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Journal of Drug Design and Research
Review Article *Corresponding author
Gian Maria Pacifici,Associate professorof

Clinical Pharmacology of Pharmacology,via Sant’Andrea 32,56127 Pisa,Italy.

Email: pacifici44@[Link]
Submitted: 19 April 2021

Ampicillin in Infants and Accepted: 25 April 2021

Published: 27 April 2021

Children
ISSN: 2379-089X
Copyright
© 2021 Pacifici GM
Gian Maria Pacifici* OPEN ACCESS
Associate professorof Pharmacology, Italy
Keywords
• Ampicillin
Abstract
• Dosing
Ampicillin is an aminopenicillin and is more active than penicillin G. Ampicillin is destroyed by β-lactamase • Treatment
and is co-formulated with sulbactam an inhibitor of β-lactamase. Ampicillin is bactericidal and it is active • Trials
against meningococci, Listeria monocytogenes, enterococci, and the co-administration with sulbactam markedly • Placental-transfer
expands the spectrum of activity against Haemophilus influenzae, Escherichia coli, Proteus, and Bacillus fragilis.
• Breast-milk
Ampicillin may be administered intravenously and orally and the intravenous dose is 50 mg twice-daily and
• Meningitis
thrice-daily in preterm and term infants, respectively. The oral dose in children ranges from 125 to 500 mg
4 times-daily and increases with the chid age. Ampicillin has been found efficacy and safe in infants and
children but may cause adverse-effects. In infants, the ampicillin elimination half-life ranges between 2.4 to
5.0 hours and decreases with infant maturation and in children it is about 0.8 hours. Ampicillin interacts with
drugs, the treatment and the trials with ampicillin have been extensively studied in infants and children. This
antibiotic freely crosses the human placenta but poorly migrates into the breast-milk. Ampicillin penetrates into
the cerebrospinal fluid in significant amounts and treated meningitis caused by different pathogens generally
co-administered with other antibiotics, particularly with chloramphenicol, but cefotaxime or cefuroxime sterilized
the cerebrospinal fluid more rapidly. The aim of this study is to review the ampicillin dosing, efficacy and
safety, effects, adverse-effects, tissue concentration, pharmacokinetics, interaction with drugs, treatment, trials,
placental transfer, migration into breast-milk, penetration into the cerebrospinal fluid, and treatment of bacterial
meningitis in infants and children.

INTRODUCTION increasing frequency. Concurred administration of a β-lactamase

inhibitor such as clavulanate or sulbactam markedly expands the
Ampicillin is an aminopenicillin and expands the spectrum ampicillin spectrum of activity, particularly against Haemophilus
of activity of penicillin G in a different direction from the influenzae, Escherichia coli, Klebsiella, Proteus, and Bacillus
penicillinase-resistant penicillins they allow for useful activity fragilis [1].
against some gram-negative organisms. Ampicillin is destroyed
by β-lactamases (from both gram-positive and gram-negative Absorption, distribution, metabolism and elimination
bacteria); thus further expansion of its activity is enhanced of ampicillin
through co-formulation with β-lactamase inhibitors: clavulanate,
sulbactam, or tazobactam [1]. Ampicillin is stable in acid and is well absorbed after
oral administration. An oral dose of 500 mg produces peak
Antimicrobial activity of ampicillin concentration in plasma of about 3 µg/ml at 2 hours. Intake of
food prior to ingestion of ampicillin diminishes absorption.
Ampicillin is generally bactericidal for sensitive gram-positive
Intramuscular injection of 500 to 1,000 mg sodium ampicillin
and gram-negative bacteria. The meningococci and Listeria
yields peak plasma concentrations of about 7 to 10 µg/ml,
monocytogenes are sensitive to ampicillin. Many pneumococcal
respectively, at 1 hour. Plasma concentrations decline with a
isolates have varying levels of resistance to ampicillin, and
half-life of about 80 min in adults. Severe renal impairment
penicillin-resistant strains should be considered ampicillin-
markedly prolongs the half-life. Peritoneal dialysis is ineffective
resistant. Haemophilus influenzae and the viridians group of
in removing the drug from the blood, but haemodialysis
streptococci exhibit varying degrees of resistance. Enterococci
removes approximately 40% of the body store in about 7 hours.
are about twice as sensitive to ampicillin as they are to penicillin G.
Adjustment of the dose of ampicillin is required in the presence
From 30 to 50% of Escherichia coli, significant number of Proteus
of renal dysfunction. Ampicillin appears in the bile, undergoes
mirabilis and practically all species of Klebsiella are resistant.
enterohepatic circulations, and is excreted in the faeces [1].
Most strains of Shigella, Pseudomonas, Serratia, Acinetobacter,
Bacillus fragilis, and indole-positive Proteus also are resistant The literature search was performed electronically using
to ampicillin. Resistant strains of Salmonella are recovered with PubMed database as search engine and the following key words

Cite this article: Pacifici GM (2021) Clinical Pharmacology of Ampicillin in Infants and Children. J Drug Des Res 8(2): 1082.
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were used: “ampicillin dosing infants, children“, ampicillin efficacy, Intravenous treatment of Listerial meningitis in infants
safety infants, children”, “ampicillin effects infants, children”, and children [4]: Infants aged up to 7 days. Give: 100 mg/kg
“ampicillin adverse-effects infants, children”, “ampicillin tissue twice-daily.
concentration”, “ampicillin pharmacokinetics infants, children”,
Infants aged 7 to 20 days. Give: 100 mg/kg thrice-daily.
“ampicillin drug interactions”, “ampicillin therapeutic use infants,
children“ “ampicillin treatment infants, children”, “ampicillin Infants aged 21 to 28 days. Give: 100 mg/kg 4 times-daily.
trials infants, children”, “ampicillin placental transfer”, “ampicillin
Children. Give: 50 mg/kg 4 to 6 times-daily.
migration into the breast-milk”, “ampicillin penetration into the
cerebrospinal fluid”, and “ampicillin treatment of meningitis in Efficacy and safety of ampicillin in Infants and
infants, children”. In addition, the books: The Pharmacological children
Basis of Therapeutics [1], Neonatal Formulary [2], NEOFAX® by
Young and Mangum [3], and The British National Formulary for Infants, aged 2 to 24 months, were hospitalized for urinary-
Children [4] were consulted. tract infections and were treated with ampicillin/sulbactam
or cephalosporins. Ampicillin/sulbactam could be an effective
RESULTS alternative to cephalosporins for the treatment of the first-
episode of the urinary-tract infections in these infants [5].
Administration schedules of ampicillin to infants and
Extremely low-birthweight infants at risk of early onset sepsis
children received ampicillin (N = 36) or penicillin G (N = 39). Ampicillin
Administration to infants [2]: Infants with a postmenstrual was efficacy and safe in treating the sepsis and was associated
aged ≤ 34 weeks and a postnatal age ≤ 7 days. Give: 50 mg with a lower mortality-rate [6]. The empirical use of ampicillin
twice-daily. to cover febrile infants caused by Listeria monocytogenes and
enterococcal infections is most justifiable in the first month of
Infants with a postmenstrual age ≤ 34 weeks and a life [7]. Children, aged 3 to 59 months, were hospitalized for
postnatal age > 7days and ≤ 28 days. Give: 75 mg twice-daily. severe pneumonia and received penicillin G or ampicillin. Both
Infants with a postmenstrual age > 34 weeks and a treatments were efficacy and safe and are efficacious options
postnatal age ≤ 28 days. Give: 50 mg thrice-daily. to treat children with pneumonia due to pneumococcal strains
having penicillin G MIC up to 4 µg/ml [8]. Children with infections
Very large dose of ampicillin may result in central nervous in the lower respiratory-tract, urinary-tract, skin, bone and soft-
system excitation or seizure activity. Moderate prolongation of tissue infections were treated with ampicillin/sulbactam and
blending times (by approximately 60 seconds) may occur after sultamicillin and this treatment was found efficacy and safe
repeated doses. Hypersensitivity reactions (maculopapular rash, and should be considered to be the first-choice options for the
urticaria, or fever) are rare in infants. Ampicillin is incompatible management of a variety of paediatric infections [9]. Either
with: amikacin, amiodarone, dopamine, epinephrine, ampicillin/sulbactam or cefuroxime provide safe and effective
erythromycin, lactobionate, fluconazole, gentamicin, hydralazine, parenteral antibiotic therapy in paediatric patients with serious
metoclopramide, midazolam, nicardipine, sodium bicarbonate, skin and skin-structure infections [10]. Twenty-three children,
and tobramycin [3]. aged 2 months to 11 years, suffering from pus-forming cervical
Administration to children [4]: [Link]. Oral treatment adenitis, and lobar pneumonia caused by Escherichia coli (N =
for susceptible infections including: (1) bronchitis, (2) 10), Staphylococcus aureus (N = 7), and Klebsiella pneumoniae
urinary-tract infections, (3) otitis media, (4) sinusitis, (5) (N = 6) were treated with ampicillin/sulbactam or penicillin/
uncomplicated community-acquired-pneumonia, and (6)
salmonellosis.
Children aged 1 to 11 months. Give: 125 mg 4 times-daily;
increase the dose if necessary to 30 mg/kg 4 times-daily.
Children aged 1 to 4 years. Give: 250 mg 4 times-daily;
increase the dose if necessary up to 30 mg/kg 4 times-daily.
Children aged 5 to 11 years. Give: 500 mg 4 times-daily;
increase the dose if necessary up to 30 mg/kg 4 times-daily
Figure 1 Ampicillin molecular structure (molecular weight = 349.41).
(maximum per dose = 1 gram 4 times-daily).
Children aged 12 to 17 years. Give: 500 mg 4 times-daily;
increase the dose if necessary to 1 gram 4 times-daily, use
increased dose in severe infection.
Intravenous infusion for treating: (1) group B
streptococcal infection and (2) enterococcal endocarditis
in combination with another antimicrobial: Children. Give:
50 mg/kg thrice-daily 4 to 6 times-daily (maximum per dose = 2
grams 6 times-daily). Figure 2 Sulbactam molecular structure (molecular weight = 233.24).

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sulbactam. Ampicillin/sulbactam proved to be safe and effective epididymis 30 to 65 min after the end of infusion. Ampicillin
treatment of non-life-threatening paediatric infections [11]. and sulbactam concentrations were 38.9+15.9 and 19.8+5.2
Ampicillin/sulbactam is an effective and well tolerated treatment µg/gram, respectively. These concentrations exceed the MIC of
for children with pneumonia [12]. many organisms including Staphylococcus pneumoniae [23].
Twenty-four children undergoing surgery in the ENT region were
Effects of ampicillin in infants and children treated with 2 grams of ampicillin and 1 gram of sulbactam. The
Ampicillin is effective in treating upper and lower respective mean concentrations in serum were 59.2 and 31.6 µg/
respiratory-tract infections caused by Streptococcus ml, respectively. About 1 hour after the end of infusion, the mean
pneumoniae, β-haemolytic streptococci, and non β-lactamase- concentrations of ampicillin and sulbactam in tissue were 33.5
producing strains of Haemophilus influenzae. It is also effective and 19.5 µg/ml. Ampicillin and sulbactam diffuses into different
in the treatment of meningitis caused by group B streptococci tissues and the serum to tissue concentration ratio is about 2
and Listeria monocytogenes [13]. Ampicillin administered [24].
at a daily dose of 50 to 70 mg/kg to children is effective in
Pharmacokinetics of ampicillin in infants
treating otitis media caused by Diplococcus pneumoniae and
Haemophilus influenzae. Ampicillin showed a relapse-rate in Tremoulet et al. [25] studied the pharmacokinetics of
excess of 20% during two months of follow-up and the adverse- ampicillin in 73 infants who were clustered into 4 groups. Group
effects occurred in 26% of treated children [14]. One-hundred- A consisted in 21 infants with gestational and postnatal ages
forty-nine children were diagnosed as bronchopneumonia and of 30.3+3.4 weeks and 2.6+2.3 days, respectively. Infants of
acute bronchial obstructive syndrome. Ampicillin is as effective group B (N = 7) had a gestational and postnatal ages of 36.9+2.5
as cefazolin or ceftriaxone for the treatment of community- weeks and 15.4+4.0 days, respectively. Group C consisted in 27
acquired-pneumonia in children [15]. Ampicillin is active against infants with gestational and postnatal ages of 38.2+2.0 weeks
Salmonella Typhimurium, Salmonella Newport, Salmonella and 2.9+2.6 days, respectively. Infants of group D (N = 18) had
bovis morbificans, Salmonella postsdam, Salmonella saint a gestational and postnatal ages of 34.8+6.4 weeks and 6.6+6.4
paul, Salmonella oranienburg, Salmonella Adelaide, Salmonella days, respectively. Table 1 shows the dosing-regimens of
enteritidis, Shigella sonnei, Shigella flexneri, and Escherichia coli ampicillin in the 4 group of infants. (Table 1) (Table 2)
[16].
This table shows that ampicillin total body clearance
Adverse-effects caused by ampicillin in children increases with the postnatal age, ampicillin elimination half-life
and ampicillin serum concentrations decrease with the postnatal
One-hundred-two children received ampicillin/sulbactam for age. Ampicillin distribution volume is lower than the water
10 days and diarrhoea occurred in 70% of children [17]. Two- volume and it is independent by the postnatal age.
thousand-five-hundred-one children received ampicillin and
the adverse-effects were diarrhoea and skin rash [18]. Twenty- Colding et al. [26] investigated the pharmacokinetics of
three children received ampicillin orally and the treatment ampicillin in 88 newborn infants who received intravenous
caused diarrhoea in 60% of children [19]. In children, the dose parenteral nutrition and ampicillin. The median gestational age
of ampicillin ranged from 50 to 200 mg/kg daily and mild, was 34 weeks (range, 27 to 42) and the median body-weight was
moderate, and severe diarrhoea occurred in 18 to 30%, 2 to 11% 1,975 grams (range, 805 to 4,850). Ampicillin was intravenously
and 1%, of children, respectively [20]. A study of 200 consecutive infused at a dose of 200 mg/kg and the median treatment
children receiving ampicillin for various reasons revealed that duration was 5 days (range, 2 to 20). (Table 3)
bowel habits changed in 16% and diarrhoea occurred in 4.5% of This table shows that the ampicillin serum concentration
children [21]. decreases with increasing the infant body-weight and the
Tissue concentrations of ampicillin sulbactam in gestational age.
children Pharmacokinetics of ampicillin and sulbactam in
Sixteen children undergoing colorectal surgery received children
2 grams of ampicillin and 1 gram of sulbactam by intravenous Nahata et al. [27] described the pharmacokinetics of ampicillin
infusion. Serum trough concentrations of sulbactam and and sulbactam in 28 children (19 males and 9 females) who were
ampicillin were 33+22 and 72+55 µg/ml, respectively, and the aged 1 to 6 years (N = 10), 6.1 to 10 years (N = 9) and 10.1 to 12
corresponding concentration in the abdominal tissue ranged years (N = 9). Ampicillin and sulbactam (2:1) was intravenously
from 2.7 to 3.8 µg/ml and from 5.6 and 6.8 µg/ml. In fat tissue, infused at a dose ranging from 40 to 80 mg/kg 4 times-daily
ampicillin concentration ranged from 1.7 to 4.0 µg/ml, and in for 2 to 6 days. (Table 4) summarizes the pharmacokinetics of
the colonic wall ampicillin concentration was 7.0+2.8 µg/ml. In ampicillin and sulbactam in these [Link] table shows that
most children, the concentrations of ampicillin/sulbactam were the pharmacokinetic parameters of ampicillin and sulbactam do
greater the MIC50 for Bacteroides fragilis in the fatty tissue. In not vary with the child age. The pharmacokinetic parameters
the colonic wall the ampicillin/sulbactam concentrations were of ampicillin and sulbactam are not significantly different. The
higher the MIC90 for Bacteroides fragilis [22]. Nine children elimination half-life of ampicillin and the distribution volume
undergoing orchiectomy for testicular cancer were treated with of ampicillin are similar among these children. The elimination
3 grams of ampicillin and 1.5 grams of sulbactam preoperatively half-life of ampicillin is longer in infants than in children and
and the concentrations of both drugs were measured in the the distribution volume is similar in infants and children. For

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Table 1: Ampicillin as prescribed by primary physicians.

Group N Ampicillin daily dose (mg/kg daily) Ampicillin dose (mg/kg) Dosing interval Typical dose
19% thrice-daily, 100 mg/kg
A 21 200 (162 – 303) 100 (81 – 109)
81% twice-daily twice-daily
B 7 185 (113 – 194) 93 (57 – 97) 100% twice-daily 100 mg twice-daily
59% thrice-daily 75 mg/kg
C 27 218 (100 – 307) 100 (43 – 102)
41% twice-daily thrice-daily
11% 4 times-daily
100 mg/kg
D 18 282 (184 – 350) 92 (46 – 100) 28% thrice-daily
thrice-daily
28% twice-daily
11% 4 times-daily
100 mg/kg
Overall 73 200 (100 – 350) 98 (43 – 109) 34% thrice-daily
twice-daily
55% twice-daily

Table 2: Pharmacokinetic parameters of ampicillin according to the 4 groups of infants.

Steady stathe concentration (µg/ml)
Group N TBC (L/h/kg) DV (L/kg) *Half-life (h) Minimum Maximum
A 21 0.055 (0.03 – 0.07) 0.40 (0.40 – 0.40) 5.0 (3.9 – 9.4) 77 (36 – 320) 318 (244 – 563)
B 7 0.070 (0.03 – 0.07) 0.40 (0.40 – 0.41) 4.0 (3.8 – 8.3) 33 (21 – 145) 266 (159 – 368)
C 27 0.086 (0.04 – 0.139 0.40 (0.40 – 0.40) 3.2 (2.2 – 6.2) 48 (5 – 173) 274 (127 – 413)
D 18 0.11 (0.06 – 0.13) 0.40 (0.40 – 0.41) 2.4 (2.1 – 4.7) 28 (5 – 173) 246 (138 – 203)
Overall 73 0.072 (0.03 – 0.13) 0.40 (0.40 – 0.41) 3.3 (2.1 – 9.4) 47 (5 – 320) 281 (127 – 563)
TBC = total body clearance. DV = distribution volume. *Elimination half-life.

Table 3: Demographic characteristics of newborns, number of treatments, ampicillin dose, and ampicillin serum concentration.
Number of treatments
Ampicillin
Gestational age Postnatal age Dosage (mg/kg Number of
Days Courses Body-weight Serum conc.
(weeks) (days) daily) measurements
(µg/ml)
≤ 32 274 42 1,217 20 161 205 45
33 – 36 153 23 1,677 8 159 124 43
≥ 37 332 43 2,730 15 164 265 33*
Body-weight
(grams)
≤ 1,000 88 13 --- 16 147 72 47
1,001 – 1,500 220 32 --- 17 164 171 41
1,501 – 2,000 150 23 --- 12 163 111 45
2,001 – 2,500 104 15 --- 11 150 80 35
2.501 – 3,000 116 13 --- 16 182 92 33
≥ 3,001 98 14 --- 19 162 82 30*
Postnatal age
(days)
≤7 242 67 1,862 -- 166 149 48
8 – 14 278 77 2,058 --- 155 260 38
15 – 21 95 24 1,950 --- 150 72 41
≥ 22 161 26 2,026 --- 178 128 31**
Mean --- --- 1,977 15 162 --- 39§
%Mean --- --- 3.4 20 45 --- 82
*P-value < 0.001. **P-value < 0.005, by 2-way analysis of variance. §Geometric main.

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comparison of pharmacokinetic parameters of infants see the rate constants (Kobs) of the reaction of N-acetyl-p-benzoquinone-
table 2. Ampicillin total body clearance is difficult to compare imine were observed with the co-administration of β-lactam
in children and infant because it has been expressed in different antibiotics. The Kobs for the reaction between N-acetyl-p-
units in children and infants. benzoquinone-imine and β-lactam antibiotics was found to
vary in the following order: Kobs amoxicillin = Kobs ampicillin
Interactions of ampicillin with drugs in infants and > Kobs penicillin at biological pH [32]. The most commonly
children prescribed multiple antibiotic were ampicillin plus gentamicin
Ampicillin inhibits the transport of other drugs [28]. Two- (N = 113, 27.1%) followed by intravenous chloramphenicol plus
hundred-eight-one newborn infants were recovered in the cloxacillin (N = 60, 14.4%). There was a significant interaction
intensive care unit who received 1,114 potential drug interaction between ampicillin and gentamicin in hospitalized children [33].
and incompatible drug interactions occurred in 25.0% of infants Chloroquine reduces the urinary excretion of ampicillin when it
and those caused by ampicillin were 408 [29]. Quinine reduced is co-administered with cloxacillin [34].
the bioavailability and the antimicrobial activity of ampicillin- Therapeutic use of ampicillin/sulbactam in children
cloxacillin which may have therapeutic implications, and caution
is required with the co-administration of these drugs [30]. Drug Ampicillin/sulbactam was used for the treatment of
rashes were observed among 22.4% of 67 hospitalized children lower respiratory-tract infections, aspiration pneumonia,
receiving allopurinol and ampicillin concomitantly, whereas the gynaecological/obstetric, intraabdominal and paediatric
rashes occurred in only 7.5% of 1,257 children who received infections such as acute epiglottitis, and periorbital cellulitis,
ampicillin only. Potentiation rashes caused by ampicillin co- diabetic foot, skin and soft-tissue infections [35]. Ampicillin/
administered with allopurinol (or hyperuricemia) seems a sulbactam is active against organisms that produce β-lactamase
likely explanation, since rashes occurred in only 2.1% of 283 including Bacteroides fragilis and Neisseria gonorrhoea.
children who received allopurinol without ampicillin [31]. A Ampicillin/sulbactam improves the therapeutic and prophylactic
drug–drug interaction between N-acetyl-p-benzoquinone-imine efficacy in a wide range of microorganisms [36]. Ampicillin/
derived from the anodic oxidation of acetaminophen when it sulbactam is a sensible option for the treatment of life-
was administered with β-lactam antibiotics. The homogeneous threatening acinetobacter infections [37]. Ampicillin/sulbactam

Table 4: Pharmacokinetic parameters of ampicillin and sulbactam which were obtained in 28 children.
Age group
1 to 6 years 6.1 to 10 years 10.1 to 12 years *P-value
Ampicillin
N Mean+SD N Mean+SD N Mean+SD
Dose (mg/kg) 10 69.5+10.2 9 63.7+13.2 9 65.9+11.2 0.9888
Peak conc. (µg/ml) 10 200+118 9 183+36.5 9 177+31.9 0.7066
AUC0-6 hours 9 179+79.2 8 159+42.6 9 175+45.5 0.7066
TBC (ml/min/kg) 9 5.11+2.36 8 4.88+1.49 9 4.31+0.92 0.8082
§
Half-life (h) 9 0.74+0.07 8 0.72+0.11 9 0.85+0.18 0.7903
DVss (L/kg) 0.34+0.17 8 0.30+0.08 9 0.32+0.07 0.7903
Sulbactam
Peak conc. (µg/ml) 10 102+64.2 9 85.8+21.2 9 81.9+20.7 0.7066
AUC0-6 hours 9 90.5+42.8 8 76.8+25.2 9 81.8+15.7 0.7903
TBC (ml/min/kg) 9 5.10+2.24 8 5.17+1.73 9 4.60+1.09 0.9041
§
Half-life (h) 9 0.77+0.08 8 0.76+0.10 9 0.89+0.13 0.7903
DVss (L/kg) 9 0.34+0.16 8 0.34+0.10 9 0.35+0.10 0.9888
Difference between pharmacokinetics of ampicillin and sulbactam (**P-value)
Peak concentration AUC0-6 hours TBC Elimination half-life DVss
Age group 1 to 6 years
0.5066 0.8248 0.8248 0.8248 1.0000
Age group 6.1 to 10 years
0.8248 0.8248 0.8248 0.8248 0.8248
Age group 10.1 to 12 years
0.8248 0.8248 0.5066 0.8248 0.8248
TBC = total body clearance. Elimination half-life. DVss = distribution volume at steady-state. *Kruskal-Wallis test. ** Mann Whitney test.
§

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Table 5: Concentration of ampicillin in the cerebrospinal fluid (CSF) and serum of healthy volunteers.
Cerebrospinal fluid Serum
Time after dosing Number of Range (µg/ Mean (µg/ Number of Range (µg/ Mean (µg/ CSF to serum
(min) specimens ml) ml) specimens ml) ml) ratio
30 0 0.00 – 0.00 0.00 6 22 – 165 116 ---
60 3 0.35 – 0.70 0.46 6 33 – 56 42 0.011
120 3 0.34 – 0.54 0.41 6 8.6 – 15.7 12.7 0.032
240 3 0.70 0.70 6 0.7 – 3.2 1.8 0.39

is used in the treatment of the upper and lower respiratory-tract cured or improved. Bacteriologic eradication also occurred
infections, urinary-tract, skin, bone, soft-tissue infections and in 46 (93.9%) of 49 infections. Side effects were diarrhoea in
meningitis and it is effective for the prophylaxis of infections two patients, acute haemolytic anaemia in one patient, and
which occurred after surgery [38]. Ampicillin/sulbactam has transient elevations in SGOT and leukopenia in one patient. Side
proved efficacy against Staphylococcus aureus, Streptococcus effects disappeared upon completion of treatment. Sulbactam/
pneumoniae, Haemophilus influenzae b, Moraxella catarrhalis, ampicillin is a safe and effective antibiotic for the treatment of
and gram-negative rods [39]. common paediatric infections [46]. Ampicillin/sulbactam has
proved to be clinically and bacteriologically effective against
Treatment with ampicillin or with ampicillin/ a variety of frequently encountered paediatric infections,
sulbactam in infants and children including mild-to-moderate upper respiratory-tract infections
An infant had an infection caused by Enterococcus faecalis (acute otitis media, sinusitis, pharyngitis, and tonsillitis), severe
which was resistant to ampicillin plus vancomycin but the post-operative, intra-abdominal and periorbital infections, acute
infection was eradicated with ampicillin plus cefotaxime [40]. epiglottitis, bacterial meningitis, and brain abscess. Ampicillin/
Seventy-five extremely low-body-weight infants had a sepsis sulbactam has also proved to be effective in the prevention of
caused by Klebsiella pneumoniae, 36 infants received ampicillin post-operative surgical infections in paediatric patients. The
and 39 infants were treated with penicillin. The eradication- clinical efficacy profile of ampicillin/sulbactam and sultamicillin,
rate of the infective organism was more rapid with ampicillin combined had excellent tolerability profile and make these agents
than with penicillin [41]. Parenteral penicillin or ampicillin for attractive options for the management of many life-threatening
treatment of non-complicated community-acquired-pneumonia infections in paediatric patients [47]. Ampicillin/sulbactam is
in hospitalized children is as effective as cefuroxime, and should clinically effective in children with infections in the respiratory-
remain the recommended first-line therapy [42]. The parenteral tract, ears, nose, throat, urinary-tract, skin and soft-issues,
ampicillin/sulbactam is indicated for the treatment of mild- obstetric and gynaecological infections, and in the treatment of
to-moderate severe infections such as intra-abdominal or gonorrhoea, streptococcal pharyngitis, and acute otitis media in
gynaecological infections. Moreover, it represents the alternative children. Ampicillin associated with cefaclor was effective in the
of choice for the treatment of Acinetobacter baumannii treatment of acute otitis media in adults. Ampicillin associated
infections which are carbapenem-resistant strains. Thus, with bacampicillin, cloxacillin and flucloxacillin is effective in
ampicillin-sulbactam remains a valuable agent in the physician’s the treatment of children with skin and soft-tissue. Ampicillin/
armamentarium for the management of adult and paediatric sulbactam is superior in efficacy to bacampicillin in the treatment
infections [43]. Twenty-five children with otitis media were of chronic respiratory-tract infections, superior to cefaclor in the
treated with amoxicillin (25 mg/kg daily in three divided doses) treatment of acute otitis media, and superior to cefadroxil in the
or with ampicillin (50 mg/kg daily in three divided doses). Results treatment of patients with complicated urinary-tract infections
were considered good in 87.7% and in 88.0% of children who in children [48]. In children with severe shigellosis, treatment
received amoxicillin or ampicillin, respectively [44]. Thirty-one with ceftriaxone for 5 days is effective and better than ampicillin
infants and children, with mean age of 3.6 years, had documented in clinical cure and in the eradication of Shigella organisms from
acute epiglottitis and received parenteral sulbactam sodium (30 the stool [49].
mg/kg daily) in combination with ampicillin (200 mg/kg daily). Trials with ampicillin in infants and children
Of 31 subjects, 26 (84.0%) had Haemophilus influenzae type b
isolated from the blood and seven of the 26 subjects (26.9%) were A randomized, controlled, open-label, non-inferiority trial
infected by Haemophilus influenzae type b who was β-lactamase- was conducted in children, aged 2 to 59 months, who received
positive. Twenty-five children (96.1%) with Haemophilus either intravenous ampicillin or intravenous amoxicillin, plus
influenzae type b epiglottitis responded rapidly to the treatment. intravenous gentamicin in both study arms. The monitoring of
The ampicillin/sulbactam appeared to be an effective and safe the patients was carried out according to the WHO protocol for
alternative to chloramphenicol/ampicillin therapy for acute the treatment of severe pneumonia. This trial demonstrated that
epiglottitis in infants and children [45]. Ampicillin/sulbactam both treatments were effective in curing infections caused be
was given by intravenous bolus at a dosage range of 75 to 450 susceptible organisms [50]. A multicentre randomized trial was
mg/kg daily in four divided doses for variable periods of time conducted in children, aged 2 to 59 months, testing the efficacy of
depending on the type and severity of the infection. Of a total chloramphenicol and ampicillin plus gentamicin for the treatment
of 83 episodes of infections, 80 (96.4%) children were either of infections caused by Staphylococcus aureus and Streptococcus

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pneumoniae. Intravenous ampicillin plus gentamicin is superior transfer of ampicillin rapidly occurs between the mothers to
to intravenous chloramphenicol for the treatment of community- foetus. Ampicillin appeared in the amniotic fluid 90 min after
acquired very severe pneumonia in these children [51]. A dosing and the amniotic fluid compartment forms a depot for
prospective, randomized, double-blind trial compared the the sequestration of ampicillin. Varying rates of transfer, out the
efficacy, safety and cost-effectiveness of ampicillin, gentamicin amniotic fluid, occur in different stages of pregnancy [57].
and clindamycin or cefotaxime and clindamycin for the treatment
of children with complicated appendicitis. Forty-seven children Migration of ampicillin into the breast-milk
were assigned to the ampicillin, gentamicin and clindamycin Low concentrations of ampicillin were found in colostrum/
regimen and 50 children received cefotaxime and clindamycin. breast milk from 6 mothers treated with pivampicillin at doses of
Forty-two children (87.4%) in the ampicillin, gentamicin and 1.0 to 2.1 grams daily during the first to eighth day postpartum
clindamycin groups had an appropriate therapeutic outcome in the maternity ward. It was calculated that the breast-fed infant
and 48 of 50 children (96.0%) who received cefotaxime and could theoretically receive 0.05 to 0.37% of the dose per kg given
clindamycin completed the trial successfully. There were no to the mother. The exposure of the breast-fed infant suckling
differences between the groups with respect to the duration from a mother under treatment with ampicillin or pivampicillin
of antibiotic administration, fever, leucocytosis or length of seems to be minimal [58]. The concentration of ampicillin was
hospitalization. Complications of therapy were uncommon and determined in the breast-milk and in the plasma of 14 lactating
neither regimen demonstrated a significant advantage from an mothers receiving pivampicillin for puerperal infections and in
economic standpoint. Children with complicated appendicitis can plasma of their suckling infants. Ampicillin could not be detected
be treated with cefotaxime and clindamycin or with ampicillin, in plasma of the infants, i.e. all levels were < 0.03 µg/ml the
gentamicin and clindamycin and both treatments had equal assay limit. Maximum ampicillin concentration occurs in plasma
efficacy [52]. Sixteen children, aged 1 to 10 years, suffering from 60 to 120 min and in milk 180 to 240 min after dosing. Milk to
urinary-tract infection, were randomly divided into two groups. plasma ratio varied between 0.01 and 0.58. The highest level of
Ten children (62.5%) were treated with ampicillin paediatric ampicillin in breast-milk was 1.02 µg/ml in a woman receiving
suspension at a dose of 100 mg/kg daily divided in 4 doses and 6 pivampicillin tablets 700 mg thrice-daily. An infant can at the
children (37.5%) were treated with pivampicillin base paediatric most ingest 0.5 mg of ampicillin daily and this dose is too small to
suspension at a dose of 64.8 mg/kg daily divided in 4 doses. The cause any symptoms in the suckling infant [59].
treatment period was 14 days and all infections were cured with
both treatments [53]. Penetration of ampicillin into the cerebrospinal fluid
(CSF)
Transfer of ampicillin across the human placenta
Thirty-five infants with suspected septicaemia were
Cord blood ampicillin concentration was assayed in 23 randomized to receive tobramycin or ceftazidime, both in
newborn infants whose mothers received the antibiotic by the combination with ampicillin. Ampicillin concentration in the
obstetrical service and the ampicillin concentration ranged CSF ranged from 1 to 80 µg/ml which should be sufficient for
from 2.9 to 36.2 µg/ml. Nineteen of 23 infants (82.6%) had a treatment of meningitis caused by enterococci and Listeria
serum ampicillin level in excess of 5 µg/ml at delivery, which monocytogenes, the most important neonatal pathogens
is significantly greater than the MIC to inhibit ampicillin- not covered by ceftazidime [60]. Five patients with Listerial
sensitive Enterobacteriaceae and far exceeds the MIC for group meningitis received ampicillin at a dose of 50 to 60 mg/kg.
B β-haemolytic streptococci. Antenatal ampicillin therapy results Ampicillin concentration ranged from 5 to 8 µg/ml which means
in significant ampicillin concentration in the neonate that may a CST to serum ratio of 3 to 5% in four patients. In the fifth
obscure cultures obtained after delivery [54]. Ampicillin was patient, the ampicillin concentration in the CSF ranged from 60 to
administered to 30 healthy pregnant women during labour by 130 µg/ml indicating a CSF to serum ratio of 40 to 87% [61]. The
continuous intravenous infusion of 1 gram or by intravenous penetration of ampicillin into the CSF was studied in 12 subjects
injection of 2 grams twice-daily. Following infusion, the maternal who had not the meninges inflamed. Ampicillin was administered
serum concentration of ampicillin ranged from 25 to 30 µg/ml at a dose of 33 mg/kg. The CSF specimens were sampled at 1, 2,
and the peak concentration ranged from 52 to 73 µg/ml after and 4 h after the beginning of the infusion. Blood samples were
intravenous injection. Ampicillin concentration in the amniotic obtained at the end of the infusion and at 45, 60, 90, 120, 180,
fluid was 5 µg/ml 2 to 3 hours and 25 µg/ml after 6 to 7 hours. and 240 min after the beginning of the infusion. (Table 5) shows
Both cord serum and amniotic fluid concentrations of ampicillin ampicillin concentration in the CSF and in the serum of these
were higher after the repeated injections. Following the repeated subjects.
intravenous injections, ampicillin concentration was sufficient
to kill gram-negative pathogens causing intrauterine infections This table shows that ampicillin penetrates into the CSF in
[55]. Ampicillin was administered intravenously to 25 pregnant significant amounts and the penetration-rate increases with the
women undergoing therapeutic abortion in the middle trimester time after dosing [62].
of pregnancy. The concentrations ampicillin became equal Twenty-eight patients with bacterial meningitis received
between maternal and foetal plasma 90 min after administration ampicillin by the intramuscular route and 16 patients received
and the foetal to maternal ratio of plasma ampicillin concentration it by the intravenous route. The mean ampicillin concentration in
steadily increased at least for 200 min following dosing. Thus the the CSF was similar in the two groups 1 h after the first or second
placenta is not a barrier for ampicillin [56]. Placental transfer day of treatment. Ampicillin concentration was higher in the
of ampicillin was studied in 103 pregnant women. A rapid

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intramuscular group on both days of treatment 4 h after the dose. production. All strains were susceptible to cefotaxime. Clinical
CSF to serum ratios were similar in both groups but considerably cure-rates and survival-rate were similar with the two treatments
higher at 4 hours than at 1 hour following the dose [63]. and no adverse adverse-effects were noted in either group.
Cefotaxime was found to be as safe and effective as ampicillin
Treatment of meningitis with ampicillin/sulbactam plus chloramphenicol for the treatment of bacterial meningitis in
or with ampicillin combined with antibiotics in children [68]. Ceftriaxone was compared in a randomized fashion
infants and children with ampicillin and chloramphenicol in the treatment of 19
Eighty-one infants and children, aged one month to 14 years, children with Haemophilus influenzae type b meningitis. Ninety
with meningitis were randomized to receive either ampicillin/ per cent of the isolates of Haemophilus influenzae type b were
sulbactam at a dose of 400/50 mg/kg (N = 41) or ampicillin/ inhibited by 0.0625 µg/ml, 1 µg/ml and 1 µg/ml of ceftriaxone,
chloramphenicol at a dose of 400/50 mg/kg (N = 40). Pathogens ampicillin and chloramphenicol, respectively. One child with
were isolated from the cerebrospinal fluid in 65 subjects (77.3%). pneumococcal meningitis and two children with meningococcal
In the ampicillin/sulbactam group, there were 18 Haemophilus meningitis recovered rapidly during ceftriaxone therapy. Three
influenzae isolates (one resistant to ampicillin), 5 Streptococcus children, with gram-negative meningitis caused by multiply-
pneumoniae, 5 Neisseria meningitides, one Klebsiella drug resistant organisms, were bacteriologically cured within
pneumoniae, one Pseudomonas aeruginosa, and one Listeria 5 days after the onset of therapy. Ceftriaxone, as a single agent,
meningitides. In the chloramphenicol/ampicillin group, there was comparable in efficacy to ampicillin and chloramphenicol
were 19 Haemophilus influenzae, 10 Streptococcus pneumoniae, in children with meningitis [69]. Seventy-eight children with
3 Neisseria meningitides, one Haemophilus parainfluenzae, and bacterial meningitis were evaluated in a prospective, randomised
one Citrobacter isolates. Sulbactam/ampicillin was as effective as study comparing twice-daily ceftriaxone as single-drug therapy
chloramphenicol/ampicillin in the eradication the pathogens and and with ampicillin and chloramphenicol given 4 times-daily.
thus in curing meningitis [64]. One-hundred-seven children with The pathogens were Haemophilus influenzae type b (N = 54),
bacterial meningitis were initially given cefuroxime or ampicillin streptococci (N = 9), meningococci (N = 9), and unknown
plus chloramphenicol for 7 days or 10 day. Organisms isolated organisms (N = 6). In 40 specimens of cerebrospinal fluid,
in the cerebrospinal fluid included Haemophilus influenzae type obtained 4 to 12 hours after initiation of therapy, the cultures
b (of which 25% were β-lactamase positive), Streptococcus were negative in 57% of children treated with ceftriaxone and in
pneumoniae, and Neisseria meningitides. Clinical cure rates were 42% of children who received ampicillin plus chloramphenicol.
similar (95%) in both treatments thus the two treatments are The mean bactericidal activity in the cerebrospinal fluid was
equivalent in eradication-rate of pathogens [65]. A prospective significantly greater in the ceftriaxone than in the ampicillin and
study was performed comparing high ampicillin dose of 400 mg/ chloramphenicol group at the beginning and at the end of therapy
kg daily and low dose of 150 mg/kg daily in the treatment of 172 but there were no significant differences in clinical responses
children with bacterial meningitis. Response to both regimens or in frequency of complications [70]. Sixty-two children with
was equivalent in terms of average hospital stay, duration of Haemophilus influenzae meningitis were treated with ampicillin
ampicillin therapy, microbiological response, and death. Children sodium at a dose of 200 mg/kg daily for 10 days. Thirty-one
with Haemophilus influenzae infections treated with low- children received the drug intravenously for 10 days and the
dosage regimens had slightly prolonged febrile courses. These other 31 children received ampicillin intravenously for 5 days
results suggest that high-dosage regimen of ampicillin offers no followed by intramuscular ampicillin during the last for 5 days of
benefit over low-dosage regimen in the treatment of bacterial treatment. Ampicillin concentrations in cerebrospinal fluid were
meningitis in children [66]. Two-hundred children, aged > 3 higher one hour after intravenous administration, but at 2 and 4
months, were randomised to receive chloramphenicol, ampicillin hours, the concentrations were greater after intramuscular doses.
(initially with chloramphenicol), cefotaxime, or ceftriaxone. Responses to therapy and rates of complications were similar in
The drugs were given in 4 equal daily doses for 7 days, except the two groups. All organisms were ampicillin-susceptible and
for ceftriaxone which was given only once-daily. The causative all cerebrospinal fluid cultures were negative by 48 hours. The
organisms were Haemophilus influenzae type b (N = 146), schedule of 5 days of intravenous treatment followed by 5 days
meningococci (N = 32), pneumococci (N = 13), and others (N = of intramuscular therapy is pharmacologically and clinically as
9). In children with Haemophilus influenzae type b meningitis, effective as 10 days of intravenous therapy and has practical
the sterilisation of the cerebrospinal fluid occurred more rapidly advantages [71].
with ceftriaxone. Ampicillin is a good and cheap alternative, DISCUSSION
but may induce resistance [67]. Fifty children with bacterial
meningitis were prospectively randomized to receive cefotaxime Ampicillin is an aminopenicillin and expands the spectrum of
(50 mg/kg 4 times-daily) or ampicillin and chloramphenicol activity of penicillin G in a different direction from the
in standard doses. Twenty-three children received cefotaxime penicillinase-resistant penicillins they allow for useful activity
and 27 children received ampicillin and chloramphenicol. against some gram-negative organisms. Ampicillin is destroyed
Bacterial isolates included Haemophilus influenzae (N = 29), by β-lactamases (from both gram-positive and gram-negative
Streptococcus pneumoniae (N = 8), Neisseria meningitides (N bacteria); thus further expansion of its activity is enhanced
= 8), group B streptococci (N = 3), and Salmonella enteritidis through co-formulation with sulbactam a β-lactamase inhibitor.
(N = 2). Ten of Haemophilus influenzae isolates were resistant Ampicillin is bactericidal for susceptible gram-positive and gram-
to ampicillin of which nine were on the basis of β-lactamase negative bacteria. Ampicillin is active against meningococci,
Listeria monocytogenes, enterococci and concurred

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administration of a β-lactamase inhibitor such as sulbactam children and infants. Ampicillin interacts with drugs [28-34].
markedly expands the ampicillin spectrum of activity against Ampicillin inhibits the transport of drugs [28], incompatible drug
Haemophilus influenzae, Escherichia coli, Klebsiella, Proteus, and interactions occurred in 25% of infants receiving ampicillin and
Bacillus fragilis. Ampicillin is absorbed after oral administration; other drugs [29], quinine reduces the bioavailability and the
the intake of food diminishes its absorption and undergoes antimicrobial activity of ampicillin-cloxacillin [30], the co-
enterohepatic circulation [1]. Ampicillin may be administered administration of allopurinol and ampicillin induces rashes [31].
intravenously and orally; the intravenous dose is 50 mg twice- A drug interaction was observed following the co-administration
daily and thrice-daily in preterm and term infants, respectively of ampicillin with N-acetyl-p-benzoquinone-imine [32], following
[2]. In children, the oral dose ranges from 125 to 500 mg 4 times- the co-administration of ampicillin and gentamicin [33], and
daily and increases with the child age [4]. Listerial meningitis is chloroquine reduces the urinary excretion of ampicillin when it is
treated with ampicillin intravenously at a dose of 100 mg/kg co-administered with cloxacillin [34]. The therapeutic use of
twice-daily, thrice-daily, and 4 times daily to infants aged up to 7 ampicillin/sulbactam has been reported in children [35-39].
days, 7 to 20 days and 21 to 28 days, respectively, and the Ampicillin/sulbactam has been used in the treatment of
intravenous dose is 50 mg/kg given 4 to 6 times-daily to children respiratory-tract, gynaecological/obstetric, intraabdominal,
[4]. Ampicillin/sulbactam or ampicillin has been found efficacy acute epiglottitis, periorbital cellulitis, diabetic food, skin, and
and safe in infants and children [5-12]. Ampicillin/sulbactam is soft-tissue infections [35]. This drug combination is found
efficacy in the treatment of urinary-tract infections in infants [5], efficacy against organisms that produce β-lactamase including
ampicillin if efficacy and safe in treating the sepsis cussed by Bacteroides fragilis and Neisseria gonorrhoea and has therapeutic
Listeria monocytogenes and enterococci in infants [6], ampicillin and prophylactic efficacy for a wide range of microorganisms
is effective in the treatment of fever and caused lower mortality- [36], ampicillin/sulbactam is efficacy for the treatment of life-
rate than penicillin G in infants [7], and in the treatment of severe threating infections caused by Acinetobacter [37], for the
pneumococcal pneumonia in children [8]. Ampicillin/sulbactam treatment of upper and lower respiratory-tract, urinary-tract,
is effective and safe in the treatment of lower respiratory-tract, skin, bone, soft-tissue infections and for the prophylaxis of
urinary-tract, skin, bone and soft-tissue infections [9] in the infections which occurred during surgery [38], and for the
treatment of serious skin and skin-structure infections in children treatment of infections caused by Staphylococcus aureus,
[10], in the treatment of pneumonia caused by Escherichia coli, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella
Staphylococcus aureus and Klebsiella pneumoniae in children catarrhalis, and gram-negative rods [39]. The treatment with
[11] and in the treatment of severe pneumonia in children [12]. ampicillin or with ampicillin/sulbactam has been performed in
Ampicillin causes different effects [13-16]. Ampicillin cures the infants and children [40-49]. Ampicillin plus cefotaxime
upper and lower respiratory-tract infections caused by eradicated the infection caused by Enterococcus faecalis in an
Streptococcus pneumoniae, β-haemolytic streptococci, group B infant [40] and the sepsis caused by Klebsiella pneumoniae in
streptococci, and Listeria monocytogenes in infants [13], infants [41], and ampicillin treated non-complicated community-
ampicillin cures the otitis media caused by Diplococcus acquired-pneumonia in children [42]. Ampicillin/sulbactam
pneumoniae and Haemophilus influenzae in children [14], successfully treated mild-to-moderate intraabdominal and
bronchopneumonia and acute bronchial obstructive syndrome in gynaecological infections caused by Acinetobacter baumannii,
children [15], and ampicillin is effective against various which were carbapenem-resistant in children [43], otitis media
salmonella species [16]. Ampicillin may induce adverse-effects [44], and epiglottitis caused by Haemophilus influenzae type b in
[17-21]. The adverse-effects are: diarrhoea [17-21] and changes children [45]. Ampicillin/sulbactam eradicated bacteriological
of bowel habits [21]. Ampicillin and sulbactam diffuse in tissues infections [46], cured otitis media infections, sinusitis,
but reaches lower concentration in the abdominal tissue, in fat pharyngitis, tonsillitis, intraabdominal, periorbital infections,
tissue and in the colonic wall [22], in the epididymis [23], and in acute epiglottitis, bacterial meningitis, brain abscess and in many
various body-tissues [24] than in serum. The pharmacokinetics life-threatening infections in paediatric patients [47]. Ampicillin/
of ampicillin have been studied in infants [25-26]. The elimination sulbactam has clinical efficacy in the treatment of respiratory-
half-life ranges from 2.4 to 5.0 hours and decreases with infant tract, ears, nose, throat, urinary-tract, skin, soft-tissue, obstetric,
gestational and the postnatal ages [25] and ampicillin serum and gynaecological infections [48] and ampicillin eradicated
concentration decreases with the gestational age and body- Shigella organism from the stool [49] in children. The trials with
weight [26]. The total body clearance ranges from 0.055 to 0.11 ampicillin have been conducted in infants and children [50-53].
L/h/kg in infants and increases with the gestational age [25]. Ampicillin plus gentamicin cured the pneumonia caused by
These pharmacokinetic modifications may be explained by the susceptible organisms [50]. Ampicillin plus gentamicin was
increase of renal function which increases with the infant efficacy as chloramphenicol in the treatment of pneumonia
maturation. The distribution volume of ampicillin is 0.40 L/kg, caused by Staphylococcus aureus and Streptococcus pneumoniae
thus it is lower than the water volume, and it is not modified by in children [51]. Trials with chloramphenicol and ampicillin plus
infant maturation [25]. In children, the elimination half-life, the gentamicin resulted efficacy in curing complicated appendicitis
total body clearance and the distribution volume are about 0.8 and this treatment is equivalent to cefotaxime and clindamycin in
hours, 5 ml/min/kg, and 0.3 L/kg, respectively [27]. Thus the children [52]. Ampicillin cured the urinary-tract infections in
ampicillin elimination half-life is shorter in children than in children [53]. Ampicillin freely crosses the human placenta [54-
infants whereas the distribution volume is similar in children and 57] and the foetal and maternal plasma concentrations of
infants. The comparison of the total body clearance in children ampicillin became equal 90 min following ampicillin
and infants is difficult because different units have been used in administration [56]. Ampicillin poorly migrates into the breast-

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milk [58, 59]. The exposure to ampicillin of the breast-fed infant in infants that children because ampicillin is mainly eliminated
suckling from a mother treated with ampicillin is minimal [58]. by renal route and the renal function increases with infant
Ampicillin penetrates into the cerebrospinal fluid in significant maturation and child development. Ampicillin interacts with
amounts [60-63]. Following ampicillin administration, ampicillin drugs and the treatment and trials with ampicillin have been
concentration in the cerebrospinal fluid is sufficient for the extensively investigated in infants and children. Ampicillin crosses
treatment of meningitis caused be enterococci and Listeria the placenta freely but poorly migrates into the breast-milk.
monocytogenes in infants [60]. The cerebrospinal fluid to serum Ampicillin penetrates into the cerebrospinal fluid in significant
ratio of ampicillin ranges in a wide interval [61] and this ratio amounts. Ampicillin/sulbactam or ampicillin co-administered
increases with the time after ampicillin administration [62, 63]. with other antibiotics, particularly with chloramphenicol,
The meningitis caused by different pathogens was treated with treated the meningitis caused by different pathogens. The aim of
ampicillin/sulbactam or with ampicillin combined with various this study is to review the clinical pharmacology of ampicillin in
antibiotics in infants and children [64-71]. Ampicillin/sulbactam infants and children.
or ampicillin/chloramphenicol eradicated Haemophilus
influenzae, Streptococcus pneumoniae, Neisseria meningitides, CONFLICT OF INTERESTS
Klebsiella pneumoniae, Pseudomonas aeruginosa and Listeria The authors declare no conflicts of financial interest in any
meningitides from the cerebrospinal fluid and cured the product or service mentioned in the manuscript, including grants,
meningitis caused by these pathogens in infants [64]. equipment, medications, employments, gifts, and honoraria.
Haemophilus influenzae type b, Streptococcus pneumoniae, and
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Cite this article

Pacifici GM (2021) Clinical Pharmacology of Ampicillin in Infants and Children. J Drug Des Res 8(2): 1082.

J Drug Des Res 8(2): 1082 (2021)

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