Acmecilin

• Approved Indications:
• Treatment of infections caused by susceptible strains of bacteria including:
• Respiratory tract infections: pneumonia, bronchitis, and pharyngitis.
• Urinary tract infections: cystitis, pyelonephritis.
• Gastrointestinal infections: salmonellosis, shigellosis.
• Meningitis caused by susceptible organisms.
• Septicemia.
• Endocarditis prophylaxis and treatment.
• Skin and soft tissue infections.
• Gonorrhea (uncomplicated).
• Off-label/Clinically Accepted Uses:
• Listeriosis.
• Prophylaxis in certain surgical procedures.

• Route: Intravenous (IV) or Intramuscular (IM).
• Adults:
• IV/IM: 1 to 2 g every 4 to 6 hours depending on infection severity. Maximum dose up to 12 g/day.
• Pediatrics:
• IV/IM: 100 to 200 mg/kg/day divided every 4 to 6 hours.
• Elderly:
• No routine dose adjustment unless renal impairment present.
• Renal Impairment:
• Dose reduction recommended in moderate to severe renal dysfunction; monitor renal function closely.
• Hepatic Impairment:
• Use with caution; no specific dose adjustment established.
• Duration: Generally 7 to 14 days; depends on infection type and clinical response.

Ampicillin is a beta-lactam antibiotic that inhibits bacterial cell wall synthesis. It binds to penicillin-binding proteins (PBPs) inside the bacterial cell wall, interfering with the cross-linking of peptidoglycan chains. This inhibition weakens the cell wall, leading to osmotic instability, cell lysis, and bacterial death. Ampicillin is bactericidal against many Gram-positive and some Gram-negative organisms.

• Absorption: Not orally absorbed when administered as sodium salt; given parenterally.
• Distribution: Widely distributed in body fluids and tissues including pleural, pericardial, synovial fluids; crosses placenta and enters fetal circulation.
• Metabolism: Minimal metabolism.
• Half-life: Approximately 1 to 1.5 hours in patients with normal renal function.
• Elimination: Primarily excreted unchanged by the kidneys via glomerular filtration and tubular secretion.

• Pregnancy: FDA Category B; animal studies show no risk, limited human data, use only if clearly needed.
• Lactation: Excreted in small amounts in breast milk; generally considered safe; monitor infant for gastrointestinal disturbances or hypersensitivity.

• Beta-lactam antibiotic; Penicillin subclass.

• Known hypersensitivity to ampicillin, penicillins, or any beta-lactam antibiotics.
• History of severe allergic reactions to beta-lactams.

• Risk of hypersensitivity reactions including anaphylaxis; discontinue immediately if signs develop.
• Monitor renal function in patients with pre-existing impairment.
• Prolonged use may result in overgrowth of non-susceptible organisms including fungi.
• Monitor for signs of Clostridioides difficile-associated diarrhea.
• Use cautiously in patients with mononucleosis due to higher risk of rash.

• Common: Diarrhea, rash, nausea, vomiting, injection site reactions.
• Serious/Rare: Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, hemolytic anemia, hepatic dysfunction, Clostridioides difficile colitis.

• Probenecid increases ampicillin plasma concentration by inhibiting renal tubular secretion.
• May reduce effectiveness of oral contraceptives.
• Additive nephrotoxicity risk with other nephrotoxic agents.
• Possible increased anticoagulant effect with warfarin; monitor INR.

• Emphasis on antimicrobial stewardship to prevent resistance development.
• Updated dosing guidelines for specific severe infections by authoritative bodies.
• No major changes in approved indications recently.

• Store at 20°C to 25°C (68°F to 77°F).
• Protect from moisture and light.
• Store dry powder in a tightly closed container.
• Reconstituted solutions: use immediately or store refrigerated and discard after 24 hours.