Guidelines for use

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1. Clinical Uses

  • Treatment of bacteremia, endocarditis, meningitis, osteomyelitis, urinary tract infection, pneumonia 
  • Prevention of intrapartum group B streptococcal infection in infants (alternative to Penicillin G)
  • Prophylaxis of infective endocarditis associated with certain procedures

2. Precautions

  • The potential for allergic cross-reactivity exists among penicillins, cephalosporins and carbapenems
  • Pregnancy: not expected to increase risk of major congenital malformations.
  • Breastfeeding: considered safe during breastfeeding. Monitor nursing infant for GI symptoms.

3. Adverse Effects

  • Nausea, abdominal pain, vomiting, diarrhea
  • Skin rash (may be a unique reaction to ampicillin/amoxicillin – no cross-reactivity with beta-lactams – common in patients with infectious mononucleosis, CMV infection, or leukemia)
  • Hypersensitivity reactions (beta-lactam type) including anaphylaxis
  • Phlebitis at site of IV infusion
  • Rarely: interstitial nephritis, blood dyscrasias, elevated liver enzymes, seizures (drug accumulation in renal insufficiency)

4. Dosage

Usual Dosage:

  • Bacteremia (with suspected/proven deep-seated infection), endocarditis, meningitis, osteomyelitis: 2 g IV q4h
  • Urinary tract infection, pneumonia, bacteremia (without deep-seated infection): 2 g IV q6h

Note: Orders for oral ampicillin are automatically converted to amoxicillin

Renal Insufficiency:

10 to 29 2 g IV q6h
< 10 (ESRD; PD) 2 g IV q8 – 12h
Hemodialysis (HD)

2 g IV q8 – 12h

On dialysis days, schedule one of the doses towards the end of HD (removed by HD)
Continuous Renal Replacement Therapy (CRRT) 2 g IV q4 – 6h

5. Administration

  • Intermittent Infusion: 1 g over 15 – 30 minutes; 2 g over 30 – 60 minutes
  • Continuous Infusion: 2 g in NS IV q4h infused over 4h
  • Please refer to IV drug monograph on pharmacy intranet page for additional administration information.

Last updated: August 18, 2016