Ampicillin Explained

Ampicillin is an antibiotic belonging to the aminopenicillin class of the penicillin family. The drug is used to prevent and treat a number of bacterial infections, such as respiratory tract infections, urinary tract infections, meningitis, salmonellosis, and endocarditis. It may also be used to prevent group B streptococcal infection in newborns. It is used by mouth, by injection into a muscle, or intravenously.[1]

Common side effects include rash, nausea, and diarrhea.[1] It should not be used in people who are allergic to penicillin.[1] Serious side effects may include Clostridium difficile colitis or anaphylaxis.[1] While usable in those with kidney problems, the dose may need to be decreased.[1] Its use during pregnancy and breastfeeding appears to be generally safe.[1] [2]

Ampicillin was discovered in 1958 and came into commercial use in 1961.[3] [4] It is on the World Health Organization's List of Essential Medicines.[5] The World Health Organization classifies ampicillin as critically important for human medicine.[6] It is available as a generic medication.[1]

Medical uses

Diseases

an aminoglycoside can be added to increase efficacy against gram-negative meningitis bacteria[7]

Ampicillin used to also be used to treat gonorrhea, but there are now too many strains resistant to penicillins.

Bacteria

Ampicillin is used to treat infections by many gram-positive and gram-negative bacteria. It was the first "broad spectrum" penicillin with activity against gram-positive bacteria, including Streptococcus pneumoniae, Streptococcus pyogenes, some isolates of Staphylococcus aureus (but not penicillin-resistant or methicillin-resistant strains), Trueperella, and some Enterococcus. It is one of the few antibiotics that works against multidrug resistant Enterococcus faecalis and E. faecium.[11] Activity against gram-negative bacteria includes Neisseria meningitidis, some Haemophilus influenzae, and some of the Enterobacteriaceae (though most Enterobacteriaceae and Pseudomonas are resistant).[12] Its spectrum of activity is enhanced by co-administration of sulbactam, a drug that inhibits beta lactamase, an enzyme produced by bacteria to inactivate ampicillin and related antibiotics.[13] [14] It is sometimes used in combination with other antibiotics that have different mechanisms of action, like vancomycin, linezolid, daptomycin, and tigecycline.[15] [16]

Available forms

Ampicillin can be administered by mouth, an intramuscular injection (shot) or by intravenous infusion.[1] The oral form, available as capsules or oral suspensions, is not given as an initial treatment for severe infections, but rather as a follow-up to an IM or IV injection. For IV and IM injections, ampicillin is kept as a powder that must be reconstituted.[17]

IV injections must be given slowly, as rapid IV injections can lead to convulsive seizures.[18]

Specific populations

Ampicillin is one of the most used drugs in pregnancy,[19] and has been found to be generally harmless both by the Food and Drug Administration in the U.S. (which classified it as category B) and the Therapeutic Goods Administration in Australia (which classified it as category A).[20] It is the drug of choice for treating Listeria monocytogenes in pregnant women, either alone or combined with an aminoglycoside. Pregnancy increases the clearance of ampicillin by up to 50%, and a higher dose is thus needed to reach therapeutic levels.[21]

Ampicillin crosses the placenta and remains in the amniotic fluid at 50–100% of the concentration in maternal plasma; this can lead to high concentrations of ampicillin in the newborn.

While lactating mothers secrete some ampicillin into their breast milk, the amount is minimal.

In newborns, ampicillin has a longer half-life and lower plasma protein binding.[22] The clearance by the kidneys is lower, as kidney function has not fully developed.

Contraindications

Ampicillin is contraindicated in those with a hypersensitivity to penicillins, as they can cause fatal anaphylactic reactions. Hypersensitivity reactions can include frequent skin rashes and hives, exfoliative dermatitis, erythema multiforme, and a temporary decrease in both red and white blood cells.

Ampicillin is not recommended in people with concurrent mononucleosis, as over 40% of patients develop a skin rash.

Side effects

Ampicillin is comparatively less toxic than other antibiotics, and side effects are more likely in those who are sensitive to penicillins and those with a history of asthma or allergies. In very rare cases, it causes severe side effects such as angioedema, anaphylaxis, and C. difficile infection (that can range from mild diarrhea to serious pseudomembranous colitis). Some develop black "furry" tongue. Serious adverse effects also include seizures and serum sickness. The most common side effects, experienced by about 10% of users are diarrhea and rash. Less common side effects can be nausea, vomiting, itching, and blood dyscrasias. The gastrointestinal effects, such as hairy tongue, nausea, vomiting, diarrhea, and colitis, are more common with the oral form of penicillin. Other conditions may develop up several weeks after treatment.[1]

Overdose

Ampicillin overdose can cause behavioral changes, confusion, blackouts, and convulsions, as well as neuromuscular hypersensitivity, electrolyte imbalance, and kidney failure.

Interactions

Ampicillin reacts with probenecid and methotrexate to decrease renal excretion. Large doses of ampicillin can increase the risk of bleeding with concurrent use of warfarin and other oral anticoagulants, possibly by inhibiting platelet aggregation.[23] Ampicillin has been said to make oral contraceptives less effective,[1] but this has been disputed.[24] It can be made less effective by other antibiotic, such as chloramphenicol, erythromycin, cephalosporins, and tetracyclines. For example, tetracyclines inhibit protein synthesis in bacteria, reducing the target against which ampicillin acts.[25] If given at the same time as aminoglycosides, it can bind to it and inactivate it. When administered separately, aminoglycosides and ampicillin can potentiate each other instead.[26]

Ampicillin causes skin rashes more often when given with allopurinol.

Both the live cholera vaccine and live typhoid vaccine can be made ineffective if given with ampicillin. Ampicillin is normally used to treat cholera and typhoid fever, lowering the immunological response that the body has to mount.[27] [28] [29]

Pharmacology

Mechanism of action

Ampicillin is in the penicillin group of beta-lactam antibiotics and is part of the aminopenicillin family. It is roughly equivalent to amoxicillin in terms of activity.[1] Ampicillin is able to penetrate gram-positive and some gram-negative bacteria. It differs from penicillin G, or benzylpenicillin, only by the presence of an amino group. This amino group, present on both ampicillin and amoxicillin, helps these antibiotics pass through the pores of the outer membrane of gram-negative bacteria, such as Escherichia coli, Proteus mirabilis, Salmonella enterica, and Shigella.[30]

Ampicillin acts as an irreversible inhibitor of the enzyme transpeptidase, which is needed by bacteria to make the cell wall. It inhibits the third and final stage of bacterial cell wall synthesis in binary fission, which ultimately leads to cell lysis; therefore, ampicillin is usually bacteriolytic.[31]

Pharmacokinetics

Ampicillin is well-absorbed from the GI tract (though food reduces its absorption), and reaches peak concentrations in one to two hours. The bioavailability is around 62% for parenteral routes. Unlike other penicillins, which usually bind 60–90% to plasma proteins, ampicillin binds to only 15–20%.

Ampicillin is distributed through most tissues, though it is concentrated in the liver and kidneys. It can also be found in the cerebrospinal fluid when the meninges become inflamed (such as, for example, meningitis). Some ampicillin is metabolized by hydrolyzing the beta-lactam ring to penicilloic acid, though most of it is excreted unchanged. In the kidneys, it is filtered out mostly by tubular secretion; some also undergoes glomerular filtration, and the rest is excreted in the feces and bile.

Hetacillin and pivampicillin are ampicillin esters that have been developed to increase bioavailability.[32]

History

Ampicillin has been used extensively to treat bacterial infections since 1961.[33] Until the introduction of ampicillin by the British company Beecham, penicillin therapies had only been effective against gram-positive organisms such as staphylococci and streptococci.[31] Ampicillin (originally branded as "Penbritin") also demonstrated activity against gram-negative organisms such as H. influenzae, coliforms, and Proteus spp.[33]

Society and culture

Economics

Ampicillin is relatively inexpensive.[34] In the United States, it is available as a generic medication.[1]

Veterinary use

In veterinary medicine, ampicillin is used in cats, dogs, and farm animals to treat:

Horses are generally not treated with oral ampicillin, as they have low bioavailability of beta-lactams.

The half-life in animals is around that same of that in humans (just over an hour). Oral absorption is less than 50% in cats and dogs, and less than 4% in horses.

External links

Notes and References

  1. Web site: Ampicillin. The American Society of Health-System Pharmacists. 1 August 2015. live. https://web.archive.org/web/20150712001731/http://www.drugs.com/monograph/ampicillin.html. 12 July 2015.
  2. Web site: Ampicillin use while Breastfeeding. 1 August 2015. March 2015. live. https://web.archive.org/web/20150923220701/http://www.drugs.com/breastfeeding/ampicillin.html. 23 September 2015.
  3. Book: Fischer J, Ganellin CR . Analogue-based Drug Discovery . 2006 . John Wiley & Sons. 9783527607495. 490. en. live. https://web.archive.org/web/20161220081307/https://books.google.ca/books?id=FjKfqkaKkAAC&pg=PA490. 20 December 2016.
  4. Book: Ravina E . The evolution of drug discovery : from traditional medicines to modern drugs. 2011. Wiley-VCH. Weinheim. 9783527326693. 262. 1. live. https://web.archive.org/web/20160809201757/https://books.google.ca/books?id=iDNy0XxGqT8C&pg=PA262. 9 August 2016.
  5. Book: ((World Health Organization)) . The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023) . 2023 . 10665/371090 . World Health Organization . World Health Organization . Geneva . WHO/MHP/HPS/EML/2023.02 . free .
  6. Book: ((World Health Organization)) . 2019 . Critically important antimicrobials for human medicine . 6th revision . World Health Organization . World Health Organization . Geneva . 10665/312266 . 9789241515528 . free .
  7. Web site: Ampicillin- ampicillin sodium injection, powder, for solution . DailyMed . 11 September 2019 . 25 January 2020 . https://web.archive.org/web/20180222104913/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0642ef5e-7eff-4117-a0df-4bd15d7b7d63 . 22 February 2018 . live .
  8. Web site: ampicillin (Rx). WebMD. Medscape. 22 August 2017. https://web.archive.org/web/20170815211547/http://reference.medscape.com/drug/ampi-omnipen-ampicillin-342475. 15 August 2017. live.
  9. Book: Harrison's Principles of Internal Medicine . 1 . Finberg R, Fingeroth J . vanc . McGraw-Hill Medical. 2012. 978-0-07-174887-2. Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J . 18th. Chapter 132: Infections in Transplant Recipients .
  10. Web site: Ampicillin injection, powder, for suspension . DailyMed . 26 October 2017 . 26 January 2020 . https://web.archive.org/web/20180222165046/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=af6eb56d-698f-43aa-bb3b-a0a69732a7ae . 22 February 2018 . live .
  11. Book: Equine Pharmacology, an Issue of Veterinary Clinics of North America: Equine Practice, E-Book. Magdesian KG . Elsevier Health Sciences. 2017. 978-0-323-52438-4. 59.
  12. Book: Saunders Handbook of Veterinary Drugs: Small and Large Animal. Papich MG . Elsevier Health Sciences. 2015. 978-0-323-24485-5. 43–47.
  13. Book: Antibiotic Basics for Clinicians: The ABCs of Choosing the Right Antibacterial Agent. Hauser AR . Lippincott Williams & Wilkins. 2012. 978-1-4511-1221-4. 25–28.
  14. Akova M . Sulbactam-containing beta-lactamase inhibitor combinations . Clinical Microbiology and Infection . 14 . 185–188 . January 2008 . Suppl 1 . 18154545 . 10.1111/j.1469-0691.2007.01847.x . free .
  15. Suleyman G, Zervos MJ . Safety and efficacy of commonly used antimicrobial agents in the treatment of enterococcal infections: a review . Expert Opinion on Drug Safety . 15 . 2 . 153–167 . 2016 . 26629598 . 10.1517/14740338.2016.1127349 . 25488987 .
  16. Book: Torok ME, Moran E, Cooke F . Oxford Handbook of Infectious Diseases and Microbiology. Oxford University Press. 9780191503108. 721. en. live. https://web.archive.org/web/20170323064830/https://books.google.com/books?id=G4KuDQAAQBAJ&pg=PA721. 23 March 2017. December 2016.
  17. Book: Applied Pharmacology for Veterinary Technicians - E-Book. Wanamaker BP, Massey K . Elsevier Health Sciences. 2014. 978-0-323-29170-5. 244.
  18. Web site: WebMD . Ampicillin Intravenous: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing . WebMD . 23 February 2018 . https://web.archive.org/web/20180223171300/https://www.webmd.com/drugs/2/drug-18412/ampicillin-intravenous/details . 23 February 2018 . live .
  19. Book: The Complete Guide to Medications During Pregnancy and Breastfeeding: Everything You Need to Know to Make the Best Choices for You and Your Baby. registration. ampicillin pregnancy.. Weiner CP, Rope K . St. Martin's Press. 2013. 978-1-250-03720-6. 47–49.
  20. Web site: Prescribing medicines in pregnancy database . Australian Government Department of Health Therapeutic Goods Administration. 25 October 2017. Therapeutic Goods Administration (TGA). Australian Government Department of Health. 23 February 2018. https://web.archive.org/web/20161220210434/https://www.tga.gov.au/prescribing-medicines-pregnancy-database. 20 December 2016. live.
  21. Book: Infectious Diseases in Critical Care. Rello J, Kollef MH, Díaz E, Rodríguez A . Springer Science & Business Media. 2010. 978-3-540-34406-3. 172.
  22. Book: Essential Drug Data for Rational Therapy in Veterinary Practice. Eghianruwa K . AuthorHouse. 2014. 978-1-4918-0010-2. 26.
  23. Web site: Drug interactions between ampicillin and anisindione. Drugs.com. 22 February 2018. https://web.archive.org/web/20180223171235/https://www.drugs.com/drug-interactions/ampicillin-with-anisindione-196-0-210-0.html?professional=1. 23 February 2018. live.
  24. Book: Drug Interactions in Infectious Diseases. Piscitelli SC, Rodvold KA, Pai MP . Springer Science & Business Media. 2011. 978-1-61779-213-7. 213–214.
  25. Web site: Drug interactions between ampicillin and bismuth subcitrate potassium / metronidazole / tetracycline. Drugs.com. 22 February 2018. https://web.archive.org/web/20180223171253/https://www.drugs.com/drug-interactions/ampicillin-with-bismuth-subcitrate-potassium-metronidazole-tetracycline-196-0-388-0.html?professional=1. 23 February 2018. live.
  26. Web site: Drug interactions between amikacin and ampicillin. Drugs.com. 22 February 2018. https://web.archive.org/web/20180223171312/https://www.drugs.com/drug-interactions/amikacin-with-ampicillin-153-0-196-0.html?professional=1. 23 February 2018. live.
  27. Web site: Drug interactions between ampicillin and cholera vaccine, live. Drugs.com. 22 February 2018. https://web.archive.org/web/20180223171311/https://www.drugs.com/drug-interactions/ampicillin-with-cholera-vaccine-live-196-0-3772-0.html?professional=1. 23 February 2018. live.
  28. Web site: Drug interactions between ampicillin and typhoid vaccine, live. Drugs.com. 22 February 2018. https://web.archive.org/web/20180223110946/https://www.drugs.com/drug-interactions/ampicillin-with-typhoid-vaccine-live-196-0-2271-0.html?professional=1. 23 February 2018. live.
  29. Web site: Cholera Medication. Handa S . 22 June 2017. Medscape. 23 February 2018. https://web.archive.org/web/20180223110950/https://emedicine.medscape.com/article/962643-medication. 23 February 2018. live.
  30. Delcour AH . Outer membrane permeability and antibiotic resistance . Biochimica et Biophysica Acta (BBA) - Proteins and Proteomics . 1794 . 5 . 808–816 . May 2009 . 19100346 . 2696358 . 10.1016/j.bbapap.2008.11.005 .
  31. Book: Brunton L, Chabner B, Knollman B . Petri WA . Goodman and Gilman's the Pharmacological Basis of Therapeutics . Twelfth . Penicillins, Cephalosporins, and Other Beta-Lactam Antibiotics . New York . 2011 . 1477–1504 . McGraw Hill Professional . 978-0-07-176939-6 .
  32. Book: Antimicrobial Therapy in Veterinary Medicine. Giguère S, Prescott JF, Dowling PM . John Wiley & Sons. 2013. 978-1-118-67507-6. 167–170.
  33. Acred P, Brown DM, Turner DH, Wilson MJ . Pharmacology and chemotherapy of ampicillin--a new broad-spectrum penicillin . British Journal of Pharmacology and Chemotherapy . 18 . 2 . 356–369 . April 1962 . 13859205 . 1482127 . 10.1111/j.1476-5381.1962.tb01416.x .
  34. Book: Hanno PM, Guzzo TJ, Malkowicz SB, Wein AJ . Penn Clinical Manual of Urology E-Book . 2014 . Elsevier Health Sciences . 978-0-323-24466-4 . 122 . en.
  35. Web site: Mastitis in Sows. Erskine R . Merck Veterinary Manual. 22 August 2017. https://web.archive.org/web/20170704115129/http://www.merckvetmanual.com/reproductive-system/mastitis-in-large-animals/mastitis-in-sows. 4 July 2017. live.

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