Doses expressed as ampicillin/sulbactam combination.
Susceptible infections: I.M., I.V.: 1.5-3 g every 6 hours
Amnionitis, cholangitis, diverticulitis, endometritis, endophthalmitis, epididymitis/orchitis, liver abscess, osteomyelitis (diabetic foot), peritonitis: I.V.: 3 g every 6 hours; Note: Due to high rates of E. coli resistance, not recommended for the treatment of community-acquired intra-abdominal infections (Solomkin, 2010)
Endocarditis: I.V.: 3 g every 6 hours with gentamicin or vancomycin for 4-6 weeks
Orbital cellulitis: I.V.: 1.5 g every 6 hours
Parapharyngeal space infections: I.V.: 3 g every 6 hours
Pasteurella multocida (human, canine/feline bites): I.V.: 1.5-3 g every 6 hours
Pelvic inflammatory disease: I.V.: 3 g every 6 hours with doxycycline
Peritonitis (CAPD): Intraperitoneal:
Anuric, intermittent: 3 g every 12 hours
Anuric, continuous: Loading dose: 1.5 g; maintenance dose: 150 mg
Aspiration, community-acquired: I.V.: 1.5-3 g every 6 hours
Hospital-acquired: I.V.: 3 g every 6 hours
Urinary tract infections, pyelonephritis: I.V.: 3 g every 6 hours for 14 days
Susceptible infections: Children ≥1 year: I.V.: 100-400 mg ampicillin/kg/day divided every 6 hours (maximum: 8 g ampicillin/day) Note: The American Academy of Pediatrics recommends a dose of up to 300 mg/kg/day for severe infection in infants >1 month of age.
Epiglottitis: Children ≥1 year: I.V.: 100-200 mg ampicillin/kg/day divided in 4 doses
Mild-to-moderate infections: Children ≥1 year: I.V.: 100-200 mg ampicillin/kg/day divided every 6 hours
Peritonsillar and retropharyngeal abscess: Children ≥1 year: I.V.: 50 mg ampicillin/kg/dose every 6 hours
Severe infections: Children ≥1 year: I.V.: 200-400 mg ampicillin/kg/day divided every 6 hours
Refer to adult dosing.
Dosing: Renal Impairment
Note: Estimation of renal function for the purpose of drug dosing should be done using the Cockcroft-Gault formula.
Clcr 15-29 mL/minute/1.73 m2: 1.5-3 g every 12 hours
Clcr 5-14 mL/minute/1.73 m2: 1.5-3 g every 24 hours
Intermittent hemodialysis (IHD) (administer after hemodialysis on dialysis days): 1.5-3 g every 12-24 hours (Heintz, 2009). Note: Dosing dependent on the assumption of 3 times/week, complete IHD sessions.
Peritoneal dialysis (PD): 3 g every 24 hours
Continuous renal replacement therapy (CRRT): Drug clearance is highly dependent on the method of renal replacement, filter type, and flow rate. Appropriate dosing requires close monitoring of pharmacologic response, signs of adverse reactions due to drug accumulation, as well as drug levels in relation to target trough (if appropriate). The following are general recommendations only (based on dialysate flow/ultrafiltration rates of 1-2 L/hour and minimal residual renal function) and should not supersede clinical judgment (Heintz, 2009; Trotman, 2005):
CVVH: Initial: 3 g; maintenance: 1.5-3 g every 8-12 hours
CVVHD: Initial: 3 g; maintenance: 1.5-3 g every 8 hours
CVVHDF: Initial: 3 g; maintenance: 1.5-3 g every 6-8 hours