Ampicillin oral
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral formulations of ampicillin
Drugs List
Therapeutic Indications
Uses
Antibiotic sensitive infections
Gonorrhoea
Typhoid: treatment
Urinary tract infection
Treatment of a wide range of infections caused by ampicillin-sensitive organisms, including:
Ear nose and throat infections
Bronchitis
Pneumonia
Urinary tract infections
Gonorrhoea (with probenecid)
Gynaecological infections
Septicaemia
Peritonitis
Endocarditis
Meningitis
Enteric fevers
Gastrointestinal infections
Ampicillin is inactivated by penicillinases including those produced by Staphylococcus aureus and gram-negative bacteria such as Escherichia coli.
Dosage
Recommended dosages are for guidance only. Dosages may be increased in severe infections.
Adults
Bronchitis
Routine therapy: 250mg four times daily.
High dosage therapy: 1g four times daily.
Enteric fevers
Acute: 1g to 2g four times daily for two weeks.
Carriers: 1g to 2g four times daily for four to twelve weeks.
Ear nose and throat infections: 250mg four times daily.
Pneumonia: 500mg four times daily.
Urinary tract infections: 500mg three times daily.
Gonorrhoea: 2g as a single dose, usually with 1g of probenecid. Repeated doses are recommended when treating females.
Gastrointestinal infections: 500mg to 750mg three to four times daily.
The following alternative dosing schedule may be suitable:
500mg to 1g every 6 hours.
Children
Children aged 10 to 18 years
(See Dosage; Adult).
Children aged under 10 years
Administer half the adult dose.
The following alternative dosing schedule may be suitable:
Susceptible infections including otitis media, salmonellosis, sinusitis, uncomplicated community-acquired pneumonia, urinary-tract infections
Children aged 12 to 18 years: 500mg four times daily; in severe infection 1g four times daily.
Children aged 5 to 12 years: 500mg four times daily; if necessary up to 30mg/kg (up to a maximum of 1g) four times daily. Children aged 1 to 5 years: 250mg four times daily; if necessary up to 30mg/kg four times daily. Children aged 1 month to 1 year: 125mg four times daily; if necessary up to 30mg/kg four times daily.
Neonates
Susceptible infections including otitis media, salmonellosis, sinusitis, uncomplicated community-acquired pneumonia, urinary-tract infections
Neonate aged 21 to 28 days: 30mg/kg (up to a maximum of 125mg) four times daily.
Neonate aged 7 to 21 days: 30 mg/kg (up to a maximum of 125mg) three times daily.
Patients with Renal Impairment
Severe renal impairment (creatinine clearance less than 10ml/minute)
A dosage reduction or extended dosage interval should be considered in these patients.
The Renal Drug Handbook suggests the following doses:
Glomerular Filtration Rate
GFR 20 to 50mL/minute: (See Dosage; Adult)
GFR 10 to 20mL/minute: 250mg to 2g every 6 hours
GFR Less than 10mL/minute: 250mg to 1g every 6 hours
Haemodialysis
Doses should be scheduled to follow haemodialysis or an additional dose should be administered following haemodialysis.
Contraindications
None known
Precautions and Warnings
Allergic disposition
Cytomegalovirus infection
Infectious mononucleosis
Restricted sodium intake
Glucose-galactose malabsorption syndrome
Haemodialysis
Hereditary fructose intolerance
Lymphatic leukaemia
Renal impairment - creatinine clearance below 10ml/minute
Reduce dose in patients with severe renal impairment
Sodium content of formulation may be significant
Before initiating therapy enquire about previous hypersensitivity reactions
Consult national/regional policy on the use of anti-infectives
May contain sodium benzoate: mild mucous membrane irritant
Some formulations contain sucrose
Breastfeeding: Monitor infant for systemic effects of treating the mother
Erythematous rash common in glandular fever, CMV inf, lymphocytic leukaemia
Prolonged use may result in superinfection with non-susceptible organisms
May affect results of some laboratory tests
Discontinue if drug-related rash or other hypersensitivity reactions occur
Pregnancy and Lactation
Pregnancy
Ampicillin is considered safe for use during pregnancy.
Ampicillin has been used extensively since 1961 and its suitability in human pregnancy has been well documented in clinical studies.
Animal studies have demonstrated no teratogenic effects.
The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Lactation
Use ampicillin with caution in breastfeeding.
Trace quantities of ampicillin can be detected in breast milk. The Drugs and Lactation database (LactMed) suggest ampicillin is acceptable to use during breastfeeding. Schaefer suggests penicillin derivatives and cephalosporins are the antibiotics of choice during breastfeeding.
Adverse effects are rare but the nursing infant can experience bowel flora changes, allergy, sensitisation, and abnormal culture results when pyrexia of unknown origin occurs.
Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Side Effects
Anaphylaxis
Angioedema
Black tongue
Cholestatic jaundice
CNS toxicity
Convulsions
Diarrhoea
Erythema multiforme
Fever
Furred tongue
Haematological reactions
Haemolytic anaemia
Haemorrhagic colitis
Hepatitis
Hypersensitivity reactions
Increase in serum transaminases
Interstitial nephritis
Joint pain
Leucopenia
Nausea
Nephritis
Nephropathy
Paraesthesia
Prolonged bleeding
Prothrombin time increased
Pruritus
Pseudomembranous colitis
Purpura
Rash
Serum sickness-like reactions
Sore mouth
Stevens-Johnson syndrome
Thrombocytopenia
Toxic epidermal necrolysis
Urticaria
Vomiting
Effects on Laboratory Tests
Enzymatic glucose oxidase methods of testing for glucose in the urine should be used during ampicillin treatment. Chemical methods may lead to false-positive readings due to high urinary concentrations of ampicillin. Tests using bacteria, e.g. the Guthrie test for phenylketonuria using Bacilus Subtilis organisms, could also be affected in patients taking ampicillin.
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: April 2015
Reference Sources
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.
The Renal Drug Handbook. Fourth Edition (2014) ed. Ashley, C and Dunleavy, A, Radcliffe Publishing Ltd, London.
Summary of Product Characteristics: Ampicillin 250mg/5ml powder for oral suspension. Chemidex Pharma Ltd. Revised July 2014.
Summary of Product Characteristics: Ampicillin 125mg/5ml Oral Suspension BP. Kent Pharmaceuticals. Revised April 2014.
Summary of Product Characteristics: Ampicillin 250mg/5ml Oral Suspension BP. Kent Pharmaceuticals. Revised April 2014.
Summary of Product Characteristics: Ampicillin 250mg Capsules. Kent Pharmaceuticals. Revised July 2014.
Summary of Product Characteristics: Ampicillin 500mg Capsules. Kent Pharmaceuticals. Revised August 2014.
Summary of Product Characteristics: Penbritin 250mg Capsules. Chemidex Pharma Ltd. Revised September 2007.
Summary of Product Characteristics: Penbritin 500mg Capsules. Chemidex Pharma Ltd. Revised September 2007.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 20 June 2017
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Ampicillin. Last revised: 10 March, 2015.
Last accessed: 15 April, 2015.
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