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Ampicillin Sulbactam/Unasyn

(see also: Penicillin Family / Ampicillin / Aumentin)

Discussion

  • for beta lactamase producing Staph aereus, Eneterococcus, H. influenza, Klebsiella, Proteus mirablis, Bacteroides
  • adult: 1.5-3 gm IM/IV q6hr (2:1 ampicillin sodium:sulbactam) adjust w/ Renal failure;
  • good diffusion from blood into CSF only with inflammation;
  • inflammed meninges: 5-10;
  • peds: Dosed as Ampicillin;
  • supplied: Powder for Injection 1.5 gm, 3.0 gm vials;

sulbactam

  • is semisynthetic beta-lactamase inhibitor w/ activity against a broad range of beta-lactamases, including those produced by bacteroides,
    Haemophilus, Klebsiella, E. coli, and N. gonorrhoeae;
  • it is currently available as parenteral preparation in combination w/ ampicillin (Unasyn -- 2 g of ampicillin and 1.0 g of sulbactam);
  • given every six hours, combination has been successful in treatment of variety of infections, including intraabdominal & pelvic infections,
    infections of skin, soft tissue, and bones and joints, and uncomplicated urethritis caused by pen-sensitive and pen-resistant N. gonorrhoeae;

cautions

  • dosing regimens for patients with renal insufficiency;
  • dose for 70 kg Adult {gm/dosing interval in hours} CrCl >80: 1.5-3/6-8; CrCl:50-79: 1.5-3/6-8; CrCl:30-49: 1.5-3/6-8; CrCl:10-29: 1.5-3/12;
  • note prophylaxis of bacterial endocarditis: Amp 2.0gm IM or IV 30min before procedure + Gent 1.5mg/kg IM or IV 30min before procedure;
  • watch for hypersensitivity, erythematous maculopapular rash occurring 2-4 weeks after 1st dose