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ampicillin (am-pi-sil-in)
Contraindications/Precautions
Contraindicated in: Hypersensitivity to penicillins.
Use Cautiously in: Severe renal insufficiency (doseprequired if CCr ⬍10 mL/
Classification
Therapeutic: anti-infectives
Pharmacologic: aminopenicillins
Pregnancy Category B
min); Infectious mononucleosis, acute lymphocytic leukemia or cytomegalovirus infection (qincidence of rash); Patients allergic to cephalosporins; OB: Has been used
during pregnancy; Lactation: Distributed into breast milk. Can cause rash, diarrhea, and sensitization in the infant.
Indications
Adverse Reactions/Side Effects
CNS: SEIZURES (high doses). GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea,
vomiting. Derm: rash, urticaria. Hemat: blood dyscrasias. Misc: allergic reac-
1
Treatment of the following infections: Skin and skin structure infections, Soft-tissue
infections, Otitis media, Sinusitis, Respiratory infections, Genitourinary infections,
Meningitis, Septicemia. Endocarditis prophylaxis. Unlabeled Use: Prevention of
infection in certain high-risk patients undergoing cesarean section.
Action
Binds to bacterial cell wall, resulting in cell death. Therapeutic Effects: Bactericidal action; spectrum is broader than penicillin. Spectrum: Active against: Streptococci, nonpenicillinase-producing staphylococci, Listeria, Pneumococci, Enterococci, Haemophilus influenzae, Escherichia coli, Enterobacter, Klebsiella,
Proteus mirabilis, Neisseria meningitidis, N. gonorrhoeae, Shigella, Salmonella.
Pharmacokinetics
Absorption: Moderately absorbed from the duodenum (30– 50%).
Distribution: Diffuses readily into body tissues and fluids. CSF penetration isqin
the presence of inflamed meninges. Crosses the placenta; enters breast milk in small
amounts.
Metabolism and Excretion: Variably metabolized by the liver (12– 50%). Renal excretion is variable (25– 60% after oral dosing; 50– 85% after IM administration).
Half-life: Neonates: 1.7– 4 hr; Children and Adults: 1– 1.5 hr (qin renal impairment).
TIME/ACTION PROFILE (blood levels)
ROUTE
ONSET
PEAK
DURATION
PO
IM
IV
rapid
rapid
rapid
1.5–2 hr
1 hr
end of infusion
4–6 hr
4–6 hr
4–6 hr
⫽ Canadian drug name.
⫽ Genetic Implication.
tions including ANAPHYLAXIS and SERUM SICKNESS, superinfection.
Interactions
Drug-Drug: Probenecidprenal excretion andqblood levels of ampicillin—
therapy may be combined for this purpose. Large doses mayqthe risk of bleeding
with warfarin.qrisk of with concurrent allopurinol therapy. Maypthe effectiveness of oral hormonal contraceptives.
Route/Dosage
Respiratory and Soft-Tissue Infections
PO (Adults and Children ⱖ20 kg): 250– 500 mg q 6 hr.
PO (Children ⬍20 kg): 50– 100 mg/kg/day in divided doses q 6– 8 hr (not to exceed 2– 3 g/day).
IM, IV (Adults and Children ⱖ40 kg ): 500 mg to 3 g q 6 hr (not to exceed 14 g/
day).
IM, IV (Children ⬍40 kg): 100– 200 mg/kg/day in divided doses q 6– 8 hr (not to
exceed 12 g/day).
Bacterial Meningitis Caused by H. influenzae, Streptococcus pneumoniae, Group B streptococcus or N. meningitidis or Septicemia
IM, IV (Adults): 500 mg to 3 g q 6 hr (not to exceed 14 g/day).
IM, IV (Children ⬎1 mo): 200– 400 mg/kg/day in divided doses q 6 hr (not to exceed 12 g/day).
IM, IV (Neonates ⱕ7 days): 200 mg/kg/day divided q 8 hr.
IM, IV (Neonates ⬎7 days): 300 mg/kg/day divided q 6 hr.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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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
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care professional immediately if these occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.
● 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 maculopapular, mildly pruritic rash.
● Lab Test Considerations: May causeqAST and ALT. May cause transientpestradiol, 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.
IM, IV (Adults and Children ⱖ40 kg ): 500 mg, repeated 8– 12 hr later; additional doses may be necessary for more complicated infections (prostatitis, epididymitis).
Potential Nursing Diagnoses
Prevention of Bacterial Endocarditis
Implementation
IM, IV (Adults): 2 g 30 min before procedure (gentamicin may be added for highrisk 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 (gentamicin 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 sensitivity 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
pg 2 # 2
Risk for infection (Indications) (Side Effects)
Noncompliance (Patient/Family Teaching)
● 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 water. Reconstituted oral suspensions retain potency for 7 days at room temperature
and 14 days if refrigerated. Combination with probenecid should be used immediately 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. Administer 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
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CONTINUED
ampicillin
●
●
● Y-Site Compatibility: acyclovir, alemtuzumab, alprostadil, amifostine, anidula-
●
fungin, argatroban, bivalirudin, bleomycin, carboplatin, carmustine, cisplatin, cyclophosphamide, cytarabine, dactinomycin, daptomycin, dexmedetomidine, docetaxel, doxacurium, doxapram, doxorubicin liposome, eptifibatide, etoposide,
etoposide phosphate, filgrastim, fludarabine, fluorouracil, foscarnet, gemcitabine, granisetron, hetastarch, ifosfamide, irinotecan, levofloxacin, linezolid,
mechlorethamine, melphalan, methotrexate, metronidazole, milrinone, octreotide, oxaliplatin, paclitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, pemetrexed, perphenazine, potassium acetate, propofol, remifentanil, rituximab, rocuronium, sodium acetate, teniposide, thiotepa, tigecycline, tirofiban,
trastuzumab, vecuronium, vincristine, vitamin B complex with C, voriconazole, zoledronic acid.
● Y-Site Incompatibility: If aminoglycosides and penicillins must be administered concurrently, administer in separate sites at least 1 hr apart. aminophylline,
amphotericin B cholesterol, amphotericin B colloidal, amphotericin B lipid complex, amphotericin B liposome, buprenorphine, caspofungin, chlorpromazine,
dantrolene, diazepam, diazoxide, diphenhydramine, dobutamine, dopamine,
doxorubicin hydrochloride, doxycycline, epirubicin, fenoldopam, fluconazole,
ganciclovir, haloperidol, hydroxyzine, idarubicin, ketamine, lorazepam, midazolam, mitoxantrone, mycophenolate, nafcillin, nesiritide, nicardipine, nitroprusside, ondansetron, papaverine, penicillin G potassium, pentamidine, pentazocine,
pentobarbital, phenobarbital, phenytoin, prochlorperazine, promethazine, protamine, quinupristin/dalfopristin, sargramostim, sodium bicarbonate, tranexamic
acid, trimethoprim/sulfamethoxazole, verapamil, vinorelbine
●
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not to treat diarrhea without consulting health care professional. May
occur up to several weeks after discontinuation of medication.
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
taught the importance of using antimicrobial prophylaxis before invasive medical
or dental procedures.
Advise patients taking oral contraceptives to use an alternate or additional nonhormonal method of contraception while taking ampicillin and until next menstrual period.
Advise female patient to notify health care professional if breast feeding.
Evaluation/Desired Outcomes
● Resolution of the signs and symptoms of infection. Length of time for complete res-
olution depends on the organism and site of infection.
● Endocarditis prophylaxis.
Why was this drug prescribed for your patient?
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 medication 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.
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