Drugs List

Therapeutic Indications

Uses

Antibiotic sensitive infections
Bacterial meningitis
Endocarditis
Group B streptococcal infection

Ampicillin is a broad spectrum penicillin indicated for a wide range of bacterial infections caused by ampicillin-sensitive organisms. Types of infection include:

Ear, nose and throat infections
Bronchitis
Pneumonia
Urinary tract infections
Gonorrhoea
Gynaecological infections
Septicaemia
Peritonitis
Endocarditis
Osteomyelitis
Meningitis
Enteric fever
Gastrointestinal infections

The sterile powder may be applied directly into wounds extraperitoneally to prevent infection following abdominal surgery.

Parenteral administration of ampicillin is indicated when oral dosing is not appropriate.

Administration

May be administered by the following routes:

Intramuscular injection
Intravenous injection (slow injection over 3-4 minutes)
Intravenous infusion (add to infusion fluids or inject, after dilution, into the drip tube over 3-4 minutes)
Intraperitoneal injection
Intrapleural injection
Intra-articular injection
Extraperitoneal application of the sterile powder

Contraindications

None known

Precautions and Warnings

Allergic disposition
Cytomegalovirus infection
Infectious mononucleosis
Restricted sodium intake
Haemodialysis
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
Erythematous rash common in glandular fever, CMV inf, lymphocytic leukaemia
Prolonged use may result in superinfection with non-susceptible organisms
May affect non-enzyme methods of urine glucose testing
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
Antibiotic-associated colitis
Cholestatic jaundice
CNS toxicity
Convulsions
Diarrhoea
Erythema multiforme
Haematological reactions
Haemolytic anaemia
Haemorrhagic colitis
Hepatitis
Hypersensitivity reactions
Increase in serum transaminases
Interstitial nephritis
Joint pain
Leucopenia
Nausea
Prolonged bleeding
Prothrombin time increased
Pruritus
Pseudomembranous colitis
Purpura
Rash
Serum sickness-like reactions
Stevens-Johnson syndrome
Thrombocytopenia
Toxic epidermal necrolysis
Urticaria
Vomiting

Presentation

Powder for solution for injection containing ampicillin

Drugs List

Therapeutic Indications

Uses

Antibiotic sensitive infections
Bacterial meningitis
Endocarditis
Group B streptococcal infection

Ampicillin is a broad spectrum penicillin indicated for a wide range of bacterial infections caused by ampicillin-sensitive organisms. Types of infection include:

Ear, nose and throat infections
Bronchitis
Pneumonia
Urinary tract infections
Gonorrhoea
Gynaecological infections
Septicaemia
Peritonitis
Endocarditis
Osteomyelitis
Meningitis
Enteric fever
Gastrointestinal infections

The sterile powder may be applied directly into wounds extraperitoneally to prevent infection following abdominal surgery.

Parenteral administration of ampicillin is indicated when oral dosing is not appropriate.

Dosage

All recommended doses are a guide only. Dosage may need to be increased in severe infections.

Adults

Children

Neonates

Patients with Renal Impairment

Administration

May be administered by the following routes:

Intramuscular injection
Intravenous injection (slow injection over 3-4 minutes)
Intravenous infusion (add to infusion fluids or inject, after dilution, into the drip tube over 3-4 minutes)
Intraperitoneal injection
Intrapleural injection
Intra-articular injection
Extraperitoneal application of the sterile powder

Contraindications

None known

Precautions and Warnings

Allergic disposition
Cytomegalovirus infection
Infectious mononucleosis
Restricted sodium intake
Haemodialysis
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
Erythematous rash common in glandular fever, CMV inf, lymphocytic leukaemia
Prolonged use may result in superinfection with non-susceptible organisms
May affect non-enzyme methods of urine glucose testing
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
Antibiotic-associated colitis
Cholestatic jaundice
CNS toxicity
Convulsions
Diarrhoea
Erythema multiforme
Haematological reactions
Haemolytic anaemia
Haemorrhagic colitis
Hepatitis
Hypersensitivity reactions
Increase in serum transaminases
Interstitial nephritis
Joint pain
Leucopenia
Nausea
Prolonged bleeding
Prothrombin time increased
Pruritus
Pseudomembranous colitis
Purpura
Rash
Serum sickness-like reactions
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.

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: August 2013

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. 3rd edition. (2009) ed. Ashley, C and Currie, Radcliffe Publishing Ltd, Abingdon.

Summary of Product Characteristics: Ampicillin 500mg Vials. Essential Generics. Revised November 2017.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 185 July 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: January 24, 2013.
Last accessed: August 6, 2013.