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Ampicillin is a medication used to manage and treat certain bacterial infections. It is in the penicillin class of medications. Ampicillin was developed to overcome the issue of drug resistance and extend the antimicrobial coverage of penicillins. It is also resistant to acid so it can be administered orally. This activity outlines the indications, action, and contraindications for ampicillin as a valuable agent in treating certain bacterial infections like those from E. coli, S. aureus, S. pneumoniae, H. influenzae, etc. In addition, this activity will highlight the mechanism of action, adverse event profile, off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, and relevant interactions pertinent for interprofessional team members in treating patients with infections caused by susceptible bacteria. Objectives: Identify the indications for the use of ampicillin. Describe the mechanism of action of ampicillin. Review the adverse effects associated with the use of ampicillin. Outline the role of interprofessional coordination in restricting unwarranted use of ampicillin and other antimicrobials. Access free multiple choice questions on this topic.

Neurological adverse reactions, including convulsions, may occur due to high CSF concentrations of ampicillin. Management of overdose requires medication discontinuation, symptomatic treatment, and supportive care. Previously, whole bowel irrigation has been reported to be effective in severe cases of oral overdoses.[33] In patients with decreased renal function, ampicillin is removable via hemodialysis but not peritoneal dialysis.[34] In case of anaphylaxis, epinephrine should be administered without delay. According to AAFP, after administering epinephrine, clinicians should administer adjunctive treatment, including corticosteroids, antihistamines, and beta2 agonists. Referral to an allergist/immunologist should be considered.[35]

Ampicillin is a widely prescribed antimicrobial by clinicians and other healthcare professionals working collaboratively as an interprofessional team. While the antimicrobial is effective, clinicians should not empirically prescribe for all infections as the resistance to this agent is increasing globally. Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials. According to CDC, core elements of outpatient antimicrobial stewardship are commitment, action for policy and practice, tracking and reporting, education, and expertise.[36] Nephrology consultation is essential for hemodialysis. Pharmacists should verify dosing, look into the appropriateness of selecting ampicillin-sulbactam based on the infection type and available antibiogram data, and check for drug-drug interactions. In most cases, nurses administer this drug, monitor for adverse events, and assess therapeutic effectiveness, informing the clinician of their findings as treatment progresses. In the case of an overdose, emergency department physicians and nurses should rapidly stabilize the patient. As outlined above, various healthcare providers, including clinicians (MDs, DOs, NPs, PAs), specialists, nurses, and pharmacists, participate in an interprofessional team-based approach to optimize patient care. Additionally, antimicrobial stewardship is necessary for reducing global drug resistance. An observational study of eight years involving twenty-three antibiotics, including ampicillin, demonstrated that rates of Clostridioides difficile infection (CDI) could be reduced using interprofessional antimicrobial stewardship between clinicians, pharmacists, infection control nurses, and other healthcare professionals.[37] [Level 3]