AMPICILLIN SODIUM AND SULBACTAM SODIUM (am-pi-sill'in/sul-bak'tam) Unasyn Classifications: antiinfective; antibiotic; aminopenicillin Prototype: Ampicillin Pregnancy Category: B
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1.5 gm, 3 gm vials
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.
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.
Treatment of infections due to susceptible organisms in skin and skin structures, intraabdominal infections, and gynecologic
infections.
Hypersensitivity to penicillins; mononucleosis.
Hypersensitivity to cephalosporins; pregnancy (category B) or lactation.
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
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Intramuscular
- Reconstitute solution with sterile water for injection by adding 6.4 mL diluent to a 3 g vial. Each mL contains 250 mg ampicillin
and 125 mg sulbactam.
- Give deep IM into a large muscle. Rotate injection sites.
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 345 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.
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- Store powder for injection at 15°30° C (59°86° F) before reconstitution. Storage times and
temperatures vary for different concentrations of reconstituted solutions; consult manufacturer's directions.
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.
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 ampicillinthis interaction is primarily significant when low doses are used; ampicillin
may interfere with the contraceptive action of oral contraceptivesfemale patients should be advised to consider nonhormonal contraception while on antibiotics.
Peak: Immediate after IV. Duration: 68 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.
Assessment & Drug Effects
- Determine previous hypersensitivity reactions to penicillins, cephalosporins, and other allergens prior to therapy.
- Lab tests: Baseline C&S tests prior to initiation of therapy; start drug pending results.
- Report promptly unexplained bleeding (e.g., epistaxis, purpura, ecchymoses).
- Monitor patient carefully during the first 30 min after initiation of IV therapy for signs of hypersensitivity and anaphylactoid
reaction (see Appendix F). Serious anaphylactoid reactions require immediate use of emergency drugs and airway management.
- Observe for and report symptoms of superinfections (see Appendix F). Withhold drug and notify physician.
- Monitor I&O ratio and pattern. Report dysuria, urine retention, and hematuria.
Patient & Family Education
- Report chills, wheezing, pruritus (itching), respiratory distress, or palpitations to physician immediately.
- Do not breast feed while taking this drug without consulting physician.