Ampicillin

Indications

Ampicillin is indicated in the treatment of infections caused by susceptible strains of the designated organism listed below:
  • Infections of the Genitourinary Tract Including Gonorrhea: E. coli, P. mirabilis, enterococci, Shigella, S. typhosa and other Salmonella, and nonpenicillinase-producing N. gononhoeae.
  • Infections of the Respiratory Tract: Nonpenicillinase-producing H. influenzae and staphylococci, and streptococci including streptococcus pneumoniae.
  • Infections of the Gastrointestinal Tract: Shigella, S. typhosa and other Salmonella, E. coli, P. mirabilis, and enterococci.
  • Meningitis: O. Meningitides.
Bacteriology studies to determine the causative organisms and their sensetivity to ampicillin should be performed. Therapy may be instituted prior to the results of susceptibility testing.

Therapeutic Class

Broad spectrum penicillins

Pharmacology

Ampicillin inhibits bacterial cell wall synthesis by binding to 1 or more of the penicillin-binding proteins (PBPs) which in turn inhibit the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

Dosage

Intra-articular:
Supplement in systemic therapy for treatment of susceptible infections-
  • Adult: 500 mg daily.
  • Child: <10 yr Half of adult routine dosage.
Intraperitoneal:
Supplement in systemic therapy for treatment of susceptible infections-
  • Adult: 500 mg daily.
  • Child: <10 yr Half of adult routine dosage.
Intrapleural:
Supplement in systemic therapy for treatment of susceptible infections-
  • Adult: 500 mg daily.
  • Child: <10 yr Half of adult routine dosage
Intravenous:
Meningitis-
  • Adult: 2 gm 6 hrly.
  • Child: 150 mg/kg daily in divided doses.
Intrapartum prophylaxis against group B Streptoccocal infection in neonates-
  • Adult: Initially, 2 gm via IV inj followed by 1 gm 4 hrly until delivery.
Oral:
Biliary tract infections, Bronchitis, Endocarditis, Gastroenteritis, Listeriosis, Otitis media, Perinatal streptococcal infections, Peritonitis-
  • Adult: 0.25-1 gm 6 hrly.
  • Child: <10 yr Half of adult routine dosage.
Typhoid and paratyphoid fever-
  • Adult: 1-2 gm 6 hrly for 2 wk in acute infections, and 4-12 wk in carriers.
Uncomplicated gonorrhoea-
  • Adult: 2 gm with 1 gm of probenecid as single dose, recommended to be repeated in female patients.
Urinary tract infections-
  • Adult: 500 mg 8 hrly.
Parenteral:
Susceptible infections-
  • Adult: 500 mg 6 hrly, via IM or slow IV inj over 3-5 min or by infusion.
  • Child: <10 yr Half of adult routine dosage.
Septicaemia-
  • Adult: 150-200 mg/kg daily. Initiate with IV admin for at least 3 days, then continue with IM inj 3-4 hrly. Continue treatment for at least 48-72 hr after the patient has become asymptomatic or when there is evidence of bacterial eradication. Recommended treatment duration for infections caused by group-A β-haemolytic streptococci: At least 10-days, to prevent occurrence of acute rheumatic fever or acute glomerulonephritis.
  • Child: Same as adult dose.

Administration

Should be taken on an empty stomach. Take 1 hr before or 2 hr after meals.

Interaction

May reduce the efficacy of oral contraceptives. May alter INR while on warfarin and phenindione. May reduce the efficacy of oral typhoid vaccines. May reduce the excretion of methotrexate. Reduced excretion with probenecid and sulfinpyrazone, resulting to increased risk of toxicity. Allopurinol increases ampicillin-induced skin reactions. Reduced absorption with chloroquine. Bacteriostatic antibacterials (e.g. erythromycin, chloramphenicol, tetracycline) may interfere with the bactericidal action of ampicillin.

Contraindications

Hypersensitivity to ampicillin and other penicillins.

Side Effects

Nausea, vomiting, diarrhoea, erythematous maculo-papular rashes, sore mouth, black/hairy tongue, rash, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, angioedema, fever, joint pains, serum sickness-like symptoms, haemolytic anaemia, thrombocytopenia, leucopenia, neutropenia, coagulation disorders, prolonged bleeding time and prothrombin time, CNS toxicity (e.g. convulsions); paraesthesia, nephropathy, interstitial nephritis, hepatitis, cholestatic jaundice, moderate and transient increase in transaminases, Anaphylaxis, Clostridium difficile-associated diarrhoea (CDAD).

Pregnancy & Lactation

Pregnancy Category B. Either animal-reproduction studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters).

Precautions

Patient with history of β-lactam allergy. During renal impairment, Pregnancy and lactation.

Overdose Effects

Symptoms: Nausea, vomiting and diarrhoea.
Management: Symptomatic and supportive treatment. May be removed from the circulation by haemodialysis.

Use in Special Population

Renal Impairment: CrCl<10: Dose reduction or increase in dose interval.

Reconstitutions

Intramuscular: Add 1.5 mL water for inj to 500 mg vial contents.

Intravenous: Dissolve 500 mg in 10 mL water for inj. May be added to infusion fluids or injected, suitably diluted into the drip tube.

Intra-articular: Dissolve 500 mg in up to 5 mL of water for inj or sterile procaine HCl 0.5% soln.

Intraperitoneal: Dissolve 500 mg in up to 10 mL water for inj.

Intrapleural: Dissolve 500 mg in 5-10 mL water for inj.

Storage Conditions

Store between 20-25° C. Reconstituted oral susp: Store between 2-8° C (discard after 14 days).

Available Brand Names

  • Acmecilin Suspension
    125 mg/5 ml
    Acme Laboratories Limited
    100 ml bottle : ৳ 39.71
  • Acmecilin Capsule
    250 mg
    Acme Laboratories Limited
    Unit Price : ৳ 3.31
  • Acmecilin Injection
    250 mg/vial
    Acme Laboratories Limited
    250 mg vial : ৳ 19.43
  • Acmecilin Injection
    500 mg/vial
    Acme Laboratories Limited
    500 mg vial : ৳ 27.32
  • Amicap Capsule
    250 mg
    Albion Pharmaceuticals Ltd.
    Price not available
  • Amicillin Suspension
    125 mg/5 ml
    Reliance Pharmaceuticals Ltd.
    Price not available
  • Ampen Suspension
    125 mg/5 ml
    Jalalabad Pharmaceuticals Ltd.
    Price not available
  • Ampen Capsule
    250 mg
    Jalalabad Pharmaceuticals Ltd.
    Price not available
  • Ampen Suspension
    125 mg/5 ml
    Jalalabad Pharmaceuticals Ltd.
    Price not available
  • Ampexin Pediatric Drop
    125 mg/1.25 ml
    Opsonin Pharma Limited
    15 ml bot : ৳ 26.51
  • Ampexin Injection
    250 mg/vial
    Opsonin Pharma Limited
    250 mg vial : ৳ 17.97
  • Ampexin Injection
    500 mg/vial
    Opsonin Pharma Limited
    500 mg vial : ৳ 23.99
  • Ampi Cap Capsule
    250 mg
    Albion Pharmaceuticals Ltd.
    Price not available
  • Ampicillin Suspension
    125 mg/5 ml
    Elixir Pharmaceuticals Ltd.
    Price not available
  • Ampicillin Suspension
    125 mg/5 ml
    Essential Drugs Company Ltd.
    Price not available
  • Ampicillin Capsule
    250 mg
    Essential Drugs Company Ltd.
    Price not available
  • Ampicillin Capsule
    500 mg
    Essential Drugs Company Ltd.
    Price not available
  • Ampicillin Suspension
    125 mg/5 ml
    Pharmacil Limited
    Price not available
  • Ampimet Capsule
    250 mg
    Medimet Pharmaceuticals Ltd.
    Unit Price : ৳ 3.25
  • Ampimet Capsule
    500 mg
    Medimet Pharmaceuticals Ltd.
    Unit Price : ৳ 5.00
  • Ampimet DS Suspension
    125 mg / 5 ml
    Medimet Pharmaceuticals Ltd.
    100 ml bot : ৳ 43.75
  • Ampin Capsule
    250 mg
    Standard Laboratories Limited
    Price not available
  • Ampina Capsule
    250 mg
    Biogene Pharma Ltd.
    Price not available
  • Ampirex Capsule
    250 mg
    Jayson Pharma Ltd.
    Unit Price : ৳ 2.04
  • Ampirex Capsule
    500 mg
    Jayson Pharma Ltd.
    Price not available
  • Ampirex Suspension
    125 mg / 5 ml
    Jayson Pharma Ltd.
    100 ml bot : ৳ 33.80
  • Ampirex Injection
    250 mg/vial
    Jayson Pharma Ltd.
    250 mg vial : ৳ 16.40
  • Ampirex Injection
    500 mg/vial
    Jayson Pharma Ltd.
    500 mg vial : ৳ 22.49
  • Amposin Capsule
    250 mg
    Nipa Pharmaceuticals Ltd.
    Price not available
  • Amposin Pediatric Drop
    125 mg/1.25 ml
    Nipa Pharmaceuticals Ltd.
    Price not available
  • Amposin Suspension
    125 mg/5 ml
    Nipa Pharmaceuticals Ltd.
    Price not available
  • Apcilin Capsule
    250 mg
    Apollo Pharmaceutical Laboratories Ltd.
    Price not available
  • Avlocillin Capsule
    250 mg
    ACI Limited
    Unit Price : ৳ 2.46
  • Avlocillin Suspension
    125 mg / 5 ml
    ACI Limited
    100 ml bottle : ৳ 40.00
  • Avlocillin Injection
    250 mg/vial
    ACI Limited
    250 mg vial : ৳ 17.00
  • Avlocillin Injection
    500 mg/vial
    ACI Limited
    500 mg vial : ৳ 23.00
  • Centacillin Capsule
    250 mg
    Central Pharmaceuticals Ltd (CPL)
    Price not available
  • Duplocin Capsule
    250 mg
    Doctor’s Chemical Works Ltd.
    Price not available
  • Duplocin Suspension
    125 mg/5 ml
    Doctor’s Chemical Works Ltd.
    Price not available
  • I-Cillin Capsule
    250 mg
    Indo Bangla Pharmaceutical
    Unit Price : ৳ 3.31
  • I-Cillin Capsule
    500 mg
    Indo Bangla Pharmaceutical
    Unit Price : ৳ 6.38
  • I-Cillin Suspension
    125 mg/5 ml
    Indo Bangla Pharmaceutical
    100 ml bottle : ৳ 43.96
  • Kamocillin Capsule
    250 mg
    Kemiko Pharmaceuticals Ltd.
    Unit Price : ৳ 2.50
  • Kamocillin Suspension
    125 mg/5 ml
    Kemiko Pharmaceuticals Ltd.
    100 ml bottle : ৳ 40.00
  • Medicillin Capsule
    250 mg
    Medicon Pharmaceuticals Ltd.
    Price not available
  • Pen-A Capsule
    250 mg
    Renata Limited
    Unit Price : ৳ 2.18
  • Pen-A Injection
    500 mg/vial
    Renata Limited
    500 mg vial : ৳ 20.43
  • Penacillin Capsule
    250 mg
    Peoples Pharma Ltd.
    Price not available
  • Penacillin Suspension
    125 mg/5 ml
    Peoples Pharma Ltd.
    Price not available
  • Pentacillin Capsule
    250 mg
    GlaxoSmithKline
    Price not available
  • Pentacillin Suspension
    125 mg/5 ml
    GlaxoSmithKline
    Price not available
  • Pharmacilin Capsule
    250 mg
    Pharmadesh Laboratories Ltd.
    Price not available
  • Polycillin Capsule
    250 mg
    National Laboratories Ltd.
    Price not available
  • Reocillin Capsule
    250 mg
    Rephco Pharmaceuticals Ltd.
    Price not available
  • Seemacillin Suspension
    125 mg/5 ml
    Seema Pharmaceuticals Ltd.
    100 ml bottle : ৳ 45.00
  • Seemacillin Pediatric Drop
    125 mg/1.25 ml
    Seema Pharmaceuticals Ltd.
    15 ml drop : ৳ 17.65
  • Simpicillin Injection
    500 mg/vial
    Gaco Pharmaceuticals Ltd.
    500 mg vial : Price Unavailable
  • Skycillin Capsule
    250 mg
    Skylab Pharmaceuticals Ltd.
    Unit Price : ৳ 2.12
  • Theracillin Capsule
    250 mg
    Therapeutics Bangladesh Ltd.
    Price not available
  • Theracillin Suspension
    125 mg/5 ml
    Therapeutics Bangladesh Ltd.
    Price not available
  • Unicillin Capsule
    250 mg
    United Chemicals & Pharmaceuticals Ltd.
    Price not available