Generic Name: silgram

Brand Name: Ampicillin; Sulbactam

Classification:
antiinfective; antibiotic; aminopenicillin

Mode of Action:
Bactericidal action. Active against: Streptococci, Pneumococci, Enterococcci, H.
Influenzae. Binds to bacterial cell wall resulting in cell death, spectrum is broader than
that of penicillin.
Indication:
Treatment of skin and skin structure, intra-abdominal, and gynecologic infections
caused by susceptible microorganisms.
Contraindication:
Hypersensitivity to penicillins.
Date ordered: February 7, 2013
Ordered Dose: Silgram 750 mg IVTT q8
Side effects:
CNS: Lethargy,hallucinations,seizures
CV: Heart failure
GI: Glossitis,stomatitis,gastritis, soremouth, nausea,vomiting,diarrhea,abdominal
pain,bloody diarrhea,enterocolitis,pseudomembranous colitis,nonspecifichepatitis
Hematology:Anemia,thrombocytopenia, leukopenia,neutropenia,prolongedbleeding
time
Hypersensitivity:Rash, fever,wheezing,anaphylaxis

Local: Pain,phlebitis,thrombosis

Drug interaction:
Allopurinol
Increases potential for ampicillin-induced skin rash. If a skin rash develops, consider
discontinuing one or both drugs.
Contraceptives, oral
May reduce efficacy of oral contraceptives. Use of alternative methods of contraception
is advisable.
Live vaccines
Ampicillin/sulbactam may decrease the effectiveness of live vaccines. Use of live
vaccines with ampicillin/sulbactam is not recommended.
Methotrexate
Methotrexate plasma concentrations may be elevated, increasing the risk of toxicity.
Monitor patients for methotrexate toxicity and measure methotrexate concentrations.
The dose and duration of leucovorin rescue may need to be increased. Consider use of
alternative antibiotic treatment.
Probenecid
Renal tubular secretion of ampicillin and sulbactam may be decreased, resulting in
increased and prolonged levels of ampicillin and sulbactam. It may be necessary to
administer ampicillin/sulbactam less frequently when probenecid is coadministered.
Tetracyclines
May impair bactericidal effects of ampicillin/sulbactam. If possible, avoid
coadministration of these agents.
Warfarin
The risk of bleeding may be increased, especially with large IV doses of ampicillin.
Monitor coagulation status and adjust the warfarin dose as needed.

Nursing interventions:
1. Determine previous hypersensitivity reactions to penicillins, cephalosporins, and
other allergens prior to therapy.
2. Report promptly unexplained bleeding (e.g., epistaxis, purpura, ecchymoses).
3. Monitor patient carefully during the first 30 min after initiation of IV therapy for
signs of hypersensitivity and anaphylactoid reaction.
4. Observe for and report symptoms of superinfections.
5. Monitor I & O ratio and pattern.
6. Report dysuria, urine retention, and hematuria.
7 .Report chills, wheezing, pruritus (itching), respiratory distress, or palpitations to
physician immediately.
8. Warn patient that diarrhea containing blood or pus may be a sign of a serious
disorder and to seek medical care if noted and not to treat at home.
9. Assess patient for infection (vital signs, wound appearance, sputum, urine, stool,
and WBCs)at beginning and throughout therapy.
10. Obtain specimens for culture and sensitivity before therapy. First dose may be
given before receiving results
11. Instruct patient to notify physician if symptoms do not improve