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ampicillin sulbactam (Unasyn)
Tradename: Unasyn.
Indications:
1) treatment of bacterial infections caused by susceptible bacteria
a) skin or soft tissue infection
- diabetic foot infection
b) infectious arthritis, osteomyelitis
c) treatment of intra-abdominal infections
- diverticulitis
- abdominal abscess
- cholangitis
d) urogenital infection
- pelvic inflammatory disease
e) acute otitis media
f) lower respiratory tract infection
- pneumonia
g) meningitis
h) mammal bite
2) broad-spectrum antibiotic coverage, especially when Enterococcus or anaerobes are suspected
3) empiric treatment of fever of unknown origin
Contraindications:
pregnancy-category B
safety in lactation ?
Dosage: 1.5-3 g IV every 6 hours.
Dosage adjustment in renal failure: creatinine clearance dosage > 50-90 mL/min every 6 hours 10-50 mL/min every 8-12 hours < 10 mL/min* every 24 hours
* dose after hemodialysis
Pharmacokinetics:
1) elimination: kidney
2) low CSF penetration in the absence of meningeal inflammation (see ampicillin)
3) 1/2 life 1-2 hours, increased with renal failure
4) removed by hemodialysis
Antimicrobial activity:
Gram positive
- Streptococcus
- Streptococcus group A
- Streptococcus group B
- Streptococcus group C
- Streptococcus group G
- Streptococcus pneumonia
- Streptococcus viridans, milleri
- Enterococcus faecalis
- Enterococcus faecium
- Staphylococcus aureus (MSSA)
- Staphylococcus epidermidis
- Listeria monocytogenes
Gram negative
- Neisseria gonorrhoeae
- Neisseria meningitidis
- Moraxella catarrhalis
- Haemophilus influenzae
- Escherichia coli
- Klebsiella species
- Salmonella species
- Shigella species
- Proteus mirabilis
- Proteus vulgaris
- Providencia species
- Morganella species
- Aeromonas species
- Acinetobacter species
- Yersinia enterocolitica (+/-)
- Pasteurella multocida
- Haemophilus ducreyi
Anaerobes
- Actinomyces
- Bacteroides fragilis
- Bacteroides melaninogenicus
- Clostridium difficile
- Clostridium species
- Peptostreptococcus species
Adverse effects:
1) common (> 10%)
- pain at injection site (16% IM, 3% IV)
2) less common (1-10%)
- diarrhea
- skin rash, urticarial rash in infectious mononucleosis
3) uncommon (< 1%)
- chest pain, fatigue, malaise, headache, chills, itching, nausea/vomiting, enterocolitis, pseudomembranous colitis, hairy tongue, dysuria, leukopenia, thrombocytopenia, anemia, elevated serum transaminases, thrombophlebitis, increased BUN & creatinine, candidiasis/superinfection, hypersensitivity reactions
4) other [3]
- blood dyscrasias (rare)
- seizures (rare)
- cholestatic hepatitis Mecahnism of action:
1) ampicillin is an inhibitor of bacterial cell wall synthesis
2) sulbactam is an inhibitor of plasmid-mediated beta-lactamase
Interactions
drug interactions
Related
beta lactamase
General
beta-lactam/beta-lactamase inhibitor
Database Correlations
PUBCHEM correlations
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- The Pharmacological Basis of Therapeutics, 8th ed.
Gilman et al, eds. Permagon Press/McGraw Hill
pg 1093
- Drug Information & Medication Formulary, Veterans Affairs,
Central California Health Care System, 1st ed., Ravnan et al
eds, 1998
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 323-324
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Deprecated Reference
Components
ampicillin (Principen, Omnipen, Amcill, Polycillin, Polycillin-N, D-cillin, J-cillin, Marcillin, Rancillin Totacillin-N)
sulbactam