Ampicillin - instructions for use, dose, side effects, contraindications

It is active against Gram-positive (alpha and beta-hemolytic streptococci, Streptococcus pneumoniae, Staphylococcus spp., Bacillus anthracis, Clostridium spp.).

Moderately active against most enterococci, incl. Enterococcus faecalis, Listeria spp., and gram-negative (Haemophilus influenzae, Neisseria meningitidis, Proteus mirabilis, Yersinia multocida (formerly Pasteurella), many species Salmonella spp., Shigella spp., Escherichia coli, Chlamydia trachomatis) microorganisms, aerobic non-spore-forming bacteria.

Ineffective against penicillinase-producing strains Staphylococcus spp., all strains Pseudomonas aeruginosa, most strains Klebsiella spp. and Enterobacter spp.

Pharmacokinetics:Absorption after oral administration is rapid, high, bioavailability - 40%; the time to reach the maximum concentration when taking 500 mg - 2 hours, the maximum concentration - 3-4 μg / ml. Connection with plasma proteins - 20%. Half-life is 1-2 hours. Evenly distributed in the organs and tissues of the body, is found in therapeutic concentrations in the pleural, peritoneal, amniotic and synovial fluids, cerebrospinal fluid, contents, blisters, urine (high concentrations), intestinal mucosa, bones, gall bladder, lungs, tissues of the female, genital organs, bile, in the bronchial secretion (in the purulent bronchial secretion, the accumulation is weak) of the paranasal sinuses, the fluid of the middle ear (with its inflammation), saliva, the tissues of the fetus. Poorly penetrates the blood-brain barrier (permeability increases with inflammation of the meninges). It is excreted mainly by the kidneys (70-80%), in the urine very high concentrations of the unchanged antibiotic are created; partially - with bile, in nursing mothers - with milk. Do not cumulate. Removed during hemodialysis.

Indications:

Bacterial infections caused by ampicillin-sensitive pathogens:

- respiratory tract and ENT organs (sinusitis, tonsillitis, pharyngitis, otitis media, bronchitis, pneumonia, lung abscess);

- kidney and urinary tract: (pyelonephritis, pyelitis, cystitis, urethritis);

- gonorrhea;

- bile ducts (cholangitis, cholecystitis);

- chlamydial infections in pregnant women (with erythromycin intolerance);

- cervicitis;

- skin and soft tissues (erysipelas, impetigo, secondarily infected dermatoses);

- musculoskeletal system;

- gastrointestinal tract (typhoid fever and paratyphoid, dysentery, salmonellosis, salmonella carcinoma).

Contraindications:

Hypersensitivity (including other penicillins, cephalosporins, carbapenems), infectious mononucleosis, lymphocytic leukemia, liver failure, gastrointestinal diseases in the anamnesis (especially colitis associated with the use of antibiotics), lactation period, children under 3 years old.

Carefully:

Bronchial asthma, pollinosis and other allergic diseases, renal insufficiency, bleeding in history, pregnancy.

Pregnancy and lactation:Use during pregnancy is possible in the case when the benefits for the motherexceeds the potential risk to the fetus. Ampicillin is excreted in breast milk in low concentrations. If you need to use ampicillin during lactation, you should decide whether to stop breastfeeding.

Dosing and Administration:

Inside for 0.5-1 hour before meals with a little water.

Dosage regimen and duration of therapy are set individually depending on the severity of the course and localization of infection, the sensitivity of the pathogen to the drug (from 5-10 days to 2-3 weeks, and in chronic processes - for several months).

Adults and children from 3 years old with a body weight above 20 kg: 0.25-0.5 g (1-2 tablets) every 6 hours. The maximum daily dose is 4 g.

Children from 3 years old with a body weight of up to 20 kg: appoint 12.5-25 mg / kg every 6 hours or 16.7-33.3 mg / kg every 8 hours.

With gonococcal urethritis - inside 3.5 g once.

Side effects:

From the digestive system: dysbacteriosis, stomatitis, gastritis, dry mouth, taste change, abdominal pain, vomiting, nausea, diarrhea, glossitis, moderate increase in the level of "liver" transaminases, pseudomembranous colitis.

From the central nervous system: headache, tremor, convulsions (with high-dose therapy).

Allergic reactions :, itching and flaky skin, urticaria, rhinitis, conjunctivitis, angioedema, fever, arthralgia, eosinophilia, erythematous and maculopapular rash, exfoliative dermatitis, multiform exudative erythema (including Stevens-Johnson syndrome), anaphylactic shock.

Other: interstitial nephritis, nephropathy, superinfection (especially in patients with chronic diseases or reduced resistance of the body), vaginal candidiasis, non-allergic ampicillin rash (may disappear without discontinuing the drug).

Laboratory indicators: leukopenia, neutropenia, thrombocytopenia, agranulocytosis, anemia.

Overdose:

Symptoms: manifestations of toxic effects on the central nervous system (especially in patients with renal insufficiency); nausea, vomiting, diarrhea, violation of water-electrolyte balance (as a consequence of vomiting and diarrhea).

Treatment: gastric lavage, Activated carbon, saline laxatives, medicines to maintain the water-electrolyte balance and symptomatic. It is excreted by hemodialysis.

Interaction:

Pharmaceutically incompatible with aminoglycosides.

Antacids, glucosamine, laxatives, food and aminoglycosides (with enteral administration) slow down and decrease absorption. Ascorbic acid increases absorption.

Bactericidal antibiotics (incl. aminoglycosides, cephalosporins, cycloserine, vancomycin, rifampicin) have a synergistic effect; bacteriostatic medicinal products (macrolides, chloramphenicol, lincosamides, tetracyclines, sulfonamides) - antagonistic.

Increases efficiency indirect anticoagulants (suppressing the intestinal microflora, reduces the synthesis of vitamin K and prothrombin index).

Reduces efficiency estrogen-containing oral contraceptives (it is necessary to use additional methods of contraception), drugs, in the process of metabolism of which is formed p-aminobenzoic acid, ethinyl estradiol (in the latter case, the risk of developing bleeding "breakthrough" is increased).

Diuretics, allopurinol, oxyphenbutazone, phenylbutazone, non-steroidal anti-inflammatory drugs and other drugs that block tubular secretion, increase the concentration of ampicillin in the plasma (due to a decrease in tubular secretion).

Allopurinol increases the risk of skin rash.

Reduces clearance and increases toxicity methotrexate.

Special instructions:

In the process of treatment, a systematic control of the kidneys, liver and peripheral blood picture is necessary. Patients with impaired renal function require a doctor recommended dosage adjustment in accordance with the values of creatinine clearance. It is possible to develop superinfection due to the growth of insensitive microflora, which requires a corresponding change in antibacterial therapy.

When using high doses in patients with renal insufficiency, a toxic effect on the central nervous system is possible.

With the use of ampicillin in patients with bacteremia (sepsis), a bacteriolysis reaction (the Yarisch-Gerxheimer reaction) is possible.

In patients who are hypersensitive to penicillins, there may be cross-allergic reactions with cephalosporin antibiotics.

In the treatment of mild diarrhea, arising against the background of course treatment should be avoided antidiarrhoeal drugs,reducing peristalsis of the intestine; You can use kaolin - or attapulgite-containing antidiarrhoeal drugs, the withdrawal of the drug is indicated. With severe diarrhea, you should see a doctor. Treatment should necessarily continue for {48-72 hours after the disappearance of clinical signs of the disease.

At the first signs of an allergy the drug is canceled and desensitizing therapy is carried out.

Effect on the ability to drive transp. cf. and fur:The drug does not affect the rate of neuromuscular conduction, in recommended doses it can be used by persons who manage motor vehicles and work with complex mechanisms.

Form release / dosage:

Tablets 250 mg.

Packaging:

For 10 tablets in a contour mesh package made of film and foil or paper.

2 contour squares with instructions for use in a pack of cardboard.

For 20 contour mesh packages with an equal number of instructions for use, place in a pack of cardboard.

Contoured Cell Packaging with instructions for use put in a box (For hospitals).

Storage conditions:

In a dry place at a temperature of no higher than 25 ° C.

Keep out of the reach of children.

Shelf life:

2 years. Do not use after the expiration date printed on the package.

Terms of leave from pharmacies:On prescription

Registration number:LS-002192

Date of registration:01.09.2011

Expiration Date:Unlimited

The owner of the registration certificate:UPDATE OF PFC, CJSC UPDATE OF PFC, CJSC Russia

Manufacturer: & nbsp

UPDATE, PFC CJSC Russia

Information update date: & nbsp21.08.2017

Illustrated instructions

Instructions

Ampicillin (Ampicillin)