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ampicillin sodium injection, powder, for solution
----------Ampicillin 1 gm Injection, USP Vial
To reduce the development of drug-resistant bacteria and maintain the effectiveness of Ampicillin and other antibacterial drugs, Ampicillin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.
Ampicillin for Injection, USP the monosodium salt of [2S-[2a, 5a, 6b(S*)]]-6-[(aminophenylacetyl)amino]-3,3-dimethyl-7-oxo-4-thia-1-azabicyclo[3.2.0]heptane-2-carboxylic acid, is a synthetic penicillin. It is an antibacterial agent with a broad spectrum of bactericidal activity against both penicillin-susceptible Gram-positive organisms and many common Gram-negative pathogens. It has the following structural formula:
The molecular formula is C16H18N3NaO4S, and the molecular weight is 371.39. Ampicillin for Injection, USP contains 2.9 milliequivalents of sodium per 1 gram of drug. Ampicillin for Injection, USP is supplied in vials equivalent to 10 g of ampicillin. A pharmacy bulk package is a container of a sterile preparation for parenteral use that contains many single doses. The contents are intended for use in a pharmacy admixture service and are restricted to the preparation of admixtures for intravenous infusion (See DOSAGE AND ADMINISTRATION, Directions for Proper Use of PHARMACY BULK PACKAGE).
Ampicillin diffuses readily into most body tissues and fluids. However, penetration into the cerebrospinal fluid and brain occurs only when the meninges are inflamed. Ampicillin is excreted largely unchanged in the urine and its excretion can be delayed by concurrent administration of probenecid. The active form appears in the bile in higher concentrations than those found in serum. Ampicillin is the least serum-bound of all the penicillins, averaging about 20% compared to approximately 60 to 90% for other penicillins. Ampicillin is well tolerated by most patients and has been given in doses of 2 grams daily for many weeks without adverse reactions.
Microbiology: While in vitro studies have demonstrated the susceptibility of most strains of the following organisms, clinical efficacy for infections other than those included in the INDICATIONS AND USAGE section has not been demonstrated. The following bacteria have been shown in in vitro studies to be susceptible to ampicillin:
GRAM-POSITIVE ORGANISMS: Hemolytic and nonhemolytic streptococci, D. pneumoniae, non-penicillinase-producing staphylococci, Clostridia spp., B. anthracis, Listeria monocytogenes, and most strains of enterococci.
GRAM-NEGATIVE ORGANISMS: H. influenzae, N. gonorrhoeae, N. meningitidis, Proteus mirabilis, and many strains of Salmonella, Shigella, and E. coli.
Susceptibility Tests: Ampicillin Susceptibility Test Discs, 10 mcg., should be used to estimate the in vitro susceptibility of bacteria to ampicillin.
Indications and Usage
To reduce the development of drug-resistant bacteria and maintain the effectiveness of Ampicillin and other antibacterial drugs, Ampicillin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy. Ampicillin is indicated in the treatment of infections caused by susceptible strains of the designated organisms in the conditions listed below:
Respiratory Tract Infections caused by S. pneumoniae (formerly D. pneumoniae), Staphylococcus aureus (penicillinase and nonpenicillinase producing), H. influenzae and Group A beta-hemolytic streptococci.
Bacterial Meningitis caused by E. coli, Group B Streptococci, and other Gram-negative bacteria (Listeria monocytogenes, N. meningitidis). The addition of an aminoglycoside with ampicillin may increase its effectiveness against Gram-negative bacteria.
Septicemia and Endocarditis caused by susceptible Gram-positive organisms including Streptococcus spp., penicillin-G-susceptible staphylococci and enterococci. Gram-negative sepsis caused by E. coli, Proteus mirabilis and Salmonella spp. respond to ampicillin. Endocarditis due to enterococcal strains usually respond to intravenous therapy. The addition of an aminoglycoside may enhance the effectiveness of ampicillin when treating streptococcal endocarditis.
Urinary Tract Infections caused by sensitive strains of E. coli and Proteus mirabilis.
Gastrointestinal Infections caused by Salmonella typhosa (typhoid fever), other Salmonella spp. and Shigella spp. (dysentery) usually respond to oral or intravenous therapy.
A history of a previous hypersensitivity reaction to any of the penicillins is a contraindication.
Serious and occasionally fatal hypersensitivity (anaphylactoid) reactions have been reported in patients on penicillin therapy. Although anaphylaxis is more frequent following parenteral therapy, it has occurred in patients on oral penicillins. These reactions are more apt to occur in individuals with a history of penicillin hypersensitivity and/or a history of sensitivity to multiple allergens.
SERIOUS ANAPHYLACTOID REACTIONS REQUIRE IMMEDIATE EMERGENCY TREATMENT WITH EPINEPHRINE, OXYGEN, INTRAVENOUS STEROIDS, AND AIRWAY MANAGEMENT, INCLUDING INTUBATION, SHOULD ALSO BE ADMINISTERED AS INDICATED.
General: Prescribing Ampicillin in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria. The possibility of superinfections with mycotic organisms or bacterial pathogens should be kept in mind during therapy. In such cases,
Information for Patients: Patients should be counseled that antibacterial drugs including Ampicillin should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When Ampicillin is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by Ampicillin or other antibacterial drugs in the future.
Laboratory Tests: As with any potent drug, periodic assessment of organ system function, including renal, hepatic and hematopoietic, should be made during prolonged therapy.
Drug Interactions: The concurrent administration of allopurinol and ampicillin increases substantially the incidence of skin rashes in patients receiving both drugs as compared to patients receiving ampicillin alone. It is not known whether this potentiation of ampicillin rashes is due to allopurinol or the hyperuricemia present in these patients.
Drug/Laboratory Test Interactions: With high urine concentrations of ampicillin, false-positive glucose reactions may occur if Clinitest, Benedict's Solution, or Fehling's Solution are used. Therefore, it is recommended that glucose tests based on enzymatic glucose oxidase reactions (such as Clinistix or Tes-Tape) be used.
Carcinogenesis, Mutagenesis and Impairment of Fertility: No long-term animal studies have been conducted with this drug.
Pregnancy category B: Reproduction studies have been performed in laboratory animals at doses several times the human dose and have revealed no evidence of adverse effects due to ampicillin. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.
Labor and Delivery: Oral ampicillin-class antibiotics are poorly absorbed during labor. Studies in guinea pigs showed that intravenous administration of ampicillin slightly decreased the uterine tone and frequency of contractions, but moderately increased the height and duration of contractions. However, it is not known whether use of these drugs in humans during labor or delivery has immediate or delayed adverse effects on the fetus, prolongs the duration of labor, or increases the likelihood that forceps delivery or other obstetrical intervention of resuscitation of the newborn will be necessary.
Nursing Mothers: Ampicillin is excreted in trace amounts in human milk. Therefore, caution should be exercised when ampicillinclass antibiotics are administered to a nursing woman.
As with other penicillins, it may be expected that untoward reactions will be essentially limited to sensitivity phenomena. They are more likely to occur in individuals who have previously demonstrated hypersensitivity to penicillins and in those with a history of allergy, asthma, hay fever or urticaria The following adverse reactions have been reported as associated with the use of ampicillin:
Gastrointestinal: Glossitis, stomatitis, black “hairy” tongue, nausea, vomiting, enterocolitis, pseudomembranous colitis, and diarrhea. (These reactions are usually associated with oral dosage forms.)
Hypersensitivity Reactions: Skin rashes and urticaria have been reported frequently. A few cases of exfoliative dermatitis and erythema multiforme have been reported. Anaphylaxis is the most serious reaction experienced and has usually been associated with the parenteral dosage form.
Liver: A moderate rise in serum glutamic oxaloacetic transminase (SGOT) has been noted, particularly in infants, but the significance of this finding is unknown. Mild transitory SGOT elevations have been observed in individuals receiving larger (two to four times) than usual and oft-repeated intramuscular injections. Evidence indicates that glutamic oxaloacetic transaminase (GOT) is released at the site of intramuscular injection of Ampicillin for Injection and that the presence of increased amounts of this enzyme in the blood does not necessarily indicate liver involvement.
Hemic and Lymphatic Systems: Anemia, thrombocytopenia, thrombocytopenic purpura, eosinophilia, leukopenia, and agranulocytosis have been reported during therapy with the penicillins. These reactions are usually reversible on discontinuation of therapy and are believed to be hypersensitivity phenomena.
In cases of overdose, discontinue medication, treat symptomatically and institute supportive measures as required. In patients with renal function impairment, ampicillin-class antibiotics can be removed by hemodialysis but not peritoneal dialysis.
Dosage and Administration
Infections of the respiratory tract and soft tissues.
Urethritis in males due to N. gonorrhoeae:
Use only freshly prepared solutions. Intramuscular and intravenous injections should be administered within on hour after preparation, since the potency may decrease significantly after this period.
For Intramuscular Use
Dissolve contents of vial with the amount of Sterile Water for Injection or Bacteriostatic Water for Injection listed in the table below.
For Direct Intravenous Use
Add 5 mL Sterile Water for Injection or Bacteriostatic Water for Injection to the 250 and 500 mg vials and administer slowly over a 3 to 5 minute period. Ampicillin for Injection, 1 g or 2 g, may also be given by direct intravenous administration. Dissolve in 7.4 or 14.8 mL Sterile Water for Injection or Bacteriostatic Water for Injection, respectively, and administer slowly over at least 10 to 15 minutes. CAUTION: More rapid administration may result in convulsive seizures.
For Administration by Intravenous Drip
Reconstitute as direct above (For Direct Intravenous Use) prior to diluting with intravenous solution. Stability studies on ampicillin at several concentrations in various intravenous solutions indicated the drug will lose less than 10% activity at the temperatures noted for the time periods stated.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
Ampicillin for Injection, USP for IM or IV injection. Ampicillin sodium equivalent to 150, 500 mg, 1 or 2 grams ampicillin per vial.
Packaged in tens.
Store at controlled room temperature 15o-30o C (59o-86o F).
Vial stoppers do not contain natural rubber latex.
APP, American Pharmaceutical Partners
Schaumberg, IL 60173
Made in Italy
Revised April 2003
Revised: 04/2011 General Injectables & Vaccines, Inc
Reproduced with permission of U.S. National Library of Medicine
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