ampicillin

(am pi sill' in)

ampicillin sodium
Oral:
Ampicin (CAN), Apo-Ampi (CAN), Novo-Ampicillin (CAN), Nu-Ampi (CAN),
Penbritin (CAN), Principen

Pregnancy Category B

Drug classes
Antibiotic
Penicillin

Therapeutic actions
Bactericidal action against sensitive organisms; inhibits synthesis of bacterial cell wall,
causing cell death.

Indications
• Treatment of infections caused by susceptible strains of Shigella, Salmonella, E.
coli, H. influenzae, P. mirabilis, N. gonorrhoeae, enterococci, gram-positive
organisms (penicillin G–sensitive staphylococci, streptococci, pneumococci)
• Meningitis caused by Neisseria meningitidis
• Unlabeled use: Prophylaxis in cesarean section in certain high-risk patients

Contraindications and cautions

• Contraindicated with allergies to penicillins, cephalosporins, or other allergens.
• Use cautiously with renal disorders.

Available forms
Capsules—250, 500 mg; powder for oral suspension—125 mg/5 mL, 250 mg/5 mL;
powder for injection—250, 500 mg, 1, 2 g

Dosages
Maximum recommended dosage: 8 mg/day; may be given IV, IM, or PO. Use parenteral
routes for severe infections, and switch to oral route as soon as possible.
ADULTS AND PEDIATRIC PATIENTS
• Respiratory and soft-tissue infections:
> 40 kg: 250–500 mg IV or IM q 6 hr.
< 40 kg: 25–50 mg/kg/day IM or IV in equally divided doses at 6–8 hr intervals.
> 20 kg: 250 mg PO q 6 hr.
< 20 kg: 50 mg/kg/day PO in equally divided doses q 6–8 hr.
• GI and GU infections, including women with N. gonorrhoeae:
> 40 kg: 500 mg IM or IV q 6 hr.
< 40 kg: 50–100 mg/kg/day IM or IV in equally divided doses q 6–8 hr.
> 20 kg: 500 mg PO q 6 hr.
< 20 kg: 100 mg/kg/day PO in equally divided doses q 6–8 hr.
 • Gonococcal infections: 500 mg q 6 hr for penicillin-sensitive organism or for
patients > 45 kg, single dose of 3.5 g PO with 1 g probenecid.
• Bacterial meningitis: 150–200 mg/kg/day by continuous IV drip and then IM
injections in equally divided doses q 3–4 hr.
• Septicemia: 150–200 mg/kg/day IV for at least 3 days, then IM q 3–4 hr.
ADULTS
• Prevention of bacterial endocarditis for GI or GU surgery or instrumentation: 2 g
ampicillin IM or IV with gentamicin 1.5 mg/kg IM or IV within 30 minutes of
starting procedure. Six hours later give 1 g ampicillin IM or IV or 1 g amoxicillin
PO.
• Prevention of bacterial endocarditis for dental, oral, or upper respiratory
procedures: 2 g ampicillin IM or IV within 30 minutes of procedure.
• Sexually transmitted diseases in pregnant women and patients allergic to
tetracycline: 3.5 g ampicillin PO with 1 g probenecid.
• Prophylaxis in cesarean section: Single IV or IM dose of 25–100 mg/kg
immediately after cord is clamped.
PEDIATRIC PATIENTS
• Prevention of bacterial endocarditis for GI or GU surgery or instrumentation:
50 mg/kg ampicillin IM or IV with 1.5 mg/kg gentamicin IM or IV within 30
minutes of procedure. Six hours later give 25 mg/kg ampicillin IM or IV or
25 mg/kg amoxicillin PO.
• Prevention of bacterial endocarditis for dental, oral, or upper respiratory
procedures: 50 mg/kg ampicillin IM or IV within 30 minutes of procedure.

Pharmacokinetics
Route Onset Peak Duration
Oral 30 min 2 hr 6–8 hr
IM 15 min 1 hr 6–8 hr
IV Immediate 5 min 6–8 hr

Metabolism: T1/2: 1–2 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Unchanged in the urine

IV facts
Preparation: Reconstitute with sterile or bacteriostatic water for injection; piggyback
vials may be reconstituted with sodium chloride injection; use reconstituted solution
within 1 hr. Do not mix in the same IV solution as other antibiotics. Use within 1 hr after
preparation because potency may decrease significantly after that.
Infusion: Direct IV administration; give slowly over 3–5 min. Rapid administration can
lead to seizures.
IV drip: Dilute as above before further dilution.
IV piggyback: Administer alone or further dilute with compatible solution.
Compatibility: Ampicillin is compatible with 0.9% sodium chloride, 5% dextrose in
water, or 0.45% sodium chloride solution, 10% invert sugar water, M/6 sodium lactate
solution, lactated Ringer's solution, sterile water for injection. Diluted solutions are stable
for 2–8 hr; check manufacturer's inserts for specifics. Discard solution after allotted time
period.
Incompatibility: Do not mix with lidocaine, verapamil, other antibiotics, dextrose
solutions.
Y-site incompatibility: Do not give with epinephrine, hydralazine, ondansetron.

Adverse effects
• CNS: Lethargy, hallucinations, seizures
• CV: CHF
• GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue, black "hairy" tongue,
nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis,
pseudomembranous colitis, nonspecific hepatitis
• GU: Nephritis
• Hematologic: Anemia, thrombocytopenia, leukopenia, neutropenia, prolonged
bleeding time
• Hypersensitivity: Rash, fever, wheezing, anaphylaxis
• Local: Pain, phlebitis, thrombosis at injection site (parenteral)
• Other: Superinfections—oral and rectal moniliasis, vaginitis

Interactions
Drug-drug
• Increased ampicillin effect with probenecid
• Increased risk of rash with allopurinol
• Increased bleeding effect with heparin, oral anticoagulants
• Decreased effectiveness with tetracyclines, chloramphenicol
• Decreased efficacy of hormonal contraceptives, atenolol with ampicillin
Drug-food
• Oral ampicillin may be less effective with food; take on an empty stomach
Drug-lab test
• False-positive Coombs' test if given IV
• Decrease in plasma estrogen concentrations in pregnant women
• False-positive urine glucose tests if Clinitest, Benedict's solution, or Fehling's
solution is used; enzymatic glucose oxidase methods (Clinistix, Tes-Tape) should
be used to check urine glucose

Nursing considerations
Assessment
• History: Allergies to penicillins, cephalosporins, or other allergens; renal
disorders; lactation
• Physical: Culture infected area; skin color, lesion; R, adventitious sounds; bowel
sounds; CBC, liver and renal function tests, serum electrolytes, hematocrit,
urinalysis

Interventions
 • Culture infected area before treatment; reculture area if response is not as
expected.
• Check IV site carefully for signs of thrombosis or drug reaction.
• Do not give IM injections in the same site; atrophy can occur. Monitor injection
sites.
• Administer oral drug on an empty stomach, 1 hr before or 2 hr after meals with a
full glass of water—no fruit juice or soft drinks.

Teaching points
• Take this drug around-the-clock.
• Take the full course of therapy; do not stop taking the drug if you feel better.
• Take the oral drug on an empty stomach, 1 hr before or 2 hr after meals; the oral
solution is stable for 7 days at room temperature.
• This antibiotic is specific to your problem and should not be used to self-treat
other infections.
• These side effects may occur: Nausea, vomiting, GI upset (eat small, frequent
meals), diarrhea.
• Report pain or discomfort at sites, unusual bleeding or bruising, mouth sores,
rash, hives, fever, itching, severe diarrhea, difficulty breathing.

Adverse effects in Italic are most common; those in Bold are life-threatening.