Ampoxin (Ampicillin and Cloxacillin)
Ampicillin is an aminopenicillin with a broad spectrum of activity. Ampicillin is bactericidal in action. Its antibacterial spectrum includes Gram positive organisms like Streptococci including Strep.pneumoniae, non beta-lactamase producing Staphylococci, Bacillus anthracis, Cl.perifringens, C.diphtheriae, Listeria monocytogenes and Enterococci; gram negative organisms like H.influenzae, N.meningitis, N.gonorrhoea, M.catarrhalis, Pasteurella, Brucella, some strains of Proteus mirabilis and E.coli. Ampicillin also has activity against Salmonella nad Shigella spp.
Certain anaerobes like Peptostreptococcus spp., Fusobacterium spp., and nonfragilis Bacteroides are also susceptible to Ampicillin. Other organisms like Actinomyces, Spirochaetes, Borrelia, Leptospira and Treponema spp., are sensitive to Ampicillin.
Cloxacillin is an isoxazolyl penicillin and is bactericidal in action. Cloxacillin is resistant to penicillinase produced by Staphylococci. The antibacterial spectrum includes penicillinase producing and non-penicillinase producing Staphylococci. It also has activity against Strep.pneumoniae, Strep.pyogenes. Cloxacillin and Ampicillin may be administered in combination to produce a wider spectrum of antibacterial activity. Synergy has been demonstrated between ampicillin and cloxacillin against some betalactamase producing organisms.
Indications and uses
Ampoxin is indicated for use for the immediate treatment of severe bacterial infections, before the infecting organism(s) is identified. It can be considered for all suspected mixed Staphyloccocal and Gram negative infections.
Typical situations when treatment needs to be started, pending bacteriology, include acute bronchopneumonia, severe lower respiratory tract infections, wound infect, post-op infections, septicaemias, patients receiving immunosuppressive therapies. Prophylactic use in major surgeries is also an indication for Ampoxin.
In premature babies or neonates, Ampoxin is indicated when bacterial infections are suspected or confirmed e.g. babies born of mothers with infected liquor or whose membranes ruptured more than 48 hours before delivery, babies following difficult delivery when liquor or mucus inhalation is suspected/possible or the liquor is meconium stained. Similarly, neonates requiring intubation, exchange transfusion or any surgical procedure carrying risk of infection, should be considered for prophylaxis with Ampoxin.
History of severe hypersensitivity reactions to Beta-lactams constituents a contraindication to the use of Ampoxin. Also, caution should be exercised when Ampoxin is being used in neonates whose mothers have a history of hypersensitivity to Beta-lactams.
In infectious mononucleosis, use of Ampoxin is likely to give rise to erythematous rash.
Periodic assessment of renal, hepatic functions and hematology should be carried out during prolonged therapy.
Usage of allopurinol concurrently with ampicillin increases the possibility of skin rsh in hyper-uricaemic subjects.
Ampoxin in pregnancy should be reserved for cases where its use is considered essential by the clinician and in his opinion, the potential benefits outweigh the risk.
Ampoxin injections and Ampoxin Neonatal Injection are incompatible with blood products or intravenous proteins and lipid emulsions. These two should therefore not be mixed in a single infusion unit.
As an anaphylactic shock may rarely occur in a hypersensitive individual, emergency equipment for resuscitation should always be available when Ampoxin injection is used.
Ampoxin is generally well tolerated. Side effects are unknown and are of mild in nature. Gastrointestinal upsets (diarrhea, nausea) and skin rashes and pruritus have been infrequently reported. As with other penicillins, patients with known hypersensitivity to Beta-lactams, may develop angioedema and anaphylaxis. Cross-sensitivity with other Beta-lactams like cephalosporin should be borne in mind while using Ampoxin in these sensitive individuals.
Rarely pseudomembranous colitis has been reported and cholestatic jaundice is reported rarely with cloxacillin.
Dosage and administration
Parenteral usage of Ampoxin is indicated where oral dosage is not possible or is considered inappropriate. Oral formulations to be given on empty stomach.
ORAL 500mg to 1g every 4 to 6 hours to be taken on empty stomach
IM OR IV INJECTION: 500mg to 1 g every 4 to 6 hours, as directed by the severity of infection. Iv injection to be given slowly, over 3 to 4 minutes.
2 to 10 years: ½ adult dose
1 month to 2 years: ¼ adult dose
2 to 10 years: 5 to 10ml every 4 to 6 hours.
1 month to 2 years: 2.5 to 5 ml every 4 to 6 hours
Syrup should be reconstituted as indicated on the label before administration.