Ampicillin

C difficile risk
Medium
Oral Bioavailability
Moderate (40 to 70%)

Dosing

IV/IM dosing; MalesIV/IM dosing; females 40 kg or greaterIV/IM dosing; females less than 40 kgsingle ORAL dose of 3.5 g in conjunction with 1 g probenecid1000 mg IV/IM divided into 2 doses given at an 8 to 12 hour interval500 mg IV/IM every 6 hours50 mg/kg/day IV/IM divided every 6 to 8 hours

IV/IM dosing; 40 kg or greaterIV/IM dosing; less than 40 kg500 mg ORALLY every 6 hours500 mg IV/IM every 6 hours50 mg/kg/day IV/IM in divided doses every 6 to 8 hours

IV/IM dosing; 40 kg or greaterIV/IM dosing; less than 40 kg500 mg ORALLY every 6 hours500 mg IV/IM every 6 hours50 mg/kg/day IV/IM in divided doses every 6 to 8 hours

IV/IM dosing; 40 kg or greaterIV/IM dosing; less than 40 kg250 mg ORALLY every 6 hours250 to 500 mg IV/IM every 6 hours25 to 50 mg/kg/day IV/IM divided every 6 to 8 hours

Ampicillin-susceptible Enterococcus faecalis/faecium2 g IV every 4 to 6 hours, with or without gentamicin 1 mg/kg IV every 8 hours

High-risk patients; dental, respiratory, or infected skin/skin structure or musculoskeletal tissue procedures2 g IV/IM 30 to 60 minutes prior to procedure

  • 150 to 200 mg/kg/day IV/IM divided every 3 to 4 hours 

  • (Empiric therapy) 12 g/day IV divided every 4 hours plus vancomycin and a 3rd-generation cephalosporin

  • (Definitive therapy for infection due to susceptible organism) 12 g/day IV divided every 4 hours 

  • (Definitive therapy for infection due to Enterococcus) 12 g/day IV divided every 4 hours plus gentamicin 
     

  • (Healthcare-associated meningitis due to beta-lactamase negative H influenza) 12 g/day IV divided every 4 hours

  • (Enterococcus, strains susceptible to penicillin and gentamicin) 2 g IV every 4 hours in combination with gentamicin sulfate 3 mg/kg/day IV/IM given in 2 or 3 divided doses for 4 to 6 weeks OR ceftriaxone 2 g IV every 12 hours for 6 weeks

  • (Enterococcus, strains susceptible to penicillin and gentamicin and unable to tolerate gentamicin) 2 g IV every 4 hours in combination with ceftriaxone 2 g IV every 12 hours for 6 weeks

  • (Enterococcus, strains susceptible to penicillin and streptomycin, and resistant to gentamicin) 2 g IV every 4 hours in combination with streptomycin 7.5 mg/kg IV/IM every 12 hours for 4 to 6 weeks

  • (Enterococcus, strains susceptible to penicillin and resistant to aminoglycosides) 2 g IV every 4 hours in combination with ceftriaxone 2 g IV every 12 hours for 6 weeks

Enterococcus species, penicillin-susceptible12 g IV every 24 hours continuously or in 6 divided doses for 6 weeks

2 g IV every 6 hours, with erythromycin 250 mg every 6 hours for 48 hours followed by amoxicillin 250 mg orally every 8 hours and erythromycin base 333 mg every 8 hours for 5 days

150 to 200 mg/kg/day IV for at least 3 days, then continue IM every 3 to 4 hours

2 g IV initially (started at time of labor or rupture of membranes), then 1 g IV every 4 hours until delivery

20 kg or lessgreater than 20 kgIV/IM dosing; females 40 kg or greaterIV/IM dosing; females less than 40 kg100 mg/kg/day ORALLY divided every 6 hourssingle ORAL dose of 3.5 g in conjunction with 1 g probenecid500 mg IV/IM every 6 hours50 mg/kg/day IV/IM divided every 6 to 8 hours

20 kg or lessgreater than 20 kgIV/IM dosing; less than 40 kgIV/IM dosing; 40 kg or greater100 mg/kg/day ORALLY in divided doses every 6 hours500 mg ORALLY every 6 hours50 mg/kg/day IV/IM in divided doses every 6 to 8 hours500 mg IV/IM every 6 hours

20 kg or lessgreater than 20 kgIV/IM dosing; less than 40 kgIV/IM dosing; 40 kg or greater100 mg/kg/day ORALLY in divided doses every 6 hours500 mg ORALLY every 6 hours50 mg/kg/day IV/IM in divided doses every 6 to 8 hours500 mg IV/IM every 6 hours

IV/IM Dosing; less than 40 kgIV/IM Dosing; 40 kg or greaterIV dosing; community-acquired pneumonia; older than 3 months50 mg/kg/day ORALLY divided every 6 to 8 hours; MAX 1000 mg/day25 to 50 mg/kg/day IV/IM divided every 6 to 8 hours250 to 500 mg IV/IM every 6 hours150 to 200 mg/kg/day IV in divided doses every 6 hours; resistant strains of Streptococcus pneumoniae (minimum inhibitory concentration for penicillin of 4 mcg/mL or greater), 300 to 400 mg/kg/day IV in divided doses every 6 hours (guideline dosing)

high-risk patients; dental, respiratory, or infected skin/skin structure or musculoskeletal tissue procedures50 mg/kg IV/IM 30 to 60 minutes prior to procedure; MAX 2 g/dose (guideline dose)

0 to 7 days8 to 28 daysOlder than 28 days0 to 7 days, group B Streptococcal meningitisOlder than 7 days, group B Streptococcal meningitis150 mg/kg/day IV divided every 8 hours (guideline dosage)200 mg/kg/day IV divided every 6 to 8 hours (guideline dosage)300 mg/kg/day IV divided every 6 hours (guideline dosage)200 to 300 mg/kg/day IV in 3 divided doses (expert opinion dosage)300 mg/kg/day IV in 4 to 6 divided doses (expert opinion dosage)150 to 200 mg/kg/day IV/IM divided every 3 to 4 hours (FDA dosage) [3]; higher dosage may be necessary to achieve adequate CSF concentrations (pharmacokinetic study dosage)

Native valve, relatively penicillin-resistant streptococciProsthetic valve, penicillin-susceptible streptococciProsthetic valve, relatively penicillin-resistant streptococciEnterococci or fully penicillin-resistant streptococciEnterococci, aminoglycoside-resistant or intolerant200 to 300 mg/kg/day IV in 4 to 6 equally divided doses (MAX, 12 g/day) for 4 weeks in combination with gentamicin sulfate 3 to 6 mg/kg/day IV/IM given in 3 divided doses for the first 2 weeks of therapy (guideline dosage)200 to 300 mg/kg/day IV in 4 to 6 equally divided doses (MAX ,12 g/day) for 6 weeks in combination with gentamicin sulfate 3 to 6 mg/kg/day IV/IM given in 3 divided doses for the first 2 weeks of therapy (guideline dosage)200 to 300 mg/kg/day IV in 4 to 6 equally divided doses (MAX , 12 g/day) for 6 weeks in combination with gentamicin sulfate 3 to 6 mg/kg/day IV/IM given in 3 divided doses for 6 weeks (guideline dosage)200 to 300 mg/kg/day IV in 4 to 6 equally divided doses (MAX ,12 g/day) in combination with gentamicin sulfate 3 to 6 mg/kg/day IV/IM given in 3 divided doses for 4 to 6 weeks (guideline dosage)200 to 300 mg/kg/day IV in 4 to 6 equally divided doses (MAX , 12 g/day) in combination with ceftriaxone 100 mg/kg/day IV given in 2 divided doses or 80 mg/kg IV once daily (MAX dose 4 g/day) for 4 to 6 weeks (guideline dosage)

150 to 200 mg/kg/day IV for at least 3 days, then continue IM every 3 to 4 hours

eGFR 0 - 10eGFR 10 - 50eGFR > 502g IV q12-24h2g IV q6-12h2g IV q6h

1-2g IV q12-24h

Dose after HD on dialysis days

Load 2g then 1-2g IV q6h

CrCl <10CrCl 10-30CrCl >302g IV q12-24h2g IV q8h2g IV q6h

General Information

Pathogen directed therapy for CNS, intravascular, intraabdominal, urinary and other infections especially Enterococcus and Listeria.

Allergy and rash as for all beta-lactams.

EBV related rash (not allergy).

Rare: cytopenias, +ve Coombs.

Increased risk of rash with allopurinol.

Antimicrobial class: Aminopenicillin

Pregnancy category: B

Average serum half life: 1 hour

Urine penetration: Therapeutic

Lung penetration: Therapeutic

CSF penetration: Therapeutic

Biliary penetration: Therapeutic

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