Editing Ampicillin (section)

==Medical uses==

=== Diseases ===
*[[Bacterial meningitis]]; an aminoglycoside can be added to increase efficacy against gram-negative meningitis bacteria<ref name="dailymed">{{cite web | title=Ampicillin- ampicillin sodium injection, powder, for solution | website=DailyMed | date=11 September 2019 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0642ef5e-7eff-4117-a0df-4bd15d7b7d63 | access-date=25 January 2020 | archive-url=https://web.archive.org/web/20180222104913/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0642ef5e-7eff-4117-a0df-4bd15d7b7d63 | archive-date=22 February 2018 | url-status=live }}</ref>
*[[Endocarditis]] by [[Enterococcus|enterococcal]] strains (off-label use); often given with an aminoglycoside<ref name="medscape">{{cite web|url=http://reference.medscape.com/drug/ampi-omnipen-ampicillin-342475|title=ampicillin (Rx)|last=WebMD|work=Medscape|access-date=22 August 2017|archive-url=https://web.archive.org/web/20170815211547/http://reference.medscape.com/drug/ampi-omnipen-ampicillin-342475|archive-date=15 August 2017|url-status=live}}</ref>
*[[Gastrointestinal]] infections caused by contaminated water or food (for example, by ''[[Salmonella]]'')<ref name="dailymed" />
*[[Genito-urinary tract]] infections<ref name="dailymed" />
*[[Healthcare-associated infections]] that are related to infections from using [[catheter|urinary catheters]] and that are unresponsive to other medications<ref name="Harrison">{{cite book|title=Harrison's Principles of Internal Medicine | volume = 1 | vauthors = Finberg R, Fingeroth J | name-list-style = vanc |publisher=McGraw-Hill Medical|year=2012|isbn=978-0-07-174887-2| veditors = Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J |edition = 18th|chapter=Chapter 132: Infections in Transplant Recipients }}</ref>
*[[Otitis media]] (middle ear infection)
*Prophylaxis (i.e. to prevent infection) in those who previously had [[rheumatic heart disease]] or are undergoing dental procedures, vaginal [[Hysterectomy|hysterectomies]], or [[C-sections]].<ref name="AHFS2015" /> It is also used in pregnant woman who are carriers of [[group B streptococci]] to prevent early-onset neonatal infections.<ref name="AHFS2015" />
*[[Respiratory infections]], including [[bronchitis]], [[pharyngitis]]<ref name="dailymed" />
*[[Sinusitis]]
*[[Sepsis]]<ref name=dailymed-vet>{{cite web | title=Ampicillin injection, powder, for suspension | website=DailyMed | date=26 October 2017 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=af6eb56d-698f-43aa-bb3b-a0a69732a7ae | access-date=26 January 2020 | archive-url=https://web.archive.org/web/20180222165046/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=af6eb56d-698f-43aa-bb3b-a0a69732a7ae | archive-date=22 February 2018 | url-status=live }}</ref>
*[[Whooping cough]], to prevent and treat [[secondary infection]]s<ref name="AHFS2015" />

Ampicillin used to also be used to treat [[gonorrhea]], but there are now too many strains resistant to penicillins.<ref name="AHFS2015" />

===Bacteria===
Ampicillin is used to treat infections by many [[gram-positive bacteria|gram-positive]] and [[gram-negative bacteria]]. It was the first "broad spectrum" penicillin with activity against gram-positive bacteria, including ''[[Streptococcus pneumoniae]]'', ''[[Streptococcus pyogenes]]'', some isolates of ''[[Staphylococcus aureus]]'' (but not penicillin-resistant or [[Methicillin-resistant Staphylococcus aureus|methicillin-resistant strains]]), ''[[Trueperella pyogenes|Trueperella]]'', and some ''[[Enterococcus]]''. It is one of the few antibiotics that works against multidrug resistant ''[[Enterococcus faecalis]]'' and ''[[E. faecium]]''.<ref name="magdesian">{{cite book|url=https://books.google.com/books?id=AiV4DgAAQBAJ&pg=PT59|title=Equine Pharmacology, an Issue of Veterinary Clinics of North America: Equine Practice, E-Book| vauthors = Magdesian KG |publisher=Elsevier Health Sciences|year=2017|isbn=978-0-323-52438-4|pages=59}}</ref> Activity against gram-negative bacteria includes ''[[Neisseria meningitidis]]'', some ''[[Haemophilus influenzae]]'', and some of the [[Enterobacteriaceae]] (though most Enterobacteriaceae and ''[[Pseudomonas]]'' are resistant).<ref name="magdesian" /><ref name=papich>{{cite book|url=https://books.google.com/books?id=ip8_CwAAQBAJ&pg=PA43|title=Saunders Handbook of Veterinary Drugs: Small and Large Animal| vauthors = Papich MG |publisher=Elsevier Health Sciences|year=2015|isbn=978-0-323-24485-5|pages=43–47}}</ref> Its spectrum of activity is enhanced by co-administration of [[sulbactam]], a drug that inhibits [[beta lactamase]], an enzyme produced by bacteria to inactivate ampicillin and related antibiotics.<ref name="Hauser">{{cite book|url=https://books.google.com/books?id=17pMk0v3_bYC&pg=PA25|title=Antibiotic Basics for Clinicians: The ABCs of Choosing the Right Antibacterial Agent| vauthors = Hauser AR |publisher=Lippincott Williams & Wilkins|year=2012|isbn=978-1-4511-1221-4|pages=25–28}}</ref><ref>{{cite journal | vauthors = Akova M | title = Sulbactam-containing beta-lactamase inhibitor combinations | journal = Clinical Microbiology and Infection | volume = 14 | pages = 185–188 | date = January 2008 | issue = Suppl 1 | pmid = 18154545 | doi = 10.1111/j.1469-0691.2007.01847.x | doi-access = free }}</ref> It is sometimes used in combination with other antibiotics that have different mechanisms of action, like [[vancomycin]], [[linezolid]], [[daptomycin]], and [[tigecycline]].<ref name="Suleyman2016rev">{{cite journal | vauthors = Suleyman G, Zervos MJ | title = Safety and efficacy of commonly used antimicrobial agents in the treatment of enterococcal infections: a review | journal = Expert Opinion on Drug Safety | volume = 15 | issue = 2 | pages = 153–167 | date = 2016 | pmid = 26629598 | doi = 10.1517/14740338.2016.1127349 | s2cid = 25488987 }}</ref><ref>{{cite book| vauthors = Torok ME, Moran E, Cooke F |title=Oxford Handbook of Infectious Diseases and Microbiology|publisher=Oxford University Press|isbn=9780191503108|page=721|url=https://books.google.com/books?id=G4KuDQAAQBAJ&pg=PA721|language=en|url-status=live|archive-url=https://web.archive.org/web/20170323064830/https://books.google.com/books?id=G4KuDQAAQBAJ&pg=PA721|archive-date=23 March 2017|date=December 2016}}</ref>

===Available forms===
Ampicillin can be administered by [[oral administration|mouth]], an [[intramuscular injection]] (shot) or by [[intravenous infusion]].<ref name=AHFS2015/> The oral form, available as [[Capsule (pharmacy)|capsules]] or oral suspensions, is not given as an initial treatment for severe infections, but rather as a follow-up to an IM or IV injection.<ref name="AHFS2015" /> For IV and IM injections, ampicillin is kept as a powder that must be reconstituted.<ref name="wanamaker">{{cite book|url=https://books.google.com/books?id=7s3sAwAAQBAJ&pg=PA243|title=Applied Pharmacology for Veterinary Technicians - E-Book| vauthors = Wanamaker BP, Massey K |publisher=Elsevier Health Sciences|year=2014|isbn=978-0-323-29170-5|pages=244}}</ref>

IV injections must be given slowly, as rapid IV injections can lead to convulsive [[seizures]].<ref name="AHFS2015" /><ref>{{cite web | last=WebMD | title=Ampicillin Intravenous: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing | work=WebMD | access-date=23 February 2018 | url=https://www.webmd.com/drugs/2/drug-18412/ampicillin-intravenous/details | archive-url=https://web.archive.org/web/20180223171300/https://www.webmd.com/drugs/2/drug-18412/ampicillin-intravenous/details | archive-date=23 February 2018 | url-status=live }}</ref>

=== Specific populations===
Ampicillin is one of the most used drugs in pregnancy,<ref name="weiner">{{cite book|url=https://archive.org/details/completeguidetom0000wein_t9k5|url-access=registration|quote=ampicillin pregnancy.|title=The Complete Guide to Medications During Pregnancy and Breastfeeding: Everything You Need to Know to Make the Best Choices for You and Your Baby| vauthors = Weiner CP, Rope K |publisher=St. Martin's Press|year=2013|isbn=978-1-250-03720-6|pages=[https://archive.org/details/completeguidetom0000wein_t9k5/page/47 47]–49}}</ref> and has been found to be generally harmless both by the [[Food and Drug Administration]] in the U.S. (which classified it as [[Pregnancy category#United States|category B]]) and the [[Therapeutic Goods Administration]] in Australia (which classified it as [[Pregnancy category#Australia|category A]]).<ref name="AHFS2015" /><ref>{{cite web|url=https://www.tga.gov.au/prescribing-medicines-pregnancy-database|title=Prescribing medicines in pregnancy database | author = Australian Government Department of Health Therapeutic Goods Administration|date=25 October 2017|work=Therapeutic Goods Administration (TGA)|publisher=Australian Government Department of Health|access-date=23 February 2018|archive-url=https://web.archive.org/web/20161220210434/https://www.tga.gov.au/prescribing-medicines-pregnancy-database|archive-date=20 December 2016|url-status=live}} {{Small|Note: scroll down to "Search by name" and type "ampicillin" into the search bar. Requires JavaScript to be enabled.}} <!-- If you can find a way to link directly to the "ampicillin" entry, please replace the URL (and title, if needed) and remove the appended note. --></ref> It is the drug of choice for treating ''[[Listeria monocytogenes]]'' in pregnant women, either alone or combined with an aminoglycoside.<ref name="AHFS2015" /> Pregnancy increases the [[Clearance (pharmacology)|clearance]] of ampicillin by up to 50%, and a higher dose is thus needed to reach therapeutic levels.<ref name="weiner" /><ref name="rello">{{cite book|url=https://books.google.com/books?id=wysQmU5bYAAC&pg=PA172|title=Infectious Diseases in Critical Care| vauthors = Rello J, Kollef MH, Díaz E, Rodríguez A |publisher=Springer Science & Business Media|year=2010|isbn=978-3-540-34406-3|pages=172}}</ref>

Ampicillin crosses the [[placenta]] and remains in the [[amniotic fluid]] at 50–100% of the concentration in maternal [[Plasma (blood)|plasma]]; this can lead to high concentrations of ampicillin in the newborn.<ref name="rello" />

While lactating mothers secrete some ampicillin into their breast milk, the amount is minimal.<ref name="AHFS2015" /><ref name="weiner" />

In newborns, ampicillin has a longer half-life and lower plasma protein binding.<ref name=eghianruwa>{{cite book|url=https://books.google.com/books?id=CtfIAgAAQBAJ&pg=PA26|title=Essential Drug Data for Rational Therapy in Veterinary Practice| vauthors = Eghianruwa K |publisher=AuthorHouse|year=2014|isbn=978-1-4918-0010-2|pages=26}}</ref> The clearance by the kidneys is lower, as kidney function has not fully developed.<ref name="AHFS2015" />