Ampicillin sulbactam precautions

# Precautions
A high percentage of patients with mononucleosis who receive ampicillin develop a skin rash. Thus, ampicillin class antibiotics should not be administered to patients with mononucleosis. In patients treated with ampicillin/sulbactam the possibility of superinfections with mycotic or bacterial pathogens should be kept in mind during therapy. If superinfections occur (usually involving Pseudomonas or Candida), the drug should be discontinued and/or appropriate therapy instituted. Prescribing ampicillin/sulbactam in the absence of proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.
Patients should be counseled that antibacterial drugs including ampicillin/sulbactam should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When ampicillin/sulbactam is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by ampicillin/sulbactam or other antibacterial drugs in the future.Diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued. Sometimes after starting treatment with antibiotics, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as two or more months after having taken the last dose of the antibiotic. If this occurs, patients should contact their physician as soon as possible.
Probenecid decreases the renal tubular secretion of ampicillin and sulbactam. Concurrent use of probenecid with ampicillin/sulbactam may result in increased and prolonged blood levels of ampicillin and sulbactam. The concurrent administration of allopurinol and ampicillin increases substantially the incidence of rashes in patients receiving both drugs as compared to patients receiving ampicillin alone. It is not known whether this potentiation of ampicillin rashes is due to allopurinol or the hyperuricemia present in these patients. There are no data with ampicillin/sulbactam and allopurinol administered concurrently. Ampicillin/sulbactam and aminoglycosides should not be reconstituted together due to the in vitro inactivation of aminoglycosides by the ampicillin component of ampicillin/sulbactam.
Administration of ampicillin/sulbactam will result in high urine concentration of ampicillin. High urine concentrations of ampicillin may result in false positive reactions when testing for the presence of glucose in urine using Clinitest, Benedicts Solution or Fehlings Solution. It is recommended that glucose tests based on enzymatic glucose oxidase reactions (such as Clinistix or Testape) be used. Following administration of ampicillin to pregnant women, a transient decrease in plasma concentration of total conjugatedestriol, estriol-glucuronide, conjugated estrone and estradiol has been noted. This effect may also occur with ampicillin/sulbactam.
Long-term studies in animals have not been performed to evaluate carcinogenic or mutagenic potential.
Reproduction studies have been performed in mice, rats, and rabbits at doses up to 10 times the human dose and have revealed no evidence of impaired fertility or harm to the fetus due to ampicillin/sulbactam. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.
Studies in guinea pigs have shown that intravenous administration of ampicillin decreased the uterine tone, frequency of contractions, height of contractions, and duration of contractions. However, it is not known whether the use of ampicillin/sulbactam in humans during labor or delivery has immediate or delayed adverse effects on the fetus, prolongs the duration of labor, or increases the likelihood that forceps delivery or other obstetrical intervention or resuscitation of the newborn will be necessary.
Low concentrations of ampicillin and sulbactam are excreted in the milk; therefore, caution should be exercised when ampicillin/sulbactam is administered to a nursing woman.
The safety and effectiveness of ampicillin/sulbactam have been established for pediatric patients one year of age and older for skin and skin structure infections as approved in adults. Use of ampicillin/sulbactam in pediatric patients is supported by evidence from adequate and well-controlled studies in adults with additional data from pediatric pharmacokinetic studies, a controlled clinical trial conducted in pediatric patients and post-marketing adverse events surveillance. The safety and effectiveness of ampicillin/sulbactam have not been established for pediatric patients for intra-abdominal infections.