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1 Contraindications/Precautions
Contraindicated in: Hypersensitivity to penicillins. PDF Page #1
ampicillin (am-pi-sil-in) Use Cautiously in: Severe renal insufficiency (doseprequired if CCr ⬍10 mL/
Classification min); Infectious mononucleosis, acute lymphocytic leukemia or cytomegalovirus in-
Therapeutic: anti-infectives fection (qincidence of rash); Patients allergic to cephalosporins; OB: Has been used
Pharmacologic: aminopenicillins during pregnancy; Lactation: Distributed into breast milk. Can cause rash, diar-
Pregnancy Category B rhea, and sensitization in the infant.
Adverse Reactions/Side Effects
Indications CNS: SEIZURES (high doses). GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea,
Treatment of the following infections: Skin and skin structure infections, Soft-tissue vomiting. Derm: rash, urticaria. Hemat: blood dyscrasias. Misc: allergic reac-
infections, Otitis media, Sinusitis, Respiratory infections, Genitourinary infections, tions including ANAPHYLAXIS and SERUM SICKNESS, superinfection.
Meningitis, Septicemia. Endocarditis prophylaxis. Unlabeled Use: Prevention of
infection in certain high-risk patients undergoing cesarean section. Interactions
Drug-Drug: Probenecidprenal excretion andqblood levels of ampicillin—
Action therapy may be combined for this purpose. Large doses mayqthe risk of bleeding
Binds to bacterial cell wall, resulting in cell death. Therapeutic Effects: Bacteri-
cidal action; spectrum is broader than penicillin. Spectrum: Active against: Strep- with warfarin.qrisk of with concurrent allopurinol therapy. Maypthe effective-
tococci, nonpenicillinase-producing staphylococci, Listeria, Pneumococci, Entero- ness of oral hormonal contraceptives.
cocci, Haemophilus influenzae, Escherichia coli, Enterobacter, Klebsiella, Route/Dosage
Proteus mirabilis, Neisseria meningitidis, N. gonorrhoeae, Shigella, Salmonella.
Respiratory and Soft-Tissue Infections
Pharmacokinetics PO (Adults and Children ⱖ20 kg): 250– 500 mg q 6 hr.
Absorption: Moderately absorbed from the duodenum (30– 50%). PO (Children ⬍20 kg): 50– 100 mg/kg/day in divided doses q 6– 8 hr (not to ex-
Distribution: Diffuses readily into body tissues and fluids. CSF penetration isqin ceed 2– 3 g/day).
the presence of inflamed meninges. Crosses the placenta; enters breast milk in small
amounts. IM, IV (Adults and Children ⱖ40 kg ): 500 mg to 3 g q 6 hr (not to exceed 14 g/
Metabolism and Excretion: Variably metabolized by the liver (12– 50%). Re- day).
nal excretion is variable (25– 60% after oral dosing; 50– 85% after IM administra- IM, IV (Children ⬍40 kg): 100– 200 mg/kg/day in divided doses q 6– 8 hr (not to
tion). exceed 12 g/day).
Half-life: Neonates: 1.7– 4 hr; Children and Adults: 1– 1.5 hr (qin renal impair- Bacterial Meningitis Caused by H. influenzae, Streptococcus pneu-
ment). moniae, Group B streptococcus or N. meningitidis or Septicemia
TIME/ACTION PROFILE (blood levels) IM, IV (Adults): 500 mg to 3 g q 6 hr (not to exceed 14 g/day).
ROUTE ONSET PEAK DURATION IM, IV (Children ⬎1 mo): 200– 400 mg/kg/day in divided doses q 6 hr (not to ex-
PO rapid 1.5–2 hr 4–6 hr ceed 12 g/day).
IM rapid 1 hr 4–6 hr IM, IV (Neonates ⱕ7 days): 200 mg/kg/day divided q 8 hr.
IV rapid end of infusion 4–6 hr IM, IV (Neonates ⬎7 days): 300 mg/kg/day divided q 6 hr.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
Name /bks_53161_deglins_md_disk/ampicillin 02/17/2014 01:27PM
2 care professional immediately if these occur. Keep epinephrine, an anti-
GI/GU Infections Other Than N. gonorrhoeae
PO (Adults and Children ⬎20 kg): 250– 500 mg q 6 hr (larger doses for more
serious/chronic infections).
PO (Children ⱕ20 kg): 50– 100 mg/kg/day in divided doses q 6 hr.
N. gonorrhoeae
PO (Adults): 3 g with 1 g probenecid.
IM, IV (Adults and Children ⱖ40 kg ): 500 mg q 6 hr.
IM, IV (Children ⬍40 kg): 100– 200 mg/kg/day in divided doses q 6– 8 hr.
Urethritis Caused by N. gonorrhoeae in Men
IM, IV (Adults and Children ⱖ40 kg ): 500 mg, repeated 8– 12 hr later; addi-
tional doses may be necessary for more complicated infections (prostatitis, epidi-
dymitis).
Prevention of Bacterial Endocarditis
IM, IV (Adults): 2 g 30 min before procedure (gentamicin may be added for high-
risk patients); additional 1 g may be given 6 hr later for high-risk patients.
IM, IV (Children): 50 mg/kg (not to exceed 2 g) 30 min before procedure (genta-
micin may be added for high-risk patients); additional 25 mg/kg may be given 6 hr
later for high-risk patients.
Renal Impairment
(Adults and Children): CCr ⱕ10 mL/min—qdosing interval to q 12 hr.
NURSING IMPLICATIONS
Assessment
● Assess patient for infection (vital signs, wound appearance, sputum, urine, stool,
and WBC) at beginning of and throughout therapy.
● Obtain a history before initiating therapy to determine previous use and reactions
to penicillins or cephalosporins. Persons with a negative history of penicillin sen-
sitivity may still have an allergic response.
● Obtain specimens for culture and sensitivity before therapy. First dose may be
given before receiving results.
● Observe patient for signs and symptoms of anaphylaxis (rash, pruritus,
laryngeal edema, wheezing). Discontinue the drug and notify health
Plate # 0-Composite pg 2 # 2
histamine, and resuscitation equipment close by in the event of an ana-
phylactic reaction. PDF Page #2
● Monitor bowel function. Diarrhea, abdominal cramping, fever, and
bloody stools should be reported to health care professional promptly
as a sign of pseudomembranous colitis. May begin up to several weeks
following cessation of therapy.
● Assess skin for “ampicillin rash,” a nonallergic, dull red, macular or maculopapu-
lar, mildly pruritic rash.
● Lab Test Considerations: May causeqAST and ALT. May cause transientpes-
tradiol, total conjugated estriol, estriol-glucuronide, or conjugated estrone in
pregnant women., May cause a false-positive direct Coombs’ test result., May
cause a false-positive urinary glucose.
Potential Nursing Diagnoses
Risk for infection (Indications) (Side Effects)
Noncompliance (Patient/Family Teaching)
Implementation
● Reserve IM or IV route for moderately severe or severe infections or patients un-
able to take oral medication. Change to PO as soon as possible.
● PO: Administer around the clock on an empty stomach at least 1 hr before or 2 hr
after meals with a full glass of water. Capsules may be opened and mixed with wa-
ter. Reconstituted oral suspensions retain potency for 7 days at room temperature
and 14 days if refrigerated. Combination with probenecid should be used immedi-
ately after reconstitution.
● IM: Reconstitute for IM or IV use by adding sterile water for injection 0.9– 1.2 mL
to the 125-mg vial, 0.9– 1.9 mL to the 250-mg vial, 1.2– 1.8 mL to the 500-mg vial,
2.4– 7.4 mL to the 1-g vial, and 6.8 mL to the 2-g vial.
IV Administration
● pH: 8– 10.
● Direct IV: Add 5 mL of sterile water for injection to each 125-, 250-, or 500-mg
vial or at least 7.4– 10 mL of diluent to each 1- or 2-g vial. Solution should be used
within 1 hr of reconstitution. Rate: Doses of 125– 500 mg may be given over 3–
5 min (not to exceed 100 mg/min). Rapid administration may cause seizures.
● Intermittent Infusion: Diluent: Reconstitute vials as per the directions above.
Further dilute in 50 mL or more of 0.9% NaCl, D5W, D5/0.45% NaCl, or LR. Ad-
minister within 4 hr (more stable in NaCl). Concentration: Not to exceed 30
mg/mL. Rate: Infuse over 10– 15 min.
䉷 2015 F.A. Davis Company CONTINUED
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3 not to treat diarrhea without consulting health care professional. May

occur up to several weeks after discontinuation of medication.
PDF Page #3
CONTINUED ● Instruct the patient to notify health care professional if symptoms do not improve.
● Patients with a history of rheumatic heart disease or valve replacement need to be
ampicillin taught the importance of using antimicrobial prophylaxis before invasive medical
or dental procedures.
● Y-Site Compatibility: acyclovir, alemtuzumab, alprostadil, amifostine, anidula- ● Advise patients taking oral contraceptives to use an alternate or additional non-
fungin, argatroban, bivalirudin, bleomycin, carboplatin, carmustine, cisplatin, cy- hormonal method of contraception while taking ampicillin and until next men-
clophosphamide, cytarabine, dactinomycin, daptomycin, dexmedetomidine, do- strual period.
cetaxel, doxacurium, doxapram, doxorubicin liposome, eptifibatide, etoposide, ● Advise female patient to notify health care professional if breast feeding.
etoposide phosphate, filgrastim, fludarabine, fluorouracil, foscarnet, gemcita-
bine, granisetron, hetastarch, ifosfamide, irinotecan, levofloxacin, linezolid, Evaluation/Desired Outcomes
mechlorethamine, melphalan, methotrexate, metronidazole, milrinone, octreo- ● Resolution of the signs and symptoms of infection. Length of time for complete res-
tide, oxaliplatin, paclitaxel, palonosetron, pamidronate, pancuronium, pantopra- olution depends on the organism and site of infection.
zole, pemetrexed, perphenazine, potassium acetate, propofol, remifentanil, ritux- ● Endocarditis prophylaxis.
imab, rocuronium, sodium acetate, teniposide, thiotepa, tigecycline, tirofiban,
trastuzumab, vecuronium, vincristine, vitamin B complex with C, voriconazole, zo- Why was this drug prescribed for your patient?
ledronic acid.
● Y-Site Incompatibility: If aminoglycosides and penicillins must be adminis-
tered concurrently, administer in separate sites at least 1 hr apart. aminophylline,
amphotericin B cholesterol, amphotericin B colloidal, amphotericin B lipid com-
plex, amphotericin B liposome, buprenorphine, caspofungin, chlorpromazine,
dantrolene, diazepam, diazoxide, diphenhydramine, dobutamine, dopamine,
doxorubicin hydrochloride, doxycycline, epirubicin, fenoldopam, fluconazole,
ganciclovir, haloperidol, hydroxyzine, idarubicin, ketamine, lorazepam, midazo-
lam, mitoxantrone, mycophenolate, nafcillin, nesiritide, nicardipine, nitroprus-
side, ondansetron, papaverine, penicillin G potassium, pentamidine, pentazocine,
pentobarbital, phenobarbital, phenytoin, prochlorperazine, promethazine, prot-
amine, quinupristin/dalfopristin, sargramostim, sodium bicarbonate, tranexamic
acid, trimethoprim/sulfamethoxazole, verapamil, vinorelbine
Patient/Family Teaching
● Instruct patient to take medication around the clock and to finish the drug com-
pletely as directed, even if feeling better. Advise patients that sharing of this medi-
cation can be dangerous.
● Advise patient to report the signs of superinfection (furry overgrowth on the
tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy.
● Caution patient to notify health care professional if fever and diarrhea
occur, especially if stool contains blood, pus, or mucus. Advise patient
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.