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