AMPICILLIN SODIUM AND SULBACTAM SODIUM
(am-pi-sill'in/sul-bak'tam)
Unasyn
Classifications: antiinfective; antibiotic; aminopenicillin
Prototype: Ampicillin
Pregnancy Category: B

Availability

1.5 gm, 3 gm vials

Actions

Antibiotic agent with activity resulting from beta-lactamase inhibition. Sulbactam inhibits beta-lactamases most frequently responsible for transferred drug resistance. Because of this action, a wide range of beta-lactamases found in organisms resistant to penicillins and cephalosporins have their growth inhibited.

Therapeutic Effects

Effective against both gram-positive and gram-negative bacteria including those that produce beta-lactamase and nonbeta-lactamase producers. Ampicillin without sulbactam is not effective against beta-lactamase producing strains.

Uses

Treatment of infections due to susceptible organisms in skin and skin structures, intraabdominal infections, and gynecologic infections.

Contraindications

Hypersensitivity to penicillins; mononucleosis.

Cautious Use

Hypersensitivity to cephalosporins; pregnancy (category B) or lactation.

Route & Dosage

Systemic Infections
Adult/Child: IV/IM 40 kg, 1.5 (1 g ampicillin, 0.5 g sulbactam) to 3 g (2 g ampicillin, 1 g sulbactam) q6h (max: 4 g sulbactam/d)
Child: IV 1 y, 300 mg/kg/d (200 mg/kg ampicillin and 100 mg/kg sulbactam) divided q6h

Administration

Intramuscular
Intravenous

PREPARE: Direct/Intermittent: Reconstitute each 1.5 g with 3.2 mL of sterile water for injection to yield 375 mg/mL (250 mg ampicillin/125 mg sulbactam); further dilute with NS, D5W, D5/NS, D5W/0.45NS, or RL to a final concentration within the range of 3–45 mg/mL.  

ADMINISTER: Direct/Intermittent : Give slowly over at least 15 min. • With solutions of 100 mL or more, set rate according to amount of solution but no faster than direct IV rate. • Convulsions may be induced by too rapid administration. • Use only freshly prepared solution; administer within 1 h after preparation. 

INCOMPATIBILITIES Solution/additive: Do not add to a dextrose-containing solution unless entire dose is given within 1 h of preparation. Y-site: Amiodarone.

Adverse Effects (1%)

Body as a Whole: Hypersensitivity (rash, itching, anaphylactoid reaction), fatigue, malaise, headache, chills, edema. GI: Diarrhea, nausea, vomiting, abdominal distention, candidiasis. Hematologic: Neutropenia, thrombocytopenia. Urogenital: Dysuria. CNS: Seizures. Other: Local pain at injection site; thrombophlebitis.

Interactions

Drug: Allopurinol increases incidence of rash; effectiveness of the aminoglycosides may be impaired in patients with severe end stage renal disease; chloramphenicol, erythromycin, tetracycline may reduce bactericidal effects of ampicillin—this interaction is primarily significant when low doses are used; ampicillin may interfere with the contraceptive action of oral contraceptives—female patients should be advised to consider nonhormonal contraception while on antibiotics.

Pharmacokinetics

Peak: Immediate after IV. Duration: 6–8 h. Distribution: Most body tissues; high CNS concentrations only with inflamed meninges; crosses placenta; appears in breast milk. Metabolism: Minimal hepatic metabolism. Elimination: Excreted in urine. Half-Life: 1 h.

Nursing Implications

Assessment & Drug Effects

Patient & Family Education


Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug