LACILLIN® (Ampicillin preparations)
Lacillin is indicated in the treatment of gastrointestinal, respiratory, systemic and urogenital infections caused by or associated with pathogens sensitive to ampicillin therapy. These infections include biliary-tract infections, bronchitis, endocarditis, epiglottitis, gonorrhea, listeriosis, meningitis, otitis media, peritonitis, pneumonia, typhoid fever, paratyphoid fever, and gastroenteritis including Escherichia coli enteritis, Salmonella enteritis and shigellosis.
Dosage and administration
Lacillin preparations are administered by the oral route on an empty stomach preferably 30minutes before meals or 2 hours after meals.
Lacillin granules are reconstituted to make 60ml and 100ml oral suspension by shaking with specified volumes of clean, boiled and cooled water respectively. Shake the bottle well before taking each dose.
The dosage of ampicillin will depend on the severity of the disease, the age of the patient and renal functions. The dose should be reduced in severe renal failure. The usual oral dose of ampicillin is 250mg to 1g every 6 hours.
Precautions and contraindications
- Lacillin is contraindicated in patients with a known hypersensitivity to ampicillin or other penicillins
- Ampicillin should preferably not be given to patients with infectious mononucleosis since they are especially susceptible to ampicillin-induced skin rashes. Patients with lymphatic leukemia or HIV infection may also be at increased risk of developing skin rashes
- Lacillin should be given with care in patients with impaired renal function because of the risk of neurotoxicity. Prolonged use of the preparations should be avoided since penicillin therapy changes the normal bacterial flora and can lead to super-infection with penicillin resistant organisms including pseudomonas or candida spp.
- Renal and haematological status should be monitored during prolonged and high-dose therapy. Care is also necessary when treating some patients because of the Jarisch-Herxheimer reaction with syphilis and other spirochaete infections.
Ampicillin may decrease the efficacy of oestrogen-containing oral contraceptives.
There may be antagonism between ampicillin, a bacteriostatic agent such as chloramphenicol or tetracyclines.
Lacillin may cause gstro-intestinal disturbances including diarrhea, nausea and vomiting. Pseudomembranous colitis has also been reported.
Hypersensitivity reactions, especially skin rashes are frequently observed and are generally either urticarial or maculopapular.
Lacillin contains ampicillin semi-synthetic penicillin derived from 3-Amino Penicillin Acid. It is a beta-lactam antibiotic with a similar mode of action to that of benzylpenicillin but with a wider spectrum of antibactericidal action on growing and dividing bacteria. It acts by inhibiting bacterial cell-wall synthesis. It inhibits the final cross-linking stage of peptidoglycan production by binding to and inactivating transpeptidases and penicillin-binding proteins on the inner surface of the bacterial cell membrane, in addition to causing bacterial lysis by inactivation of endogenous inhibitors of bacterial autolysis.
Antimicrobial action and resistance
Lacillin is active on both Gram-positive and Gram-negative pathogens, and has a broader spectrum of activity than benzylpenicillin, especially against Gram-negative bacilli. Ampicillin is active on Streptococcus pneumonia, Listeria monocytogenes, Moraxella Catarrhalis, Neisseria gonorrhoeae, Neisseria meningitis, Haemophilia influenza, Escherichia coli, Proteus mirabilis, Salmonella and Shigella spp. Ampicillin has similar activity as benzylpenicillin against many anaerobes and Actinomyces spp. It is inactive against Pseudomonas aeruginosa.