Ampicillin + Cloxacillin

Indications

Ampicillin + Cloxacillin is used for: Infections of the respiratory tract, ear, nose and throat (ENT), urinary tract, gastro-intestinal tract, skin and soft-tissue; Septicaemia, pelvic infections, endocarditis and orthopaedic infections

Adult Dose

By mouth, 0.5–1 g 6 hourly or more frequently according to the severity of the infection. By IM Injection, 0.5–1 g 6 hourly By IV Injection, 0.5–1 g 4–6 hourly; up to 12 g by IV infusion. By IM Injection, 75 mg 8 hourly By IV Injection, 75 mg 8 hourly

Child Dose

By IV injection, CHILD (1 month–2 years): by mouth, ¼ adult dose; 2–10 years, ½ adult dose. NEONATE: Oral drops, 0.6 mL (90 mg) suspension 4 hourly

Renal Dose

Administration

Contra Indications

History of hypersensitivity to penicillins, cephalosporins, penicillin derivatives or penicillamine

Precautions

History of GI disease especially antibiotic associated colitis (ampicillin like other penicillins may cause pseudomembranous colitis). May cause skin rash in patients with infectious mononucleosis. Renal impairment

Pregnancy-Lactation

Recommendations on the use of Ampicillin in Pregnancy & Lactation: Ampicillin, like other penicillins, is considered low risk at all stages of pregnancy (Briggs & Freeman, 2015; Schaefer et al., 2015). Ampicillin is excreted into breast milk. Though considered compatible with breastfeeding, its use has been associated with modification of the bowel flora and allergic response or sensitization in the breastfeeding infant (Briggs & Freeman, 2015; National Library of Medicine (US), 2006). References: 1. Briggs, G. G., & Freeman, R. K. (2015). Drugs in pregnancy and lactation: A reference guide to fetal and neonatal risk (Tenth edition). Wolters Kluwer/Lippincott Williams & Wilkins Health. 2. National Library of Medicine (US). (2006). Ampicillin. In Drugs and Lactation Database (LactMed) (Updated 2018 October). National Library of Medicine (US). http://www.ncbi.nlm.nih.gov/books/NBK500994/ 3. Schaefer, C., Peters, P., & Miller, R. K. (2015). Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment (Third Edition). Academic Press

Interactions

Bacteriostatic antibiotics such as tetracyclines, erythromycin or sulphonamides may antagonize the bactericidal effect of penicillin (avoid co-administration). Probenecid decreases renal tubular secretion of penicillins resulting in increased and more prolonged penicillin concentrations. Allopurinol (increased incidence of skin rash). Oral contraceptives (decreased efficacy of oral contraceptives due to reduction in enterohepatic circulation of oestrogens. Advise patient to use alternative or additional method of contraception while taking ampicillin)

Adverse Effects

Side effects of Ampicillin + Cloxacillin : GI reactions such as nausea, vomiting, diarrhoea, pseudomembranous colitis, cholestatic jaundice; Neutropenia; anaphylaxis, serum sickness-like reactions, skin rash, hives, itching; Oral candidiasis

Mechanism of Action