Ampicillin/Sulbactam: Difference between revisions
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*Excretion:  
*Excretion:  
*Mechanism of Action:
*Mechanism of Action:
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Group'''
| align="center" style="background:#f0f0f0;"|'''Organism'''
| align="center" style="background:#f0f0f0;"|'''Sensitivity'''
|-
| Gram Positive||[[Strep. Group A, B, C, G]]||'''S'''
|-
| ||[[Strep. Pneumoniae]]||'''S'''
|-
| ||[[Viridans strep]]||I
|-
| ||Strep. anginosus gp||'''S'''
|-
| ||[[Enterococcus faecalis]]||'''S'''
|-
| ||[[Enterococcus faecium]]||'''S'''
|-
| ||[[MSSA]]||'''S'''
|-
| ||[[MRSA]]||R
|-
| ||[[CA-MRSA]]||R
|-
| ||[[Staph. Epidermidis]]||R
|-
| ||[[C. jeikeium]]||R
|-
| ||[[L. monocytogenes]]||'''S'''
|-
| Gram Negatives||[[N. gonorrhoeae]]||'''S'''
|-
| ||[[N. meningitidis]]||'''S'''
|-
| ||[[Moraxella catarrhalis]]||'''S'''
|-
| ||[[H. influenzae]]||'''S'''
|-
| ||[[E. coli]]||'''S'''
|-
| ||[[Klebsiella]] sp||'''S'''
|-
| ||E. coli/Klebsiella ESBL+||R
|-
| ||E coli/Klebsiella KPC+||R
|-
| ||[[Enterobacter]] sp, AmpC neg||R
|-
| ||[[Enterobacter]] sp, AmpC pos||R
|-
| ||[[Serratia]] sp||R
|-
| ||Serratia marcescens||X1
|-
| ||[[Salmonella]] sp||'''S'''
|-
| ||[[Shigella]] sp||'''S'''
|-
| ||[[Proteus mirabilis]]||'''S'''
|-
| ||[[Proteus vulgaris]]||'''S'''
|-
| ||[[Providencia sp.]]||'''S'''
|-
| ||[[Morganella sp.]]||'''S'''
|-
| ||[[Citrobacter freundii]]||R
|-
| ||[[Citrobacter diversus]]||R
|-
| ||[[Citrobacter sp.]]||R
|-
| ||[[Aeromonas sp]]||'''S'''
|-
| ||[[Acinetobacter sp.]]||'''S'''
|-
| ||[[Pseudomonas aeruginosa]]||R
|-
| ||[[Burkholderia cepacia]]||R
|-
| ||[[Stenotrophomonas maltophilia]]||R
|-
| ||[[Yersinia enterocolitica]]||I
|-
| ||[[Francisella tularensis]]||X1
|-
| ||[[Brucella sp.]]||X1
|-
| ||[[Legionella sp.]]||R
|-
| ||[[Pasteurella multocida]]||'''S'''
|-
| ||[[Haemophilus ducreyi]]||'''S'''
|-
| ||[[Vibrio vulnificus]]||X1
|-
| Misc||[[Chlamydophila sp]]||R
|-
| ||[[Mycoplasm pneumoniae]]||R
|-
| ||[[Rickettsia sp]]||X1
|-
| ||[[Mycobacterium avium]]||X1
|-
| Anaerobes||[[Actinomyces]]||'''S'''
|-
| ||[[Bacteroides fragilis]]||'''S'''
|-
| ||[[Prevotella melaninogenica]]||'''S'''
|-
| ||[[Clostridium difficile]]||X2
|-
| ||[[Clostridium (not difficile)]]||'''S'''
|-
| ||[[Fusobacterium necrophorum]]||'''S'''
|-
| ||[[Peptostreptococcus sp.]]||'''S'''
|}
===Key===
{{Template:Antibacterial Spectra Key}}


==See Also==
==See Also==

Revision as of 03:23, 24 June 2014

General

  • Type: Amino-Penicillins
  • Dosage Forms: IM, IV
  • Common Trade Names: Unasyn

Adult Dosing

General

  • 1.5-3g IV/IM q6 hours
  • Max: 12g/day

Bite (for Pasteurella multocida Coverage)

  • 1.5-3g IM/IV q6 hours

Orbital Cellulitis

  • 3g IM/IV q6 hours

Diabetic Foot Osteomyelitis[1]

  • 3g IM/IV q6 hours

PID

Pneumonia

  • Aspiration or CAP
    • 1.5-3g IM/IV q6 hours
  • Hospital-acquired: 3g IM/IV q6 hours

UTI, Pyelonephritis

  • 3g IM/IV q6 hours x 14 days

Pediatric Dosing (<40kg)

Unasyn (ampicillin/sulbactam) is formulated at a 2:1 ratio (3g vial = 2g ampicillin + 1g sulbactam)

General[2]

  • Mild-moderate
    • 100-200mg ampicillin/kg/day IM/IV divided q6 hours
    • First Dose: 25-50mg ampicillin/kg IM/IV x 1 (37.5-75mg Unasyn/kg IM/IV x 1)
    • Max: 1000mg ampicillin (1500mg Unasyn)
  • Severe
    • 200mg ampicillin/kg/day IM/IV divided q6 hours
    • First Dose: 50mg ampicillin/kg IM/IV x 1 (75mg Unasyn/kg IM/IV x 1)
    • Max: 2000mg ampicillin (3000mg Unasyn)

Meningitis

  • 400mg ampicillin/kg/day IM/IV divided q6 hours
  • First Dose: 100mg ampicillin/kg IM/IV x 1 (150mg Unasyn/kg IM/IV x 1)
  • Max: 2000mg ampicillin (3000mg Unasyn)

Endocarditis

  • 200mg ampicillin/kg/day IM/IV divided q4-6 hours +/- gentamicin x 4-6 weeks

SSTI

  • 200mg ampicillin/kg/day IM/IV divided q6 hours

Special Populations

  • Pregnancy: B
  • Lactation: Use caution
  • Renal Dosing
    • Adult
    • Pediatric
  • Hepatic Dosing
    • Adult
    • Pediatric

Contraindications

  • Allergy to class/drug

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life:
  • Metabolism:
  • Excretion:
  • Mechanism of Action:

Antibiotic Sensitivities[3]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G S
Strep. Pneumoniae S
Viridans strep I
Strep. anginosus gp S
Enterococcus faecalis S
Enterococcus faecium S
MSSA S
MRSA R
CA-MRSA R
Staph. Epidermidis R
C. jeikeium R
L. monocytogenes S
Gram Negatives N. gonorrhoeae S
N. meningitidis S
Moraxella catarrhalis S
H. influenzae S
E. coli S
Klebsiella sp S
E. coli/Klebsiella ESBL+ R
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg R
Enterobacter sp, AmpC pos R
Serratia sp R
Serratia marcescens X1
Salmonella sp S
Shigella sp S
Proteus mirabilis S
Proteus vulgaris S
Providencia sp. S
Morganella sp. S
Citrobacter freundii R
Citrobacter diversus R
Citrobacter sp. R
Aeromonas sp S
Acinetobacter sp. S
Pseudomonas aeruginosa R
Burkholderia cepacia R
Stenotrophomonas maltophilia R
Yersinia enterocolitica I
Francisella tularensis X1
Brucella sp. X1
Legionella sp. R
Pasteurella multocida S
Haemophilus ducreyi S
Vibrio vulnificus X1
Misc Chlamydophila sp R
Mycoplasm pneumoniae R
Rickettsia sp X1
Mycobacterium avium X1
Anaerobes Actinomyces S
Bacteroides fragilis S
Prevotella melaninogenica S
Clostridium difficile X2
Clostridium (not difficile) S
Fusobacterium necrophorum S
Peptostreptococcus sp. S

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

Source

  1. ↑ Lipsky, 2004
  2. ↑ Red Book, 2012
  3. ↑ Sanford Guide to Antimicrobial Therapy 2014
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