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

aerobic Gram-positive bacteria - Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus, Streptococcus pyogenes, Streptococcus anthracis, Streptococcus pneumoniae, Streptococcus groups viridans, Enterococcus faecalis, Corynebacterium spp., Listeria monocytogenes;

anaerobic Gram-positive bacteria - Clostridium spp., Peptococcus spp., Peptostreptococcus spp .;

aerobic gram-negative bacteria - Escherichia coli, Proteus mirabilis, Proteus vulgaris, Klebsiella spp., Salmonella spp., Shigella spp., Bordetella pertussis, Yersinia enterocolitica, Gardnerella vaginalis, Neisseria meningitidis, Neisseria gonorrhoeae, Moraxella catarrhalis, Haemophilus influenzae, Haemophilus ducreyi, Yersinia multocida, Campylobacter jejuni, Acinetobacter spp .;

anaerobic gram-negative bacteria - Bacteroides spp., including Bacteroides fragilis.

Sulbactam is a beta-lactamase inhibitor that, without changing the activity of ampicillin, expands its range of action against resistant strains. Has no significant antibacterial activity except for Neisseriaceae and Acinetobacter.

Pharmacokinetics:

Amoxicillin. Binding to blood plasma proteins - 20%. Amoxicillin is distributed in most tissues and body fluids, penetrates the placental barrier and is found in breast milk. Half-life from the blood plasma - 1 hour. It is excreted mainly by the kidneys - 70-80% and with bile - 5-10%.

Sulbactam. Binding to blood plasma proteins - 40%. Semi-well - 1 hour. Sulbactam is almost completely unchanged in the form of kidneys (75-85%), it penetrates the placental barrier, does not affect the pharmacokinetics of amoxicillin.

Indications:

Infections of the lower respiratory tract (bronchitis, pneumonia, empyema of the pleura, lung abscess).

Infections of the ENT organs (sinusitis, tonsillitis, otitis media).

Infections of the biliary tract (cholangitis, cholecystitis).

Intestinal infections (shigellosis, salmonellosis, salmonella carcinoma).

Infections of the genitourinary system and pelvic organs (pyelonephritis, pyelitis, cystitis,urethritis, prostatitis, cervicitis, salpingitis, salpingoophoritis, tubo-ovarian abscess, endometritis, bacterial vaginitis, septic abortion, postpartum sepsis, pelvic peritonitis, chancroid, gonorrhea).

Infections of the skin and soft tissues (erysipelas, impetigo, secondarily infected dermatoses, abscess, phlegmon, wound infection).

Osteomyelitis, endocarditis, meningitis, sepsis, peritonitis, postoperative infections.

Prevention of infectious and inflammatory complications in surgery.

ICD-10

X.J90-J94.J90 Pleural effusion, not elsewhere classified

X.J90-J94.J91 * Pleural effusion in conditions classified elsewhere

XVIII.R00-R09.R09.1 Pleurisy

Contraindications:

Individual intolerance, including other beta-lactam antibiotics.

Infectious mononucleosis.

Nonspecific ulcerative colitis.

Breast-feeding.

Carefully:

Severe hepatic or renal insufficiency.

Diseases of the gastrointestinal tract in anamnesis associated with admission penicillins.

Plively age.

Pregnancy.

Pregnancy and lactation:

Use during pregnancy is only possible if the intended benefit to the mother exceeds the potential risk to the fetus.If it is necessary to use the drug during lactation, breastfeeding should be stopped.

Dosing and Administration:

The drug is administered iv. (jet or infusion), w / m, inside, the dosage of the drug and the frequency of use are selected by the attending physician individually in each specific case.

Adults and adolescents over 12 years of age - 1 g (in terms of amoxicillin) 2-3 times a day; children under 2 years - 40-60 mg / kg 2-3 times a day; 2-6 years - 250 mg 3 times a day; 6-12 years - 500 mg 3 times a day.

The duration of treatment is up to 14 days.

For the prevention of postoperative infections in operations lasting less than 1 h - 1 g IV during the introductory anesthesia, with prolonged operations - 1 g every 6 hours during the day.

Chronic renal failure implies a reduction in dose.

For w / m and in / in The contents of the vial are dissolved with sterile water, for in / in infusion introduction - in a 5% solution of dextrose, 0.9% solution of NaCl or Ringer lactate and injected for 15-60 minutes.

Side effects:

Digestive system: increased activity of "liver" transaminases, cholestatic jaundice, nausea, vomiting, diarrhea, hepatitis, pseudomembranous colitis.

Allergic reactions: exfoliative dermatitis, urticaria, Quincke's edema, erythema multiforme exudative, anaphylactic shock, angioedema, malignant exudative erythema (Stevens-Johnson syndrome).

Local reactions: phlebitis in place in / in introduction.

Other: development of superinfection, reversible increase in prothrombin time, candidomycosis, when used in high doses - convulsions (especially often in patients with chronic renal insufficiency).

Overdose:

In case of an overdose, there is a violation of the function organs of the digestive system and water-electrolyte balance. Symptomatic treatment is prescribed, hemodialysis is effective.

Interaction:

Antacids, glucosamine, laxatives drugs, aminoglycosides, when combined, slow down and reduce absorption.

Ascorbic acid, when used at the same time, increases absorption.

Bactericidal antibiotics have a synergistic effect, bacteriostatic (macrolides, chloramphenicol, lincosamides, tetracyclines, sulfonamides) - antagonistic.

Amoxicillin + Sulbactam slows the excretion of methotrexate.

Amoxicillin + Sulbactam improves the effectiveness of indirect anticoagulants, therefore constant monitoring is very important indicators of blood coagulability with simultaneous use.

Reduces the effectiveness of oral contraceptives.

With simultaneous use with ethinyl estradiol, the risk of bleeding "breakthrough" increases.

Allopurinol increases the risk of skin rash.

Special instructions:

With prolonged use, control of liver and kidney function is necessary, with superinfection the drug is canceled urgently.

In the suspension for oral administration, a small precipitate may form, so before each use it must be shaken!

Instructions

Ampicillin + Sulbactam (Ampicillinum + Sulbactamum)