Infections caused by Streptococcus, Staphylococcus, Escherichia coli, Klebsiella, Haemophilus influenzae, Citrobacter, Anaerobic bacteria (Bacteroides Fusobacterium, Clostridium difficile), and Branhumella catarrhalis.

Antibiotic, Penicillin
1.Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis.
2.Sulbactam, a beta-lactamase inhibitor, to ampicillin extends the spectrum of ampicillin to include some beta-lactamase-producing organisms.

Ampicillin
1.Absorption
Tmax, IM: 1 hour following 500 mg dose
Tmax, IV: 2 hours following 500 mg bolus
2.Distribution: Vd: 19.5 to 27 L
3.Protein binding: 20%
4.Excretion: Bile: higher concentrations of the active form in bile than in serum
5.Elimination Half Life: 1 to 1.9 hours (normal patients)
Sulbactam:
1.Distribution: Widely distributed to bile, blister, and tissue fluids; poor penetration into CSF with uninflamed meninges; higher concentrations attained with inflamed meninges.
2.Vd: Adults: 0.36 L/kg .
3.Protein binding: 38%.
4.Half-life elimination: Adults (normal renal function): 1 to 1.3 hours.
5.Excretion: Urine (~75% to 85% as unchanged drug) within 8 hours.

Hypersensitivity (eg, anaphylaxis or Stevens-Johnson syndrome) to ampicillin, sulbactam, or to other beta-lactam antibacterial drugs (eg, penicillins, cephalosporins), or any component of the formulations; history of cholestatic jaundice or hepatic dysfunction associated with ampicillin/sulbactam.

The manufacturer recommends that caution be used if administering to breastfeeding patients.

1.Local: Pain at injection site (IM: 16%; IV: 3%)
2.Cardiovascular: Phlebitis (1%), thrombophlebitis (3%)
3.Dermatologic: Skin rash (<2%)
4.Gastrointestinal: Diarrhea (3%)

Usual dosage range:
IM, IV: 1.5 to 3 g every 6 hours (maximum: ampicillin/sulbactam 12 g daily); for the treatment of infections caused by Acinetobacter spp., higher doses have been described.

1.Acinetobacter baumannii infection, multidrug-resistant: IV: 9 g every 8 hours over 4 hours or 27 g/day over 24 hours as a continuous infusion.
2.Diabetic foot infection, moderate to severe: IV: 3 g every 6 hours (Ref). Usual duration of therapy (including oral step-down therapy) is 2 to 4 weeks.
3.Pelvic infections (alternative agent): Intra-amniotic infection (chorioamnionitis): IV: 3 g every 6 hours.

General dosing:
1.Mild to moderate infection: Infants, Children, and Adolescents: IV, IM: 100 to 200 mg ampicillin/kg/day divided every 6 hours; usual maximum dose: 2,000 mg ampicillin/dose .
2.Severe infection (eg, meningitis, resistant Streptococcus pneumoniae): Infants, Children, and Adolescents: IV: 200 to 400 mg ampicillin/kg/day divided every 6 hours; usual maximum dose: 2,000 mg ampicillin/dose.

1.CrCl 30 mL/minute: No dosage adjustment necessary.
2.CrCl 15 to 29 mL/minute: 1.5 to 3 g every 12 hours.
3.CrCl 5 to 14 mL/minute: 1.5 to 3 g every 24 hours.

There is no dosage adjustment provided in the manufacturer's labeling.