Ampicillin

Ampicillin tablets are a penicillin-class (beta-lactam) antibiotic used to treat certain bacterial infections when the bacteria are susceptible. In Australia, they should only be used on the advice of a prescriber and exactly as directed. Antibiotics do not work for colds, flu or other viral illnesses.

How ampicillin works

Ampicillin is a beta-lactam antibiotic. It kills bacteria and works in a similar way to penicillin G (benzylpenicillin). As an aminopenicillin with an amino side chain attached to the basic penicillin structure, ampicillin can better penetrate the outer membrane of some Gram-negative bacteria and has a broader spectrum of activity.

Spectrum of activity

Ampicillin is similar to benzylpenicillin in its action against Gram-positive organisms, including Streptococcus pneumoniae and other streptococci, but, with the possible exception of activity against Enterococcus faecalis, it may be slightly less potent than benzylpenicillin. Listeria monocytogenes is generally susceptible. The Gram-negative cocci Moraxella catarrhalis (Branhamella catarrhalis), Neisseria gonorrhoeae, and N. meningitidis may be susceptible, depending on local resistance patterns.

Ampicillin is more active than benzylpenicillin against some Gram-negative bacilli, including Haemophilus influenzae and Enterobacteriaceae such as Escherichia coli, Proteus mirabilis, Salmonella and Shigella spp. It is inactive against Pseudomonas aeruginosa.

Ampicillin also has activity similar to benzylpenicillin against other organisms, including many anaerobes and Actinomyces spp.

Activity with other antimicrobials. Synergy has been shown between ampicillin and aminoglycosides against some organisms, including enterococci. Effects ranging from synergy to antagonism have been reported between ampicillin and other beta-lactams, bacteriostatic drugs such as chloramphenicol, and rifampicin.

Resistance. Like benzylpenicillin, ampicillin is inactivated by beta-lactamases, although other mechanisms may be responsible for resistance in some species. Resistance rates vary by region; many strains of staphylococci and some Gram-negative organisms may be resistant.

Pharmacokinetics

Ampicillin is relatively resistant to inactivation by gastric acid and is moderately well absorbed from the gastrointestinal tract after oral doses. Food can interfere with ampicillin absorption, so doses are often taken on an empty stomach (e.g. at least 30 minutes before meals). Peak plasma concentrations are reached in about 1 to 2 hours; after a 500-mg oral dose, peak levels have been reported to range from 3 to 6 mcg/mL.

Ampicillin is widely distributed and crosses the placenta; small amounts pass into breast milk. There is little diffusion into the CSF except when the meninges are inflamed. About 20% is bound to plasma proteins, and the plasma half-life is about 1 to 1.5 hours, but this may be increased in neonates, older adults and patients with renal impairment.

Ampicillin is metabolised to some extent to penicilloic acid and is eliminated mainly by the kidneys. Renal clearance occurs partly by glomerular filtration and partly by tubular secretion, and is reduced by probenecid.

Uses

Ampicillin tablets are used to treat a range of infections caused by susceptible organisms. Common examples include certain respiratory tract infections, urinary tract infections, gastrointestinal infections, and skin and soft tissue infections when the causative bacteria are known or likely to be susceptible. Whenever possible, in Australian clinical practice, treatment should be guided by culture and susceptibility results.

Ampicillin vs amoxicillin

How to take

Take ampicillin tablets exactly as prescribed by your Australian doctor. Because food can reduce absorption, it is often taken on an empty stomach (e.g. at least 30 minutes before meals). Finish the full course unless your prescriber tells you to stop.

Side effects

Common side effects may include diarrhoea, nausea, vomiting and skin rash. Get urgent medical help for signs of a severe allergic reaction (e.g. swelling of the face or throat, trouble breathing), severe skin reactions, or severe or persistent diarrhoea (which can be a sign of Clostridioides difficile-associated diarrhoea).

Pregnancy and breastfeeding

Pregnancy: animal studies with penicillins have not shown harm to the fetus, but there are no adequate, well-controlled studies in pregnant women. Use during pregnancy only if clearly needed and as prescribed by an Australian doctor.

Breastfeeding: ampicillin-class antibiotics are excreted in breast milk and may cause sensitisation in the infant; use with caution and contact a clinician if the baby develops rash, diarrhoea or thrush.

Administration in renal impairment

Dose adjustment may be needed in renal impairment. Follow your prescriber's instructions if you have kidney disease or are receiving dialysis.

Storage

Store at 20°C to 25°C (68°F to 77°F). Keep the container tightly closed and out of the reach of children.