Ampicillin + Flucloxacillin


Concise Prescribing Info
Indications/Uses
Severe infections.
Dosage/Direction for Use
Adult : PO Each cap contains ampicillin 250 mg and flucloxacillin 250 mg: >10 yr 1 cap 4 times/day. Each 5 mL susp contains ampicillin 125 mg and flucloxacillin 125 mg: >10 yr 10 mL 4 times/day. IM/IV Each 500 mg vial contains ampicillin 250 mg and flucloxacillin 250 mg: >10 yr 500 mg 4 times/day.
Dosage Details
Oral
Severe infections
Adult: Each cap contains ampicillin 250 mg and flucloxacillin 250 mg: >10 yr 1 cap 4 times/day. Each 5 mL susp contains ampicillin 125 mg and flucloxacillin 125 mg: >10 yr 10 mL 4 times/day.
Child: Each 5 mL susp contains ampicillin 125 mg and flucloxacillin 125 mg: ≤10 yr 5 mL 4 times/day.

Parenteral
Severe infections
Adult: IM/IV: Each 500 mg vial contains ampicillin 250 mg and flucloxacillin 250 mg: >10 yr 500 mg 4 times/day.
Child: IM/IV: Each 500 mg vial contains ampicillin 250 mg and flucloxacillin 250 mg: <2 yr 125 mg 4 times/day; 2-10 yr 250 mg 4 times/day.
Administration
Should be taken on an empty stomach. Take 30 min-1 hr before meals.
Reconstitution
Parenteral:
IM: Add 1.5 mL water for inj to the vial. IV: Dissolve 500 mg in 10 mL water for inj. Administer by slow IV inj.
Incompatibility
Incompatible w/ aminoglycosides. IV should not be mixed w/ other proteinaceous fluids (e.g. protein hydrolysates), IV lipid emulsions or w/ blood products.
Contraindications
Hypersensitivity to β-lactam antibiotics (e.g. cephalosporins, penicillins). Patient w/ history of flucloxacillin-associated jaundice/hepatic dysfunction; infectious mononucleosis; acute or chronic leukaemia.
Special Precautions
Renal and hepatic impairment. Pregnancy and lactation.
Adverse Reactions
Hypersensitivity reactions (e.g. rash, erythema multiforme, purpura, eosinophilia, angioneurotic oedema, fever, arthralgia, myalgia); GI disturbances, pseudomembranous colitis; hepatitis, cholestatic jaundice, transient elevation of liver enzymes; interstitial nephritis; leucopenia, thrombocytopenia.
Potentially Fatal: Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis.
MonitoringParameters
Monitor renal and hepatic function esp during prolonged use.
Overdosage
Symptoms: GI effects (e.g. nausea, vomiting and diarrhoea). Management: Symptomatic and supportive treatment. Ampicillin may be removed via haemodialysis.
Drug Interactions
May reduce efficacy of oral contraceptives. Increased and prolonged serum levels of both ampicillin and flucloxacillin w/ probenecid. Increased risk of allergic skin reactions w/ allopurinol.
Lab Interference
May cause false-positive result in glucose testing.
Action
Description: Ampicillin exerts bactericidal action on both gm+ve and gm-ve organisms. Its spectrum includes gm+ve organisms e.g. Strep. pneumoniae and other Streptococci, L. monocytogenes and gm-ve bacteria e.g. M. catarrhalis, N. gonorrhoea, N. meningitidis, E. coli, P. mirabilis, Salmonella, Shigella, and H. influenzae. Ampicillin exerts its action by inhibiting the synthesis of bacterial cell wall. Flucloxacillin is bactericidal against penicillinase-producing and non-penicillinase-producing staphylococci. Its activity against streptococci e.g. Strep. pneumoniae and Strep. pyogenes is less than that of benzylpenicillin, but sufficient to be useful when these organisms are present w/ penicillin-resistant staphylococci.
Pharmacokinetics:
Absorption: Both are well absorbed from the GI tract and absorption is reduced by food. Peak plasma concentration: Ampicillin: Approx 1-2 hr; Flucloxacillin: Approx 1 hr.
Distribution: Both cross the placenta and small amounts are distributed into breast milk. Plasma protein binding: Ampicillin: Approx 20%; Flucloxacillin: Approx 95%.
Metabolism: Ampicillin: Metabolised to some extent to penicilloic acid.
Excretion: Ampicillin: Via urine approx 20-40% as unchanged drug (oral), 60-80% (parenteral); via bile and milk (in small amount). Flucloxacillin: Via urine approx 66% (oral), approx 76% (parenteral). Plasma half-life: Ampicillin: Approx 1-1.5 hr; Flucloxacillin: Approx 1 hr.
Storage
Store below 25°C. Reconstituted susp: Store at 2-8°C.
MIMS Class
References
Anon. Ampicillin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 06/09/2013.

Buckingham R (ed). Ampicillin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/09/2013.

Buckingham R (ed). Flucloxacillin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/09/2013.

Co-fluampicil Capsules (Crescent Pharma Limited). MHRA. https://products.mhra.gov.uk/. Accessed 06/09/2013.

Co-Fluampicil Oral Suspension 125/125mg/5ml (Crescent Pharma Limited). MHRA. https://products.mhra.gov.uk/. Accessed 06/09/2013.

McEvoy GK, Snow EK, Miller J et al (eds). Ampicillin, Ampicillin Sodium, Ampicillin Trihydrate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 06/09/2013.

Disclaimer: This information is independently developed by MIMS based on Ampicillin + Flucloxacillin from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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