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Medication Safety Issues
Sound-alike/look-alike issues:
Ampicillin may be confused with aminophylline
Pronunciation
(am pi SIL in)
Index Terms
Generic Available
Yes
Canadian Brand Names
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Treatment of susceptible bacterial infections (nonbeta-lactamase-producing organisms); treatment or prophylaxis of infective endocarditis; susceptible bacterial infections caused by streptococci, pneumococci, nonpenicillinase-producing staphylococci, Listeria, meningococci; some strains of H. influenzae, Salmonella, Shigella, E. coli, Enterobacter, and Klebsiella
Use: Dental
I.V. or I.M. administration for the prevention of infective endocarditis in patients not allergic to penicillin and unable to take oral amoxicillin; I.V. or I.M. administration for prophylaxis in total joint replacement patients not allergic to penicillin and unable to take oral medications undergoing dental procedures which produce bacteremia
Pregnancy Risk Factor
B
Pregnancy Considerations
Adverse events have not been observed in animal studies; therefore, ampicillin is classified as pregnancy category B. Ampicillin crosses the human placenta, providing detectable concentrations in the cord serum and amniotic fluid. Most studies have not identified a teratogenic potential for ampicillin use during pregnancy. Two possible associations (congenital heart disease and cleft palate) have been noted; each of these was observed in a single study, was not substantiated by other studies, and may have been chance associations. Ampicillin is recommended for use in pregnant women for the management of premature rupture of membranes. Ampicillin is considered an acceptable alternative to penicillin for the prevention of early-onset Group B Streptococcal (GBS) disease in newborns.The volume of distribution of ampicillin is increased during pregnancy and the half-life is decreased. As a result, serum concentrations in pregnant patients are approximately 50% of those in nonpregnant patients receiving the same dose. Higher doses may be needed during pregnancy. Although oral absorption is not altered during pregnancy, oral ampicillin is poorly-absorbed during labor.
Lactation
Enters breast milk/use caution
Breast-Feeding Considerations
Ampicillin is excreted in breast milk. The manufacturer recommends that caution be exercised when administering ampicillin to nursing women. Due to the low concentrations in human milk, minimal toxicity would be expected in the nursing infant. Nondose-related effects could include modification of bowel flora and allergic sensitization.
Contraindications
Hypersensitivity to ampicillin, any component of the formulation, or other penicillins
Warnings/Precautions
Concerns related to adverse effects:
• Anaphylactoid/hypersensitivity reactions: Serious and occasionally severe or fatal hypersensitivity (anaphylactoid) reactions have been reported in patients on penicillin therapy, especially with a history of beta-lactam hypersensitivity, history of sensitivity to multiple allergens, or previous IgE-mediated reactions (eg, anaphylaxis, angioedema, urticaria). Use with caution in asthmatic patients.
• Rash: Appearance of a rash should be carefully evaluated to differentiate a nonallergic ampicillin rash from a hypersensitivity reaction; rash occurs in 5% to 10% of children and is a generalized dull red, maculopapular rash, generally appearing 3-14 days after the start of therapy. It normally begins on the trunk and spreads over most of the body. It may be most intense at pressure areas, elbows, and knees.
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
Disease-related concerns:
• Infectious mononucleosis: A high percentage of patients with infectious mononucleosis have developed rash during therapy.
• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment recommended.
Adverse Reactions
Frequency not defined.
Central nervous system: Fever, penicillin encephalopathy, seizure
Dermatologic: Erythema multiforme, exfoliative dermatitis, rash, urticaria
Note: Appearance of a rash should be carefully evaluated to differentiate (if possible) nonallergic ampicillin rash from hypersensitivity reaction. Incidence is higher in patients with viral infection, Salmonella infection, lymphocytic leukemia, or patients that have hyperuricemia.
Gastrointestinal: Black hairy tongue, diarrhea, enterocolitis, glossitis, nausea, oral candidiasis, pseudomembranous colitis, sore mouth or tongue, stomatitis, vomiting
Hematologic: Agranulocytosis, anemia, hemolytic anemia, eosinophilia, leukopenia, thrombocytopenia purpura
Hepatic: AST increased
Renal: Interstitial nephritis (rare)
Respiratory: Laryngeal stridor
Miscellaneous: Anaphylaxis, serum sickness-like reaction
Drug Interactions
Allopurinol: May enhance the potential for allergic or hypersensitivity reactions to Ampicillin. Risk C: Monitor therapy
Atenolol: Ampicillin may decrease the bioavailability of Atenolol. Risk C: Monitor therapy
Fusidic Acid: May diminish the therapeutic effect of Penicillins. Risk D: Consider therapy modification
Methotrexate: Penicillins may decrease the excretion of Methotrexate. Risk C: Monitor therapy
Tetracycline Derivatives: May diminish the therapeutic effect of Penicillins. Risk D: Consider therapy modification
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Risk D: Consider therapy modification
Uricosuric Agents: May decrease the excretion of Penicillins. Risk C: Monitor therapy
Ethanol/Nutrition/Herb Interactions
Food: Food decreases ampicillin absorption rate; may decrease ampicillin serum concentration.
Storage
Oral: Oral suspension is stable for 7 days at room temperature or for 14 days under refrigeration.
I.V.:
Solutions for I.M. or direct I.V. should be used within 1 hour. Solutions for I.V. infusion will be inactivated by dextrose at room temperature. If dextrose-containing solutions are to be used, the resultant solution will only be stable for 2 hours versus 8 hours in the 0.9% sodium chloride injection. D5W has limited stability.
Stability of parenteral admixture in NS at room temperature (25°C) is 8 hours.
Stability of parenteral admixture in NS at refrigeration temperature (4°C) is 2 days.
Reconstitution
I.V.: Minimum volume: Concentration should not exceed 30 mg/mL due to concentration-dependent stability restrictions. Standard diluent: 500 mg/50 mL NS; 1 g/50 mL NS; 2 g/100 mL NS.
Compatibility
Incompatible in D5W, D5NS, D10W, fat emulsion 10%, hetastarch 6%, LR; variable stability (consult detailed reference) in NS.
Y-site administration: Compatible: Acyclovir, amifostine, aztreonam, clarithromycin, cyclophosphamide, docetaxel, doxorubicin liposome, enalaprilat, esmolol, etoposide, famotidine, filgrastim, fludarabine, foscarnet, gatifloxacin, gemcitabine, granisetron, heparin, heparin with hydrocortisone sodium succinate, insulin (regular), labetalol, levofloxacin, linezolid, magnesium sulfate, melphalan, meperidine, morphine, multivitamins, ofloxacin, perphenazine, phytonadione, potassium chloride, propofol, remifentanil, tacrolimus, teniposide, theophylline, thiotepa, tolazoline, vitamin B complex with C. Incompatible: Amphotericin B cholesteryl sulfate complex, epinephrine, fluconazole, hydralazine, midazolam, ondansetron, sargramostim, verapamil, vinorelbine. Variable (consult detailed reference): Calcium gluconate, cisatracurium, diltiazem, hetastarch, hydromorphone, vancomycin.
Compatibility in syringe: Compatible: Chloramphenicol, colistimethate, diatrizoate meglumine 52%, diatrizoate sodium 8%, diatrizoate sodium 60%, heparin, iohexol, iopamidol, iothalamate meglumine 60%, ioxaglate meglumine 39.3%, ioxaglate 19.6%, procaine. Incompatible: Erythromycin lactobionate, gentamicin, hydromorphone, kanamycin, lincomycin, metoclopramide. Variable (consult detailed reference): Lidocaine, polymyxin B sulfate, streptomycin.
Compatibility when admixed: Compatible: Clindamycin, erythromycin lactobionate, floxacillin, furosemide. Incompatible: Amikacin, chlorpromazine, dopamine, gentamicin, hydralazine, prochlorperazine. Variable (consult detailed reference): Aztreonam, cefepime, cimetidine, heparin, hydrocortisone sodium succinate, metronidazole, metronidazole with sodium bicarbonate, ranitidine, sodium bicarbonate, verapamil.
Mechanism of Action
Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.
Pharmacodynamics/Kinetics
Absorption: Oral: 50%
Distribution: Bile, blister, and tissue fluids; penetration into CSF occurs with inflamed meninges only, good only with inflammation (exceeds usual MICs)
Normal meninges: Nil; Inflamed meninges: 5% to 10%
Protein binding: 15% to 25%
Half-life elimination:
Children and Adults: 1-1.8 hours
Anuria/end-stage renal disease: 7-20 hours
Time to peak: Oral: Within 1-2 hours
Excretion: Urine (?90% as unchanged drug) within 24 hours
Dosage
Usual dosage range:
Infants and Children:
Oral: 50-100 mg/kg/day in doses divided every 6 hours (maximum: 2-4 g/day)
I.M., I.V.: 100-400 mg/kg/day in divided doses every 6 hours (maximum: 12 g/day)
Adults: Oral, I.M., I.V.: 250-500 mg every 6 hours
Indication-specific dosing:
Infants and Children:
Prophylaxis against Infective endocarditis:
Dental, oral, or respiratory tract procedures: I.M., I.V.: 50 mg/kg within 30-60 minutes prior to procedure in patients not allergic to penicillin and unable to take oral amoxicillin. Intramuscular injections should be avoided in patients who are receiving anticoagulant therapy. In these circumstances, orally administered regimens should be given whenever possible. Intravenously administered antibiotics should be used for patients who are unable to tolerate or absorb oral medications.
Note: American Heart Association (AHA) guidelines now recommend prophylaxis only in patients undergoing invasive procedures and in whom underlying cardiac conditions may predispose to a higher risk of adverse outcomes should infection occur.
Genitourinary and gastrointestinal tract procedures: I.M., I.V.:
High-risk patients: 50 mg/kg (maximum: 2 g) within 30 minutes prior to procedure, followed by ampicillin 25 mg/kg (or amoxicillin 25 mg/kg orally) 6 hours later; must be used in combination with gentamicin. Note: As of April 2007, routine prophylaxis for GI/GU procedures is no longer recommended by the AHA.
Moderate-risk patients: 50 mg/kg within 30 minutes prior to procedure
Mild-to-moderate infections:
Oral: 50-100 mg/kg/day in doses divided every 6 hours (maximum: 2-4 g/day)
I.M., I.V.: 100-150 mg/kg/day in divided doses every 6 hours (maximum: 2-4 g/day)
Severe infections, meningitis: I.M., I.V.: 200-400 mg/kg/day in divided doses every 6 hours (maximum: 6-12 g/day)
Adults:
Actinomycosis: I.V.: 50 mg/kg/day for 4-6 weeks then oral amoxicillin
Cholangitis (acute): I.V.: 2 g every 4 hours with gentamicin
Diverticulitis: I.M., I.V.: 2 g every 6 hours with metronidazole
Endocarditis:
Infective: I.V.: 12 g/day via continuous infusion or divided every 4 hours
Prophylaxis: Dental, oral, or respiratory tract: I.M., I.V.: 2 g within 30-60 minutes prior to procedure in patients not allergic to penicillin and unable to take oral amoxicillin. Intramuscular injections should be avoided in patients who are receiving anticoagulant therapy. In these circumstances, orally administered regimens should be given whenever possible. Intravenously administered antibiotics should be used for patients who are unable to tolerate or absorb oral medications.
Note: American Heart Association (AHA) guidelines now recommend prophylaxis only in patients undergoing invasive procedures and in whom underlying cardiac conditions may predispose to a higher risk of adverse outcomes should infection occur.
Prophylaxis in total joint replacement patient: I.M., I.V.: 2 g 1 hour prior to the procedure
Genitourinary and gastrointestinal tract procedures:
High-risk patients: I.M., I.V.: 2 g within 30 minutes prior to procedure, followed by ampicillin 1 g (or amoxicillin 1g orally) 6 hours later; must be used in combination with gentamicin. Note: As of April 2007, routine prophylaxis for GI/GU procedures is no longer recommended by the AHA.
Moderate-risk patients: I.M., I.V.: 2 g within 30 minutes prior to procedure
Group B strep prophylaxis (intrapartum): I.V.: 2 g initial dose, then 1 g every 4 hours until delivery
Listeria
infections: I.V.: 200 mg/kg/day divided every 6 hours
Sepsis/meningitis: I.M., I.V.: 150-250 mg/kg/day divided every 3-4 hours (range: 6-12 g/day)
Urinary tract infections (enterococcus suspected): I.V.: 1-2 g every 6 hours with gentamicin
Dosing interval in renal impairment:
Clcr >50 mL/minute: Administer every 6 hours
Clcr 10-50 mL/minute: Administer every 6-12 hours
Clcr <10 mL/minute: Administer every 12-24 hours
Hemodialysis: Moderately dialyzable (20% to 50%); administer dose after dialysis
Peritoneal dialysis: Moderately dialyzable (20% to 50%)
Administer 250 mg every 12 hours
Continuous arteriovenous or venovenous hemofiltration effects: Dose as for Clcr 10-50 mL/minute; ?50 mg of ampicillin per liter of filtrate is removed
Dental Usual Dosing
Infective endocarditis prophylaxis: I.M., I.V.: Dental, oral, or respiratory tract procedures:
Infants and Children: 50 mg/kg within 30-60 minutes prior to procedure in patients not allergic to penicillin and unable to take oral amoxicillin.
Adults: 2 g within 30-60 minutes prior to procedure in patients not allergic to penicillin and unable to take oral amoxicillin.
Note: Intramuscular injections should be avoided in patients who are receiving anticoagulant therapy. In these circumstances, orally administered regimens should be given whenever possible. Intravenously administered antibiotics should be used for patients who are unable to tolerate or absorb oral medications.
Note: American Heart Association (AHA) guidelines now recommend prophylaxis only in patients undergoing invasive procedures and in whom underlying cardiac conditions may predispose to a higher risk of adverse outcomes should infection occur.
Prophylaxis in total joint replacement patient: Adults: I.M., I.V.: 2 g 1 hour prior to the procedure
Administration: Oral
Administer around-the-clock to promote less variation in peak and trough serum levels. Administer on an empty stomach (ie, 1 hour prior to, or 2 hours after meals) to increase total absorption.
Administration: I.V.
Administer around-the-clock to promote less variation in peak and trough serum levels. Administer over 3-5 minutes (125-500 mg) or over 10-15 minutes (1-2 g). More rapid infusion may cause seizures. Ampicillin and gentamicin should not be mixed in the same I.V. tubing.
Some penicillins (eg, carbenicillin, ticarcillin, and piperacillin) have been shown to inactivate aminoglycosides in vitro. This has been observed to a greater extent with tobramycin and gentamicin, while amikacin has shown greater stability against inactivation. Concurrent use of these agents may pose a risk of reduced antibacterial efficacy in vivo, particularly in the setting of profound renal impairment. However, definitive clinical evidence is lacking. If combination penicillin/aminoglycoside therapy is desired in a patient with renal dysfunction, separation of doses (if feasible), and routine monitoring of aminoglycoside levels, CBC, and clinical response should be considered.
Administration: I.V. Detail
pH: 8-10 (reconstituted solution)
Monitoring Parameters
With prolonged therapy, monitor renal, hepatic, and hematologic function periodically; observe signs and symptoms of anaphylaxis during first dose
Test Interactions
May interfere with urinary glucose tests using cupric sulfate (Benedict's solution, Clinitest®)
Some penicillin derivatives may accelerate the degradation of aminoglycosides in vitro, leading to a potential underestimation of aminoglycoside serum concentration.
Dietary Considerations
Take on an empty stomach 1 hour before or 2 hours after meals.
Sodium content of 5 mL suspension (250 mg/5 mL): 10 mg (0.4 mEq)
Sodium content of 1 g: 66.7 mg (3 mEq)
Patient Education
Do not take any new medication during therapy unless approved by prescriber. Take entire prescription, even if you are feeling better. Take at equal intervals around-the-clock; preferably on an empty stomach with a full glass of water (1 hour before or 2 hours after meals). Maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. If you have diabetes, drug may cause false test results with Clinitest® urine glucose monitoring; use of another type of glucose monitoring is preferable. May cause nausea or vomiting (small, frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help); or diarrhea (buttermilk, boiled milk, or yogurt may help). Report immediately any rash; persistent diarrhea; swelling of face, tongue, mouth, or throat; or chest tightness. Report if condition being treated worsens or does not improve by the time prescription is completed.
Geriatric Considerations
Adjust dose for renal function.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Oral candidiasis, black hairy tongue, glossitis, sore mouth or tongue, and stomatitis.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Infectious Diseases Comment
A well-documented reaction can occur between beta-lactam and aminoglycoside antibiotics in vitro, leading to complexation, opening of the beta-lactam ring, and presumably, loss of antibacterial activity for one or both agents. However, the conditions under which this reaction occurs are variable and influenced by (but not limited to) assay methodology, sampling time and storage, and drug selection and concentration. In general, many of the in vitro studies employed artificial conditions that tested high concentrations of the penicillin derivative (equating to serum levels most likely observed only in severe renal impairment) in combination with gentamicin or tobramycin. Incubation of the agents at conditions of 37°C for up to 48 hours has definitely demonstrated inactivation and loss of bactericidal activity. However, some of these studies permitted a considerable time lapse prior to assaying the medium, or stored the samples at higher temperatures (-20°C or greater), which may have allowed continued chemical degradation prior to assay. In general, amikacin was the most resistant to penicillin-mediated chemical degradation, and cephalosporins were much less likely than penicillins to inactivate the aminoglycosides.
The more robust studies have been those which evaluated in vivo effects via rapid and frequent blood sampling during concomitant dosing. In vivo, there are a number of studies documenting significant changes in the half-life of gentamicin in combination with primarily ticarcillin and carbenicillin, but usually only in the setting of end-stage renal disease. A number of literature reports suggest that despite documented changes in gentamicin kinetics, this is not likely to lead to clinically-significant differences in outcomes in patients with normal renal function. Furthermore, there are no published, prospective, outcomes-based studies that provide compelling evidence of changes in rates of clinical or microbiological response as a function of dosing separation.
Based on the weight of evidence to date, coadministration of (but not coadmixture of) a penicillin or cephalosporin antibiotic with an aminoglycoside should not pose a significant concern in patients with even mild renal impairment. However, specific circumstances exist in which this approach should be undertaken with caution. Concurrent administration of either gentamicin or tobramycin with piperacillin, carbenicillin, or ticarcillin (including combinations with beta-lactamase inhibitors), particularly in the face of moderate-to-severe renal failure, would warrant careful monitoring of aminoglycoside serum levels, CBCs, and clinical response to avoid potentially-reduced efficacy due to chemical inactivation.
Mental Health: Effects on Mental Status
Large I.V. doses may rarely produce encephalopathy; penicillins have been reported to cause apprehension, illusions, agitation, insomnia, depersonalization, and encephalopathy
Mental Health: Effects on Psychiatric Treatment
Rarely may cause bone marrow suppression; use caution with clozapine and carbamazepine
Nursing: Physical Assessment/Monitoring
Assess results of culture and sensitivity tests and patient's allergy history prior to starting therapy. Assess potential for interactions with other medications patient may be taking. Caution patients with diabetes about altered response to Clinitest®. Assess therapeutic effectiveness and adverse reactions (eg, opportunistic infection [fever, chills, unhealed sores, white plaques in mouth or vagina, purulent vaginal discharge, fatigue]). Teach patient proper use, possible side effects/appropriate interventions, and adverse symptoms to report.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule: 250 mg, 500 mg
Injection, powder for reconstitution, as sodium: 125 mg, 250 mg, 500 mg, 1 g, 2 g, 10 g
Powder for oral suspension: 125 mg/5 mL (100 mL, 200 mL); 250 mg/5 mL (100 mL, 200 mL)
Pricing: U.S. (www.drugstore.com)
Capsules (Ampicillin)
250 mg (30): $12.99
250 mg (90): $31.95
500 mg (100): $49.99
References
Boguniewicz M and Leung DY, “Hypersensitivity Reactions to Antibiotics Commonly Used in Children,” Pediatr Infect Dis J, 1995, 14(3):221-31.
Brown RD and Campoli-Richards DM, “Antimicrobial Therapy in Neonates, Infants, and Children,” Clin Pharmacokinet, 1989, 17(Suppl 1):105-15.
Chow MS, Quintiliani R, and Nightingale CH, "In Vivo Inactivation of Tobramycin by Ticarcillin. A Case Report," JAMA, 1982, 247(5):658-9.
Dajani AS, Taubert KA, Wilson W, et al, “Prevention of Bacterial Endocarditis Recommendations by the American Heart Association,” JAMA, 1997, 277(22):1794-801.
Daly JS, Dodge RA, Glew RH, et al, "Effect of Time and Temperature on Inactivation of Aminoglycosides by Ampicillin at Neonatal Dosages," J Perinatol, 1997, 17(1):42-5.
Donowitz GR and Mandell GL, “Beta-Lactam Antibiotics,” N Engl J Med, 1988, 318(7):419-26 and 318(8):490-500.
Dowell JA, Korth-Bradley J, Milisci M, et al, "Evaluating Possible Pharmacokinetic Interactions Between Tobramycin, Piperacillin, and a Combination of Piperacillin and Tazobactam in Patients With Various Degrees of Renal Impairment," J Clin Pharmacol, 2001, 41:979-86.
Farchione LA, "Inactivation of Aminoglycosides by Penicillins," J Antimicrob Chemother, 1982, 8(Suppl A):27-36.
Fuchs PC, Stickel S, Anderson PH, et al, "In Vitro Inactivation of Aminoglycosides by Sulbactam, Other Beta-Lactams, and Sulbactam-Beta-Lactam Combinations," Antimicrob Agents Chemother, 1991, 35(1):182-4.
Halstenson CE, Wong MO, Herman CS, et al, "Effect of Concomitant Administration of Piperacillin on the Dispositions on Isepamicin and Gentamicin in Patients With End-Stage Renal Disease," Antimicrob Agents Chemother, 1992, 36(9):1832-36.
Hitt CM, Patel KB, Nicolau DP, et al, "Influence of Piperacillin-Tazobactam on Pharmacokinetics of Gentamicin Given Once Daily," Am J Health Syst Pharm, 1997, 54(23):2704-8.
Konishi H, Goto M, Nakamoto Y, et al, "Tobramycin Inactivation by Carbenicillin, Ticarcillin, and Piperacillin," Antimicrob Agents Chemother, 1983, 23(5):653-57.
Lau A, Lee M, Flascha S, et al, "Effect of Piperacillin on Tobramycin Pharmacokinetics in Patients With Normal Renal Function," Antimicrob Agents Chemother, 1983, 24(4):533-37.
Russoe ME and Atkins-Thor E, "Gentamicin and Ticarcillin in Subjects With End-Stage Renal Disease. Comparison of Two Assay Methods and Evaluation of Inactivation Rate," Clin Nephrol, 1981, 15(4):175-80.
Tenenbein M, Cohen S, and Sitar DS, “Whole Bowel Irrigation as a Decontamination Procedure After Acute Drug Overdose,” Arch Intern Med, 1987, 147(5):905-7.
Thompson MIB, Russo ME, Saxon BJ, et al, "Gentamicin Inactivation by Piperacillin or Carbenicillin in Patients With End-Stage Renal Disease," Antimicrob Agents Chemother, 1982, 21(2):268-73.
Triggs EJ, Johnson JM, and Learoyd B, “Absorption and Disposition of Ampicillin in the Elderly,” Eur J Clin Pharmacol, 1980, 18(2):195-8.
Viollier AF, Standiford HC, Drusano GL, et al, "Comparative Pharmacokinetics and Serum Bactericidal Activity of Mezlocillin, Ticarcillin and Piperacillin, With and Without Gentamicin," J Antimicrob Chemother, 1985, 15(5):597-606.
Walterspiel JN, Feldman S, Van R, et al, "Comparative Inactivation of Isepamicin, Amikacin, and Gentamicin by Nine Beta-Lactams and Two Beta-Lactamase Inhibitors, Cilastatin and Heparin," Antimicrob Agents Chemother, 1991, 35(9):1875-8.
Wilson W, Taubert KA, Gewitz M, et al, “Prevention of Infective Endocarditis. Guidelines From the American Heart Association. A Guideline From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group,” Circulation, 2007, 115. Available at http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.106.183095v1; last accessed July 26, 2007.
Wright AJ, “The Penicillins,” Mayo Clin Proc, 1999, 74(3):290-307.
International Brand Names
Lexi-Comp.com
Last full review/revision August 2008
Content last modified August 2008
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