicillin + 1 g sulbactam) IV q24hr
- CrCl 15-29 mL/min/1.73 m²: 3 g (2 g ampicillin + 1 g sulbactam) IV q12hr
- CrCl ≥ 30 mL/min/1.73 m²: No dose adjustment necessary
Dosage Forms & Strengths
powder for solution
- 1.5g (ampicillin 1g/sulbactam 0.5g)
- 3g (ampicillin 2g/sulbactam 1g)
- 15g (ampicillin 10g/sulbactam 5g)
Skin Infections
>1 year (<40 kg): 200 mg/kg/day IV divided q6hr; not to exceed 14 days of therapy
>1 year (>40 kg): 1.5 g (1 g ampicillin + 0.5 g sulbactam) to 3 g (2 g ampicillin + 1 g sulbactam) q6hr; not to exceed 12 g/day
Epiglottitis
Children and adolescents: 100-200 mg ampicillin/kg/day IV divided q6hr
Mild/Moderate Infection
>1 month-1 year: 100-150 mg ampicillin/kg/day IV/IM divided q6hr
>1 year: 100-200 mg ampicillin/kg/day IV/IM divided q6hr
Meningitis/Severe Infections
>1 month-1 year: 200-300 mg ampicillin/kg/day IV/IM divided q6hr
>1 year: 200-400 mg ampicillin/kg/day IV/IM divided q6hr
Peritonsillar and Retropharyngeal Abscess
Children and adolescents: 200 mg ampicillin/kg/day IV divided q6hr
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (13)
- BCG vaccine live
ampicillin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cholera vaccine
ampicillin, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.
- demeclocycline
demeclocycline decreases effects of ampicillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Tetracyclines may interfere with the bactericidal action of penicillins. Monitor for decreased therapeutic effects of penicillins if concomitantly used with a tetracycline.
- doxycycline
doxycycline decreases effects of ampicillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Tetracyclines may interfere with the bactericidal action of penicillins. Monitor for decreased therapeutic effects of penicillins if concomitantly used with a tetracycline.
- eravacycline
eravacycline decreases effects of ampicillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Tetracyclines may interfere with the bactericidal action of penicillins. Monitor for decreased therapeutic effects of penicillins if concomitantly used with a tetracycline.
- microbiota oral
ampicillin decreases effects of microbiota oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Microbiota oral contains bacterial spores. Antibacterial agents may decrease efficacy if coadministered. Complete antibiotic regimens 2-4 days before initiating microbiota oral. .
- minocycline
minocycline decreases effects of ampicillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Tetracyclines may interfere with the bactericidal action of penicillins. Monitor for decreased therapeutic effects of penicillins if concomitantly used with a tetracycline.
- mycophenolate
ampicillin, mycophenolate. Either increases levels of the other by decreasing renal clearance. Avoid or Use Alternate Drug.
- omadacycline
omadacycline decreases effects of ampicillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Tetracyclines may interfere with the bactericidal action of penicillins. Monitor for decreased therapeutic effects of penicillins if concomitantly used with a tetracycline.
- oxytetracycline
oxytetracycline decreases effects of ampicillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
- sarecycline
sarecycline decreases effects of ampicillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Tetracyclines may interfere with the bactericidal action of penicillins. Monitor for decreased therapeutic effects of penicillins if concomitantly used with a tetracycline.
- tetracycline
tetracycline decreases effects of ampicillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Tetracyclines may interfere with the bactericidal action of penicillins. Monitor for decreased therapeutic effects of penicillins if concomitantly used with a tetracycline.
- typhoid vaccine live
ampicillin decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
Monitor Closely (29)
- aspirin
ampicillin, aspirin. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
- aspirin rectal
ampicillin, aspirin rectal. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
- aspirin/citric acid/sodium bicarbonate
ampicillin, aspirin/citric acid/sodium bicarbonate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
- bazedoxifene/conjugated estrogens
ampicillin will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- chloroquine
chloroquine decreases levels of ampicillin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate doses by at least 2 hr.
- choline magnesium trisalicylate
ampicillin, choline magnesium trisalicylate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
ampicillin, choline magnesium trisalicylate. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor. - deflazacort
ampicillin and deflazacort both decrease serum potassium. Use Caution/Monitor.
- dexlansoprazole
dexlansoprazole will decrease the level or effect of ampicillin by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.
- dienogest/estradiol valerate
ampicillin will decrease the level or effect of dienogest/estradiol valerate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. An alternate or additional form of birth control may be advisable during concomitant use.
- esomeprazole
esomeprazole will decrease the level or effect of ampicillin by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.
- ethinylestradiol
ampicillin will decrease the level or effect of ethinylestradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- ibuprofen/famotidine
ibuprofen/famotidine will decrease the level or effect of ampicillin by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.
- lansoprazole
lansoprazole will decrease the level or effect of ampicillin by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.
- lanthanum carbonate
lanthanum carbonate decreases levels of ampicillin by cation binding in GI tract. Use Caution/Monitor. Administer ampicillin at least 2 hr before or after lanthanum. Interaction applies to oral ampicillin.
- levonorgestrel oral/ethinylestradiol/ferrous bisglycinate
ampicillin will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. Antibiotics may decrease hormonal contraceptive efficacy.
- mestranol
ampicillin will decrease the level or effect of mestranol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.
- methotrexate
ampicillin increases levels of methotrexate by decreasing renal clearance. Use Caution/Monitor. Increased serum concentrations of methotrexate with concomitant hematologic and gastrointestinal toxicity have been observed with concurrent administration of high or low doses of methotrexate and penicillins.
- omeprazole
omeprazole will decrease the level or effect of ampicillin by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.
- pantoprazole
pantoprazole will decrease the level or effect of ampicillin by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.
- rabeprazole
rabeprazole will decrease the level or effect of ampicillin by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.
- rose hips
ampicillin, rose hips. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- sodium bicarbonate
sodium bicarbonate will decrease the level or effect of ampicillin by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.
- sodium citrate/citric acid
sodium citrate/citric acid will decrease the level or effect of ampicillin by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.
- sodium phenylacetate
ampicillin, sodium phenylacetate. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- sodium picosulfate/magnesium oxide/anhydrous citric acid
ampicillin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol
ampicillin and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.
- spironolactone
ampicillin increases effects of spironolactone by unspecified interaction mechanism. Use Caution/Monitor. Hyperkalemia.
- sulfasalazine
ampicillin, sulfasalazine. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ampicillin, sulfasalazine. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - willow bark
ampicillin, willow bark. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
Minor (18)
- allopurinol
ampicillin, allopurinol. Mechanism: unknown. Minor/Significance Unknown. Increased incidence of rash.
- atenolol
ampicillin decreases levels of atenolol by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- azithromycin
azithromycin decreases effects of ampicillin by pharmacodynamic antagonism. Minor/Significance Unknown.
- bendroflumethiazide
bendroflumethiazide increases effects of ampicillin by decreasing renal clearance. Minor/Significance Unknown. May increase side effects.
- chloramphenicol
chloramphenicol decreases effects of ampicillin by pharmacodynamic antagonism. Minor/Significance Unknown.
- chlorothiazide
chlorothiazide increases levels of ampicillin by decreasing renal clearance. Minor/Significance Unknown.
- clarithromycin
clarithromycin decreases effects of ampicillin by pharmacodynamic antagonism. Minor/Significance Unknown.
- colestipol
colestipol decreases levels of ampicillin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- didanosine
didanosine will decrease the level or effect of ampicillin by increasing gastric pH. Applies only to oral form of both agents. Minor/Significance Unknown.
- erythromycin base
erythromycin base decreases effects of ampicillin by pharmacodynamic antagonism. Minor/Significance Unknown.
- erythromycin ethylsuccinate
erythromycin ethylsuccinate decreases effects of ampicillin by pharmacodynamic antagonism. Minor/Significance Unknown.
- erythromycin lactobionate
erythromycin lactobionate decreases effects of ampicillin by pharmacodynamic antagonism. Minor/Significance Unknown.
- erythromycin stearate
erythromycin stearate decreases effects of ampicillin by pharmacodynamic antagonism. Minor/Significance Unknown.
- hydrochlorothiazide
hydrochlorothiazide increases levels of ampicillin by decreasing renal clearance. Minor/Significance Unknown.
- methyclothiazide
methyclothiazide increases levels of ampicillin by decreasing renal clearance. Minor/Significance Unknown.
- metolazone
metolazone increases levels of ampicillin by decreasing renal clearance. Minor/Significance Unknown.
- rifampin
rifampin decreases levels of ampicillin by increasing metabolism. Minor/Significance Unknown.
- roxithromycin
roxithromycin decreases effects of ampicillin by pharmacodynamic antagonism. Minor/Significance Unknown.
Adverse Effects
>10%
IM injection site pain (16%)
1-10%
Diarrhea (3%)
IV injection site pain (3%)
Thrombophlebitis (3%)
Rash ( < 2%)
<1%
Abdominal distention
Black, "hairy" tongue
Candidiasis
Chest pain
Chills
Dysuria
Edema
Epistaxis
Erythema
Fatigue
Flatulence
Glossitis
Headache
Itching
Malaise
Mucosal bleeding
Nausea
Pseudomembranous colitis
Seizure
Tightness in throat
Thrombocytopenia
Urine retention
Vomiting
Postmarketing Reports
Gastrointestinal disorders: Abdominal pain, cholestatic hepatitis, cholestasis, hyperbilirubinemia, jaundice, abnormal hepatic function, melena, gastritis, stomatitis, dyspepsia, and Clostridium difficile associated diarrhea
Nervous system disorders: Convulsion and dizziness
Respiratory, Thoracic and mediastinal disorders: Dyspnea
Skin and subcutaneous tissue disorders: Toxic epidermal necrolysis, Stevens-Johnson syndrome, angioedema, acute generalized exanthematous pustulosis (AGEP), erythema multiforme, exfoliative dermatitis, and urticaria
Immune disorders: Serious and fatal hypersensitivity (anaphylactic) reactions
Cardiac disorders: Acute myocardial ischemia with or without myocardial infarction may occur as part of an allergic reaction
Warnings
Contraindications
Hypersensitivity to drug or components
Patients with previous history of cholestatic jaundice/hepatic dysfunction associated with ampicillin sulbactam
Cautions
Use caution in patients with allergy to cephalosporins and carbapenems
Adjust dose in renal failure
Prolonged use is associated with fungal or bacterial superinfection
Hepatic dysfunction, including hepatitis and cholestatic jaundice reported; hepatic toxicity is usually reversible; however, deaths have occurred; monitor hepatic function at regular intervals in patients with hepatic impairment
A generalized dull red maculopapular rash may occur in 5-10% of children 3-14 days after initiating therapy; carefully evaluate the rash to differentiate a nonallergic ampicillin rash from a hypersensitivity reaction; it normally begins on the trunk and spreads over most of the body; it may be most intense at pressure areas, elbows, and knees
Hepatotoxicity reported; monitor hepatic function at regular intervals in patients with hepatic impairment
A high percentage of patients with infectious mononucleosis have developed rash during therapy; therapy is not recommended in these patients
May cause severe skin reactions, such as toxic epidermal necrolysis (TEN), Stevens- Johnson syndrome (SJS), dermatitis exfoliative, erythema multiforme, and acute generalized exanthematous pustulosis (AGEP); if patients develop skin rash monitor closely and discontinued therapy if lesions progress
Pregnancy & Lactation
Pregnancy category: B
Lactation: Excreted in breast milk; use caution
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Drug combination of beta-lactamase inhibitor with ampicillin; interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms; alternative to amoxicillin when unable to take medication orally; covers skin, enteric flora, and anaerobes; not ideal for nosocomial pathogens.
Absorption
Ampicillin
- Bioavailability: 30-40%
- Peak plasma time: 1-2 hr (oral)
Distribution
Ampicillin
- Protein bound: 15-25%
- Blister and tissue fluids, bile, and CSF with inflamed meninges
Sulbactam
- Protein bound: 38%
- Bile, blister, and tissue fluids
Metabolism
Ampicillin and sulbactam
- Liver
Elimination
Ampicillin
- Half-life: 1-1.8 hr (normal renal function); 7-20 hr (anuria/end-stage renal disease)
- Excretion: Urine (90% within 24 hr)
Sulbactam
- Half-life: 1-1.3 hr
- Excretion: Urine (75-85%)
Administration
IV Incompatibilities
Additive: Aminoglycosides, ciprofloxacin
Y-site: Aminoglycosides, amiodarone, amphotericin B cholesteryl sulfate, ciprofloxacin, cisatracurium(?), diltiazem(?), idarubicin, nicardipine, ondansetron, sargramostim
IV Compatibilities
Solution: NS
Additive: Aztreonam
Y-site: Amifostine, aztreonam, bivalirudin, cefepime, dexmedetomidine, docetaxel, enalaprilat, etoposide PO4, famotidine, fenoldopam, filgrastim, fluconazole, fludarabine, gatifloxacin, gemcitabine, granisetron, heparin, Hextend, insulin, linezolid, meperidine, morphine, paclitaxel, remifentanil, tacrolimus, teniposide, theophylline, thiotepa, vancomycin
IV/IM Preparation
Reconstitute with SWI or 0.5% or 2% lidocaine injection (IM) to obtain a 250 mg ampicillin-125 mg sulbactam/mL solution
IM: Use within 1 hr after preparation
IV: Further dilute to 3-45 mg/mL with appropriate diluent
Use NS for IV piggyback
IV: Use within 8 hr after preparation
IV/IM Administration
Administer around-the-clock to promote less variation in peak and trough serum levels
Slow IV injection over at least 10-15 min or infusion over 15-30 min
IM: Deep into large muscle mass
Storage
Store intact vials <30°C
Images
Formulary
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