Staphylococcus aureus (methicillin susceptible), Coagulase negative Staphylococci, Streptococcus pneumoniae (penicillin susceptible), Streptococcus spp., Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitides, Neisseria gonorrhoeae, Enterobacteriaceae, E. coli
The beta-lactamase inhibitors are recognized as substrates for the beta-lactamases produced by bacteria. This allows the actual beta-lactams to attack the bacterial cell wall by binding to penicillin binding proteins
Time dependent killer (Time > MIC)
(of the sulbactam)
Dose 500mg: Cmax: 20-43 mcg/L; Protein binding: 38%; Volume of distribution: 0.16-0.5L/kg; Table 5
No new adverse effects are seen as a result of adding beta-lactamase inhibitors to beta-lactam antibiotics. The adverse reactions would remain the same for the parent compound
IV: Complete listing on Table 6
Mild/Moderate: 1.5g q6-8h
Severe: 3g q6h
Mild/Moderate: 150-300mg/kg/day divided q6h
Severe: 150-300mg/kg/day divided q6h
Renal failure: CrCl > 30mL/min: 1.5-3g q6-8h
CrCl 15-29mL: 1.5-3g q8-12h
CrCl 5-14mL/min: 1.5-3g q12-24h
Hepatic failure: No dosing changes recommended at this time.
CVVH (Continuous venovenous hemofiltration): 3g IV q12h
CVVHD (Continuous venovenous hemodialysis): 3g IV q8h
CVVHDF (Continuous venovenous hemodiafiltration) 3g IV q8h
Note: CVVH is mainly for fluid removal alone. Many institutions will employ more CVVHD or CVVHDF which combine dialysis with fluid removal.
Precautions: hypersensitivity to penicillins, history of gastrointestinal disease, particularly colitis, renal impairment
Allopurinol – higher probablility of ampicillin rash; Atenolol – decreased atenolol effectiveness; Contraceptives - decreased contraceptive effectiveness; Lansoprazole – loss of ampicillin efficacy; Live Typhoid Vaccine - decreased immunological response to the typhoid vaccine; Omeprazole – loss of ampicillin efficacy; Pantoprazole – loss of ampicillin efficacy; Probenecid - increased ampicillin levels; Rabeprazole – loss of ampicillin efficacy
Category B: No evidence of risk in humans but studies inadequate.
Therapeutic: Culture and sensitivities, serum levels, signs and symptoms of infection, white blood cell count
Toxic: Urinalysis, BUN, SCr, AST and ALT, skin rash, Neutropenia and leukopenia,