Dose: 100-150 mg/kg/DAY IV (Dosage recommendations are based on the ampicillin content)

Frequency: Preterm infants Q 12 hour
                     Term Infants Q 8 hours
                     Infants > 1 month Q 6 hours                     

Indications: This drug is rarely used in the NICU. It is a combination of ampicillin and sulbactam (a beta-lactamase inhibitor). Ampicillin is effective against susceptible Pneumococci, Streptococci, Listeria, E. coli, H. influenza, Syphilis, Clostridium tetani, Shigella, Enterococci, and Neisseria gonorrhea, Salmonella, staphylococci. The combination with sulbactam increases the spectrum to organisms producing betalactamases such as S. aureus, H. influenzae, E. coli, Klebsiella, Acinetobacter, Enterobacter, Proteus mirabilis, B. fragilis, and anaerobes.  The sugested doses are based on the ampicillin content of the medication and the total dose of sulbactam the infant will receive in 24 hours (Campoli-Richards and Brogden, 1987). Larger doses (200-300 mg/kg/day) have been recommended in treating meningitis. Further comments on ampicillin.  In the presence of renal failure, adjustments in dose are similar to those of ampicillin.

Toxicity:    Diarrhea is probably the most common adverse effect that has been noted with ampicillin. Adverse reactions to penicillin. Infection with CMV or EB virus increases risk of ampicillin-induced maculopapular rash.

Preparation: An IV preparation of Unasyn 45 mg/ml (30 mg ampicillin and 15 mg sulbactam per ml) is prepared by pharmacy by adding 33 ml of LR, SWFI, or NS to 1.5 gm of Unasyn.  Infuse over 15 to 30 minutes.  When reconstituted with SWFI or NS, this solution has a stability of 8 hours at room temperature and 48 hours if refrigerated at 4^oC.

An IM concentration can be prepared by adding 3.2 ml to 1.5 gm of Unasyn to make a 375 mg/ml concentration (250 mg Ampicillin and 125 mg Sulbactam). Discard after single use.
 

Compatibility: Compatibility with filter, TPN, and lipids is unknown.  It is compatible with normal saline and sterile water for injection as well as aztreonam, enalaprilat, fluconazole, heparin, insulin, and morphine. It is incompatible aminoglycoside antibiotics (i.e., amikacin,  gentamicin, kanamycin, and tobramycin).  Ampicillin and sulbactam infusions are stable in the following: NS, SWFI, and LR for 8 hours, D5 1/2 NS for 4 hours, D5W for 2 hours.