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Ampicillin: Pediatric drug information

Ampicillin: Pediatric drug information
(For additional information see "Ampicillin: Drug information" and see "Ampicillin: Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: Canada
  • APO-Ampi [DSC];
  • NOVO-Ampicillin
Therapeutic Category
  • Antibiotic, Penicillin
Dosing: Neonatal

General dosing, non-CNS involvement: Note: Use in combination with gentamicin for empiric therapy and treatment of early-onset sepsis (EOS) in both term and preterm neonates.

Gestational age-directed dosing (Ref):

Preterm and term neonates: IV, IM:

Gestational Age

Postnatal Age

Dose

≤34 weeks

≤7 days

50 mg/kg/dose every 12 hours

8 to 28 days

75 mg/kg/dose every 12 hours

>34 weeks

≤28 days

50 mg/kg/dose every 8 hours

Weight-directed dosing (Ref):

Preterm and term neonates: IM, IV:

Body Weight

Postnatal Age

Dose

≤2 kg

≤7 days

50 mg/kg/dose every 12 hours

8 to 28 days

75 mg/kg/dose every 12 hours

29 to 60 days

50 mg/kg/dose every 6 hours

>2 kg

≤28 days

50 mg/kg/dose every 8 hours

29 to 60 days

50 mg/kg/dose every 6 hours

Duration of therapy: Empiric therapy may generally be discontinued when blood cultures are sterile at 36 to 48 hours incubation unless there is evidence of site-specific infection (Ref).

For confirmed EOS, treatment duration is dependent upon organism, site of infection, and clinical response; longer duration may be necessary for prolonged or complicated courses; in general durations are as follows (Ref):

Group B streptococcal (GBS) bacteremia (without a focus): 10 days.

Listeria bacteremia: 14 days.

GBS bone/joint infections (eg, septic arthritis, osteomyelitis): 3 to 4 weeks.

GBS endocarditis: ≥4 weeks.

Meningitis

Meningitis:

Empiric therapy or treatment, non-Group B streptococcal (Ref): Note: Duration of therapy dependent upon pathogen and clinical response; for gram-negative or Listeria meningitis, treat for ≥21 days; longer durations may be necessary for prolonged or complicated courses (Ref).

Preterm and term neonates: IV; IM:

Gestational Age

Postnatal Age

Dose

≤34 weeks

≤7 days

50 mg/kg/dose every 12 hours

8 to 28 days

75 mg/kg/dose every 12 hours

>34 weeks

≤28 days

50 mg/kg/dose every 8 hours

Group B streptococcal meningitis (Ref): Note: For uncomplicated courses, treat for 14 days; for ventriculitis, treat for ≥4 weeks; individualize based on patient response; longer durations may be necessary for prolonged or complicated courses (Ref).

Preterm and term neonates: IV:

Gestational Age

Postnatal Age

Dose

≤34 weeks

≤7 days

100 mg/kg/dose every 8 hours

8 to 60 days

75 mg/kg/dose every 6 hours

>34 weeks

≤7 days

100 mg/kg/dose every 8 hours

8 to 60 days

75 mg/kg/dose every 6 hours

Surgical prophylaxis

Surgical prophylaxis: IV: 50 mg/kg as a single dose within 60 minutes prior to surgical incision (Ref).

Dosing: Pediatric

General dosing, susceptible infection (Ref):

Infants, Children, and Adolescents:

Oral: 50 to 100 mg/kg/day divided every 6 hours; maximum daily dose: 2,000 mg/day.

IM, IV: 50 to 200 mg/kg/day divided every 6 hours; maximum daily dose: 8 g/day; higher doses (300 to 400 mg/kg/day; maximum daily dose: 12 g/day) are recommended for some infections.

Endocarditis; treatment

Endocarditis; treatment:

Children and Adolescents: IV: 200 to 300 mg/kg/day divided every 4 to 6 hours; maximum daily dose: 12 g/day; use in combination with other antibiotics for at least 4 weeks; some organisms may require longer duration (Ref).

Endocarditis; prophylaxis before invasive dental procedures

Endocarditis; prophylaxis before invasive dental procedures (alternative agent): Limited data available:

Note: Alternative agent for use in patients unable to take oral medication. Recommended only in patients who are at highest risk for infective endocarditis (IE) or adverse outcomes (eg, history of IE, cardiac valve repair using prosthetic valves or material, unrepaired cyanotic congenital heart disease [CHD], left ventricular assist device or implantable heart, repaired CHD with prosthetic material or device during first 6 months after procedure, pulmonary artery valve or conduit placement [eg, Melody valve, Contegra conduit], repaired CHD with residual defects at the site or adjacent to site of prosthetic patch or device, heart transplant recipients with cardiac valvulopathy) (Ref).

Infants, Children, and Adolescents: IV, IM: 50 mg/kg as a single dose administered 30 to 60 minutes prior to dental procedure; maximum dose: 2,000 mg/dose (Ref).

Intra-abdominal infection, complicated

Intra-abdominal infection, complicated: Infants, Children, and Adolescents: IV: 200 mg/kg/day divided every 6 hours; maximum single dose: 2,000 mg; maximize doses if undrained abdominal abscesses (Ref).

Meningitis

Meningitis (including health care-associated meningitis and ventriculitis): Infants, Children, and Adolescents: IV: 300 to 400 mg/kg/day divided every 4 to 6 hours; maximum daily dose: 12 g/day (Ref).

Peritonitis

Peritonitis (CAPD): Limited data available: Infants, Children, and Adolescents: Intraperitoneal: 125 mg per liter of dialysate for 2 weeks (Ref).

Pneumonia, community-acquired

Pneumonia, community-acquired (CAP) (Ref): Infants >3 months, Children, and Adolescents: Note: May consider addition of vancomycin or clindamycin to empiric therapy if community-acquired MRSA suspected. In children ≥5 years, a macrolide antibiotic should be added if atypical pneumonia cannot be ruled out.

Empiric treatment or S. pneumoniae (MICs for penicillin ≤2 mcg/mL) or H. influenzae (beta-lactamase negative) in fully immunized patients: IV: 150 to 200 mg/kg/day divided every 6 hours.

Group A Streptococcus: IV: 200 mg/kg/day divided every 6 hours.

S. pneumoniae (MICs for penicillin ≥4 mcg/mL): IV: 300 to 400 mg/kg/day divided every 6 hours.

Surgical prophylaxis

Surgical prophylaxis: Infants, Children, and Adolescents: IV: 50 mg/kg within 60 minutes prior to surgical incision; may repeat in 2 hours if lengthy procedure or excessive blood loss; maximum dose: 2,000 mg/dose (Ref).

Dosing: Kidney Impairment: Pediatric

Infants, Children, and Adolescents: There are no dosage adjustments provided in the manufacturer's labeling; however, the following adjustments have been recommended (Ref). Note: Renally adjusted dose recommendations are based on IM, IV doses of 100 to 200 mg/kg/day divided every 6 hours: IM, IV:

GFR 30 to 50 mL/minute/1.73 m2: 35 to 50 mg/kg/dose every 6 hours

GFR 10 to 29 mL/minute/1.73 m2: 35 to 50 mg/kg/dose every 8 to 12 hours

GFR <10 mL/minute/1.73 m2: 35 to 50 mg/kg/dose every 12 hours

Intermittent hemodialysis: 35 to 50 mg/kg/dose every 12 hours

Peritoneal dialysis (PD): 35 to 50 mg/kg/dose every 12 hours

Continuous renal replacement therapy (CRRT): 35 to 50 mg/kg/dose every 6 hours

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Adult

(For additional information see "Ampicillin: Drug information")

Dosage guidance:

Clinical consideration: For oral therapy, including oral step-down therapy after IV ampicillin, oral amoxicillin is usually preferred over oral ampicillin due to improved bioavailability and absorption (bioavailability 77% versus 39% to 54%, respectively) (Ref).

Dosing: For ease of outpatient IV ampicillin administration, the total daily dose may be administered as a 24-hour continuous infusion (Ref).

Bloodstream infection

Bloodstream infection :

Pathogen-directed therapy for Enterococcus spp.: IV: 2 g every 4 hours; use as part of an appropriate combination regimen in the setting of suspected endocarditis or critical illness (Ref). Duration of therapy is 7 to 14 days for uncomplicated infection (ie, fever resolution within 72 hours and absence of metastatic focus of infection or endovascular hardware) (Ref). Some experts recommend a duration of 5 to 7 days for uncomplicated infection with rapid blood culture clearance (within 24 hours) and in the absence of metastatic infection (Ref).

Pathogen-directed therapy for Listeria monocytogenes: IV: 2 g every 4 hours; use in combination with gentamicin for nonpregnant patients. Duration should be individualized based on patient factors, source and extent of infection, and clinical response, but ampicillin is usually continued for at least 14 to 21 days (Ref).

Endocarditis, prophylaxis

Endocarditis, prophylaxis (dental or invasive respiratory tract procedures) (alternative agent for patients unable to take oral therapy) (off-label use): IM, IV: 2 g as a single dose 30 to 60 minutes before procedure; if inadvertently not given prior to the procedure, may be administered up to 2 hours after the procedure. Note: Reserve for select situations (cardiac condition with the highest risk of adverse endocarditis outcomes and procedure likely to result in bacteremia with an organism that can cause endocarditis) (Ref).

Endocarditis, treatment

Endocarditis, treatment:

Enterococcus faecalis, native or prosthetic valve (penicillin-susceptible): IV: 2 g every 4 hours as part of an appropriate combination regimen (eg, with ceftriaxone or gentamicin). Duration is usually 6 weeks; for patients with native valve endocarditis and symptoms <3 months, the combination of ampicillin and gentamicin can be given for 4 weeks. Note: Ampicillin plus ceftriaxone is the preferred regimen in patients with or at risk of renal insufficiency or with gentamicin resistance (Ref), and some experts favor this combination for all patients with native valve endocarditis (Ref).

HACEK organisms, native or prosthetic valve (ampicillin-susceptible) (off-label use): IV: 2 g every 4 hours for 4 weeks (native valve) or 6 weeks (prosthetic valve) (Ref). Note: In vitro susceptibility should be confirmed prior to use.

Viridans group streptococci and Streptococcus gallolyticus (Streptococcus bovis) (alternative agent):

Native valve: Highly penicillin-susceptible (minimum inhibitory concentration [MIC] ≤0.12 mcg/mL): IV: 2 g every 4 hours for 4 weeks (Ref).

Native valve: Relatively penicillin-resistant (MIC >0.12 to <0.5 mcg/mL): IV: 2 g every 4 hours for 4 weeks in combination with gentamicin for the first 2 weeks (Ref).

Native valve: Penicillin-resistant (MIC ≥0.5 mcg/mL): IV: 2 g every 4 hours in combination with gentamicin. The duration of this regimen is not well established; infectious diseases consultation recommended (Ref).

Prosthetic valve: Highly penicillin-susceptible (MIC ≤0.12 mcg/mL): IV: 2 g every 4 hours for 6 weeks (with or without concomitant gentamicin for the first 2 weeks) (Ref).

Prosthetic valve: Relatively penicillin-resistant (MIC >0.12 to <0.5 mcg/mL) or fully penicillin-resistant (MIC ≥0.5 mcg/mL): IV: 2 g every 4 hours in combination with gentamicin for 6 weeks (Ref). For relatively resistant strains, some experts prefer a shorter duration of the gentamicin component (≥2 weeks) (Ref).

Intra-abdominal infection, health care–associated

Intra-abdominal infection, health care–associated (off-label use): Empiric or pathogen-directed therapy for Enterococcus spp. in high-risk patients (eg, postoperative infection or healthcare-associated infection in patients with prior use of antibiotics that select for Enterococcus, immunocompromising condition, valvular heart disease, or prosthetic intravascular material):

IV: 2 g every 4 hours as part of an appropriate combination regimen (Ref). Total duration of therapy (which may include transition to oral antibiotics) is 4 to 5 days following adequate source control (Ref).

Meningitis, bacterial

Meningitis, bacterial: As a component of empiric therapy (community-acquired infections in immunocompetent patients >50 years of age and immunocompromised patients) or pathogen-directed therapy (eg, Haemophilus influenzae [beta-lactamase negative], L. monocytogenes, Neisseria meningitidis [penicillin MIC <0.1 mcg/mL], Streptococcus agalactiae, Streptococcus pneumoniae [penicillin MIC ≤0.06 mcg/mL], Enterococcus spp. [ampicillin-susceptible]):

IV: 2 g every 4 hours; for empiric therapy and for directed therapy for Enterococcus or Listeria, use as part of an appropriate combination regimen. Treatment duration is 7 to 21 days, depending on causative pathogen(s) and clinical response (Ref).

Osteomyelitis and/or discitis, treatment

Osteomyelitis and/or discitis, treatment (off-label use): Pathogen-directed therapy for penicillin-susceptible Enterococcus or Streptococcus spp.: IV: 2 g every 4 hours or 12 g as a continuous infusion every 24 hours, generally for ≥6 weeks. Shorter courses are appropriate if the affected bone is completely resected (eg, by amputation) (Ref). For Enterococcus, some experts use with ceftriaxone in the setting of retained hardware (Ref).

Pelvic infections

Pelvic infections (off-label use):

Intra-amniotic infection (chorioamnionitis): IV: 2 g every 6 hours in combination with gentamicin. In females undergoing cesarean delivery, an anti-anaerobic agent should also be added. Continue regimen until vaginal delivery or for 1 dose after cesarean delivery (Ref). Note: Some experts recommend 1 additional dose after vaginal delivery and extension of antibiotics after cesarean delivery until patient is afebrile and asymptomatic ≥48 hours (Ref).

Postpartum endometritis: Note: For patients known to be colonized with GBS (Ref).

IV: 2 g every 6 hours in combination with clindamycin and gentamicin; treat until patient is clinically improved (no fundal tenderness) and afebrile for 24 to 48 hours (Ref).

Tubo-ovarian abscess: IV: 2 g every 6 hours in combination with clindamycin and gentamicin (Ref). After 24 to 48 hours of sustained clinical improvement, may transition to oral therapy to complete 14 days of treatment (Ref).

Peritonitis, treatment

Peritonitis, treatment (peritoneal dialysis patients) (off-label use): Note: Intraperitoneal administration is preferred to IV administration (Ref). Consider a 25% dose increase in patients with significant residual renal function (urine output >100 mL/day) (Ref).

Pathogen-directed therapy (eg, Enterococcus spp., Streptococcus spp.): Continuous (with every exchange): Intraperitoneal: 125 mg/L of dialysate with each exchange (Ref). Duration of therapy is ≥2 weeks for patients with adequate clinical response (Ref).

Prosthetic joint infection

Prosthetic joint infection (off-label use): Pathogen-directed therapy (eg, penicillin-susceptible Enterococcus spp. or Streptococcus spp.): IV: 2 g every 4 hours or 12 g continuous infusion every 24 hours. Duration varies, but is generally 4 to 6 weeks; for enterococcal infections, some experts use with ceftriaxone in the setting of retained hardware (Ref).

Streptococcus, maternal prophylaxis for prevention of neonatal disease

Streptococcus (group B), maternal prophylaxis for prevention of neonatal disease (alternative agent) (off-label use):

IV: 2 g as a single dose at onset of labor or prelabor rupture of membranes, then 1 g every 4 hours until delivery (Ref).

Urinary tract infection

Urinary tract infection:

Note: Uncomplicated urinary tract infection (UTI) has traditionally been defined as infection in an otherwise healthy nonpregnant female with a normal urinary tract; UTI in other patient populations has been considered complicated. Some experts instead categorize UTI as either acute simple cystitis (mild infection limited to the bladder with no signs/symptoms of upper tract or systemic infection in a nonpregnant adult) or complicated UTI (pyelonephritis or cystitis symptoms with other signs/symptoms of systemic infection) (Ref). Ampicillin is not recommended for empiric therapy given decreased efficacy compared to first-line agents and high prevalence of resistance (Ref).

Acute uncomplicated or simple cystitis due to Enterococcus spp.: Oral: 500 mg every 6 hours for 5 to 7 days (Ref).

Acute pyelonephritis or other complicated urinary tract infection due to Enterococcus spp. (off label): IV: 1 to 2 g every 4 to 6 hours; can give with an aminoglycoside for critical illness (Ref). Switch to an appropriate oral regimen once patient has improvement in symptoms. Duration of therapy depends on the antimicrobial chosen to complete the regimen and ranges from 5 to 14 days (Ref).

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Altered kidney function: IV:

Note: There are no dosage adjustments provided in the manufacturer's labeling and pharmacokinetic data is limited. The following recommendations are based primarily on expert opinion.

Ampicillin Dose Adjustments in Altered Kidney Function

CrCl (mL/minute)

If usual recommended dose is 1 to 2 g every 6 hoursa

If usual recommended dose is 2 g every 4 hoursb

aExpert opinion, Aronoff 2007, Blackwell 1990, Heintz 2009, Wright 1983.

bExpert opinion only.

cDialyzable (39% to 63% [Jusko 1973]); administer after hemodialysis when scheduled dose falls on dialysis days (Heintz 2009).

50 to <130

1 to 2 g every 6 hours

2 g every 4 hours

30 to <50

1 to 2 g every 8 hours

2 g every 6 hours

15 to <30

1 to 2 g every 12 hours

2 g every 8 hours

<15

1 to 2 g every 24 hours

2 g every 12 hours

Hemodialysis, intermittent (thrice weekly)c

1 to 2 g every 24 hours

2 g every 12 hours

Peritoneal dialysis

1 to 2 g every 24 hours

2 g every 12 hours

Augmented renal clearance (measured urinary CrCl ≥130 mL/minute/1.73 m2): Augmented renal clearance (ARC) is a condition that occurs in certain critically ill patients without organ dysfunction and with normal serum creatinine concentrations. Young patients (<55 years of age) admitted post trauma or major surgery are at the highest risk for ARC, as well as those with sepsis, burns, or hematologic malignancies. An 8- to 24-hour measured urinary CrCl is necessary to identify these patients (Ref).

IV:

If usual recommended dose is 1 to 2 g every 6 hours: 2 g every 4 hours (Ref).

If usual recommended dose is 2 g every 4 hours: Some patients may not meet pharmacodynamic targets with 2 g every 4 hours dosing; monitor closely, consider utilizing a prolonged or continuous infusion, and if necessary, switching to an alternative agent (Ref).

CRRT: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Recommendations are based on high-flux dialyzers and effluent flow rates of 20 to 25 mL/kg/hour (or ~1,500 to 3,000 mL/hour) unless otherwise noted. Appropriate dosing requires consideration of adequate drug concentrations (eg, site of infection) and consideration of initial loading doses. Close monitoring of response and adverse reactions (eg, neurotoxicity) due to drug accumulation is important.

CVVH/CVVHD/CVVHDF: IV:

If usual recommended dose is 1 to 2 g every 6 hours: 2 g every 8 to 12 hours (Ref).

If usual recommended dose is 2 g every 4 hours: 2 g every 6 to 8 hours (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Appropriate dosing requires consideration of adequate drug concentrations (eg, site of infection) and consideration of initial loading doses. Close monitoring of response and adverse reactions (eg, neurotoxicity) due to drug accumulation is important.

Note: Where possible, schedule one of the doses for after the PIRRT session (Ref).

IV:

If usual recommended dose is 1 to 2 g every 6 hours: 2 g every 8 to 12 hours (Ref).

If usual recommended dose is 2 g every 4 hours: 2 g every 8 hours (Ref).

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.

Central nervous system: Brain disease (penicillin-induced), glossalgia, seizure, sore mouth

Dermatologic: Erythema multiforme, exfoliative dermatitis, skin rash, urticaria

Note: Appearance of a rash should be carefully evaluated to differentiate (if possible) nonallergic ampicillin rash from hypersensitivity reaction. Incidence is higher in patients with viral infection, Salmonella infection, lymphocytic leukemia, or patients that have hyperuricemia.

Gastrointestinal: Diarrhea, enterocolitis, glossitis, melanoglossia, nausea, oral candidiasis, pseudomembranous colitis, stomatitis, vomiting

Hematologic & oncologic: Agranulocytosis, anemia, eosinophilia, hemolytic anemia, immune thrombocytopenia, leukopenia

Hepatic: Increased serum AST

Hypersensitivity: Anaphylaxis

Immunologic: Serum sickness-like reaction

Renal: Interstitial nephritis (rare)

Respiratory: Stridor

Miscellaneous: Fever

<1%, postmarketing, and/or case reports: Dysgeusia (Syed 2016)

Contraindications

Hypersensitivity (eg, anaphylaxis) to ampicillin, any component of the formulation, or other penicillins; infections caused by penicillinase-producing organisms

Warnings/Precautions

Concerns related to adverse effects:

• Hypersensitivity/anaphylactoid reactions: Serious and occasionally severe or fatal hypersensitivity (anaphylactoid) reactions have been reported in patients on penicillin therapy, especially with a history of beta-lactam hypersensitivity or a history of sensitivity to multiple allergens. Serious anaphylactoid reactions require emergency treatment and airway management. Appropriate treatments must be readily available.

• Rash: Appearance of a rash should be carefully evaluated to differentiate a nonallergic ampicillin rash from a hypersensitivity reaction; rash occurs in 5% to 10% of children and is a generalized dull red, maculopapular rash, generally appearing 3 to 14 days after the start of therapy. It normally begins on the trunk and spreads over most of the body. It may be most intense at pressure areas, elbows, and knees.

• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including Clostridioides difficile–associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.

Disease-related concerns:

• Infectious mononucleosis: A high percentage of patients with infectious mononucleosis have developed rash during therapy; ampicillin-class antibiotics not recommended in these patients. Rash (generalized maculopapular and pruritic) usually appears 7 to 10 days after initiation and usually resolves within a week of discontinuation. It is not known whether these patients are truly allergic to ampicillin

• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment recommended.

Warnings: Additional Pediatric Considerations

Ampicillin has been shown to prolong the bleeding time in neonates in 2 prospective studies. The first study found a prolonged bleeding time by an average of 60 seconds longer than baseline in neonates (n=15; GA: 33 to 41 weeks; weight: 1,760 to 3,835 g) after receiving the third and fourth doses of ampicillin (50 to 100 mg/kg/dose every 12 hours) (Sheffield 2010). The second study evaluated the effect on bleeding time in very low birth weight patients (n=20; GA: 23 to 33 weeks; weight: 400 to 1,410 g); results showed that patients receiving ampicillin for ≥10 days had a prolonged bleeding time compared to baseline; on average bleeding time was 2 minutes longer (p=0.001) (Sheffield 2011). The clinical significance of ampicillin's effect on bleeding time is unknown, but probably depends on the patient's clinical status and risk of hemorrhage.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral:

Generic: 500 mg

Solution Reconstituted, Injection, as sodium [strength expressed as base, preservative free]:

Generic: 125 mg (1 ea); 250 mg (1 ea); 500 mg (1 ea); 1 g (1 ea); 2 g (1 ea)

Solution Reconstituted, Intravenous, as sodium [strength expressed as base, preservative free]:

Generic: 1 g (1 ea); 2 g (1 ea); 10 g (1 ea)

Generic Equivalent Available: US

Yes

Pricing: US

Capsules (Ampicillin Oral)

500 mg (per each): $0.65

Solution (reconstituted) (Ampicillin Sodium Injection)

1 g (per each): $1.93 - $9.00

2 g (per each): $2.80 - $16.75

125 mg (per each): $5.22

250 mg (per each): $2.34 - $4.19

500 mg (per each): $2.70 - $4.41

Solution (reconstituted) (Ampicillin Sodium Intravenous)

1 g (per each): $16.37 - $17.91

2 g (per each): $31.76 - $34.75

10 g (per each): $76.80 - $107.77

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral:

Generic: 250 mg, 500 mg

Solution Reconstituted, Injection, as sodium [strength expressed as base]:

Generic: 250 mg (1 ea); 500 mg (1 ea); 1 g (1 ea); 2 g (1 ea)

Additional Information

Sodium content: Oral suspension (250 mg/5 mL, 5 mL): 10 mg (0.4 mEq); parenteral (1 g): 66.7 mg (3 mEq)

Administration: Pediatric

Oral: Administer on an empty stomach (ie, 30 minutes prior to or 2 hours after meals) to increase total absorption; shake suspension well before using.

Parenteral:

IM: Inject deep IM into a large muscle mass.

IV:

IV push: Doses ≤500 mg should be administered over 3 to 5 minutes; doses >500 mg should be administered over 10 to 15 minutes; rapid administration has been associated with seizures.

Intermittent IV infusion: Avoid infusing concomitantly with aminoglycosides if feasible; consult drug interactions database for more information.

Neonates: Infuse over ≥20 minutes; shorter infusions may result in peak concentrations above the neurotoxicity exposure threshold (Ref).

Infants, Children, and Adolescents: Infuse over 10 to 15 minutes.

Administration: Adult

Administer around-the-clock to promote less variation in peak and trough serum levels.

Oral: Administer on an empty stomach with a full glass (8 oz) of water (ie, 30 minutes prior to or 2 hours after meals) to increase total absorption.

IM.: Inject deep IM into a large muscle mass

IV: Direct IV bolus: Administer over 3 to 5 minutes (125 to 500 mg) or over 10 to 15 minutes (1 to 2 g). More rapid infusion may cause seizures.

Infusion: Rapid infusion may cause seizures. Adjust rate of infusion so that the total dose is administered before admixture stability expires.

Storage/Stability

Oral:

Capsules: Store at 20°C to 25°C (68°F to 77°F).

Oral suspension: Store dry powder at 20°C to 25°C (68°F to 77°F). Once reconstituted, oral suspension is stable for 14 days under refrigeration.

Parenteral:

Store intact vials at 20°C to 25°C (68°F to 77°F).

Solutions for IM or direct IV should be used within 1 hour.

Stability of parenteral admixture in NS at 25°C (77°F) is 8 hours (concentrations up to 30 mg/mL) and at 4°C (39°F) is 24 hours (concentration of 30 mg/mL) or 48 hours (concentrations up to 20 mg/mL). Protect from freezing.

Use

Treatment of susceptible respiratory, gastrointestinal, and urinary tract infections; bacterial meningitis, septicemia, and endocarditis (FDA approved in pediatric patients [age not specified] and adults); susceptible organisms may include streptococci, pneumococci, enterococci, nonpenicillinase-producing staphylococci, Listeria, meningococci; some strains of Haemophilus influenzae, Proteus mirabilis, Salmonella, Shigella, Escherichia coli, Enterobacter, and Klebsiella; has also been used for endocarditis prophylaxis, prophylaxis of peritonitis in patients with peritoneal dialysis catheters undergoing invasive dental procedures, and treatment of exit site or tunnel infections in patients with peritoneal dialysis catheters.

Medication Safety Issues
Sound-alike/look-alike issues:

Ampicillin may be confused with aminophylline

Metabolism/Transport Effects

Substrate of OAT1/3

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Acemetacin: May increase the serum concentration of Penicillins. Risk C: Monitor therapy

Allopurinol: May enhance the potential for allergic or hypersensitivity reactions to Ampicillin. Risk C: Monitor therapy

Aminoglycosides: Penicillins may decrease the serum concentration of Aminoglycosides. Primarily associated with extended spectrum penicillins, and patients with renal dysfunction. Risk C: Monitor therapy

Atenolol: Ampicillin may decrease the bioavailability of Atenolol. Risk C: Monitor therapy

Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider therapy modification

BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Risk C: Monitor therapy

Chloroquine: May decrease the serum concentration of Ampicillin. Management: Separate the administration of ampicillin and chloroquine by at least 2 hours to minimize any potential negative impact of chloroquine on ampicillin bioavailability. Risk D: Consider therapy modification

Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination

Dichlorphenamide: Penicillins may enhance the hypokalemic effect of Dichlorphenamide. Risk C: Monitor therapy

Fecal Microbiota (Live) (Oral): May diminish the therapeutic effect of Antibiotics. Risk X: Avoid combination

Fecal Microbiota (Live) (Rectal): Antibiotics may diminish the therapeutic effect of Fecal Microbiota (Live) (Rectal). Risk X: Avoid combination

Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor therapy

Khat: May decrease the serum concentration of Ampicillin. Management: Consider administering ampicillin 2 hours after khat chewing to avoid reductions in ampicillin bioavailability. Risk D: Consider therapy modification

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy

Lanthanum: May decrease the serum concentration of Ampicillin. Management: Administer oral ampicillin at least two hours before or after lanthanum. Risk D: Consider therapy modification

Methotrexate: Penicillins may increase the serum concentration of Methotrexate. Risk C: Monitor therapy

Mycophenolate: Penicillins may decrease serum concentrations of the active metabolite(s) of Mycophenolate. This effect appears to be the result of impaired enterohepatic recirculation. Risk C: Monitor therapy

Probenecid: May increase the serum concentration of Penicillins. Risk C: Monitor therapy

Sodium Benzoate: Penicillins may diminish the therapeutic effect of Sodium Benzoate. Risk C: Monitor therapy

Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification

Tegoprazan: May decrease the serum concentration of Ampicillin. Risk C: Monitor therapy

Tetracyclines: May diminish the therapeutic effect of Penicillins. Risk C: Monitor therapy

Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider therapy modification

Vitamin K Antagonists (eg, warfarin): Penicillins may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy

Food Interactions

Food decreases ampicillin absorption rate; may decrease ampicillin serum concentration. Management: Take at equal intervals around-the-clock, preferably on an empty stomach (30 minutes before or 2 hours after meals). Maintain adequate hydration, unless instructed to restrict fluid intake.

Dietary Considerations

Take on an empty stomach 30 minutes before or 2 hours after meals. Some products may contain sodium.

Pregnancy Considerations

Ampicillin crosses the placenta.

Detectable concentrations of ampicillin are present in the cord serum and amniotic fluid following maternal IM, IV, and oral administration (Nau 1987). In a study of women treated with IV ampicillin for group B streptococcal (GBS) prophylaxis, peak concentrations in the umbilical cord were observed 30 minutes after the maternal dose and effective neonatal concentrations continued for ≥4 hours when a loading dose was given (Berardi 2018).

Due to pregnancy-induced physiologic changes, the pharmacokinetics of ampicillin may be altered; dose adjustments may be needed. Although oral absorption is not altered during pregnancy, oral ampicillin is poorly absorbed during labor (Kubacka 1983; Nau 1987).

As a class, penicillin antibiotics are widely used in pregnant patients. Based on available data, penicillin antibiotics are generally considered compatible for use during pregnancy (Ailes 2016; Bookstaver 2015; Crider 2009; Czeizel 2001; Damkier 2019; Heinonen 1977; Lamont 2014; Muanda 2017a; Muanda 2017b).

Untreated intraamniotic infection (chorioamnionitis) may lead to adverse pregnancy outcomes, including pneumonia, meningitis, and sepsis, in the newborn. Maternal complications may include postpartum uterine atony with hemorrhage, endometritis, peritonitis, sepsis, or adult respiratory distress syndrome. Ampicillin is part of the recommended regimen for the treatment of intraamniotic infection (ACOG 2017).

Untreated asymptomatic GBS disease can result in maternal urinary tract infection, intraamniotic infection, endometritis, preterm labor, and/or stillbirth. Vertical transmission from the mother can cause sepsis, pneumonia, or meningitis in the newborn. IV ampicillin is recommended as an alternative antibiotic for intrapartum prophylaxis to prevent neonatal GBS early-onset disease (ACOG 2020b).

Ampicillin is recommended for use in pregnant patients for the management of preterm prelabor rupture of membranes (PROM); treatment with antibiotics is used to prolong pregnancy and decrease maternal and newborn infections (ACOG 2020a). Ampicillin may also be used in certain situations prior to vaginal delivery in patients at high risk for endocarditis (ACOG 2018).

Ampicillin may be a preferred agent for the treatment of asymptomatic bacteriuria in pregnancy (IDSA [Nicolle 2019]).

Maternal Listeria monocytogenes infection varies from asymptomatic disease requiring no therapy to a febrile illness with or without additional symptoms, resulting in severe pregnancy outcomes, including fetal loss, preterm labor, neonatal sepsis, meningitis, and maternal death. Maternal treatment with IV ampicillin is recommended when fever is present, exposure is suspected, and no other cause of illness is known (ACOG 2014).

Monitoring Parameters

With prolonged therapy, monitor renal, hepatic, and hematologic function periodically; observe for change in bowel frequency; observe for signs of anaphylaxis with first dose

Mechanism of Action

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

Pharmacokinetics (Adult Data Unless Noted)

Absorption: Oral: 50%

Distribution: Into bile; penetration into CSF occurs with inflamed meninges only

Protein binding: Neonates: 10%; Adults: 15% to 18%

Half-life elimination:

Neonates:

PNA 2 to 7 days: 4 hours

PNA 8 to 14 days: 2.8 hours

PNA 15 to 30 days: 1.7 hours

Children and Adults: 1 to 1.8 hours (Bergan 1978)

Anuric patients: 8 to 20 hours

Time to peak serum concentration: Oral: Within 1 to 2 hours

Excretion: Urine (∼90%, unchanged within 24 hours); feces

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Anti-infective considerations:

Parameters associated with efficacy:

Time-dependent; associated with time free drug concentration (fT) > minimum inhibitory concentration (MIC), goal: ≥40% fT>MIC (bactericidal) (Craig 1998; Lacy 1999); some experts favor 100% fT>MIC in critically ill patients, including neonates (Le 2022; Roberts 2014).

Expected drug exposure in normal renal function:

Adults, Cmax (peak):

250 mg dose (oral capsule): ~2.3 mg/L.

500 mg dose (oral capsule): ~3 mg/L.

500 mg every 6 hours (IV), steady state: 10.2 ± 0.8 mg/L (Lacy 1999).

1 g every 6 hours (IV), steady state: 40.9 ± 6.6 mg/L (Lacy 1999).

Postantibiotic effect: Generally <1 hour, varies by organism (Craig 1993; Craig 1998).

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Ampicillin | Ampicillin Pierrel | Ampicina | Ampicipen | Ampicyn | Ampidar | Ampilag | Amplital | Binotal | Epicocillin | Extrapen | Julphapen | Lifeampil | Norcipen | Overcillina | Pamecil | Penbritin | Pentrexyl K | Rivocillin | Roscillin | Servicillin;
  • (AR) Argentina: Alpovex | Ampi bis | Ampicilina | Ampicilina duncan | Ampicilina fecofar | Ampicilina ingram | Ampicilina lemax | Ampicilina richet | Ampicler | Ampigen simple | Ampigrand | Ampitenk | Atecilina | Cronopen | Decilina | Fada Ampicilina | Histopen | Hostes | Trifacilina;
  • (AT) Austria: Standacillin;
  • (AU) Australia: Agpen | Alphacin | Ampicyn | Austrapen | Ibimicyn | Penbritin;
  • (BD) Bangladesh: Acmecilin | Admox | Aldapen | Almoxil | Amblosin | Ampen | Ampexin | Ampicillin | Ampicin | Ampimet | Ampirex | Ampisina | Ampritin | Avlocillin | Bipicillin | Centacillin | Champicin | Decilin | Ficillin | Kamocillin | Navacillin | Pen-A | Penacillin | Simpicillin | Skycillin;
  • (BE) Belgium: Penbritin | Pentrexyl;
  • (BF) Burkina Faso: Ampicilline | Ampicilline tm | Ampicilline ubigen | Philco ampicillin;
  • (BG) Bulgaria: Ampicillin | Standacillin | Upsampi;
  • (BR) Brazil: Ambezetal | Ampi | Ampiciflan | Ampicil | Ampicilab | Ampicilase | Ampicilib | Ampicilil | Ampicilina | Ampicilina sodica | Ampicilon | Ampicinal | Ampicler | Ampifar | Ampifar Balsamico | Ampiger | Ampigran | Ampilozin | Ampitrat | Ampival | Ampixin | Ampizan | Amplacilina | Amplacin | Amplatil | Amplibac | Amplitor | Amplocilin | Amplotal | Bacterinil | Benzotal | Binotal | Bipencil | Cilinon | Cilipen | Durapen | Emicilin | Expectocilin | Furp ampicilina | Genocilina | Neo ampicilin | Optacilin | Praticilin | Sifcilina | Uni ampicilin | Uniao ampicilina;
  • (CH) Switzerland: Cimexillin | Penbristol | Penbritin | Servicillin;
  • (CI) Côte d'Ivoire: Ampicillin | Ampicilline | Ampicilline creat | Ampicilline ubigen | Apo-ampi | Standacillin;
  • (CL) Chile: Ampicilina;
  • (CN) China: A bi xian | Ampicillin | Ampilin | An bi xian | An bi xian-sanye | An sa | Bi xian su | En pu luo | Servicillin | Yi xi de;
  • (CO) Colombia: Ambigel | Ambiopen | Amfipen | Ampicilina | Ampicilina mk | Ampicilina MK | Ampicilina sodica | Ampicyl | Ampyfec | Binotal | Eucilina | Meprizina | Omnipen | Penamplia | Pentrexyl | Picylin | Principen | Servicilina;
  • (CZ) Czech Republic: Ampicillin | Apo ampi | Penstabil | Pentrexyl | Semicillin | Servicillin;
  • (DE) Germany: Ampicillin | Ampicillin ratiopharm | Ampicillin STADA | Binotal | Duraampicillin | Penbrock;
  • (DO) Dominican Republic: Alfacin | Alpra | Ampibex | Ampicilex | Ampicilina | Ampicilina Calox | Ampicilina mk | AmpiDek | Ampidelta | Ampifarma | Ampimer | Ampina | Ampisan | Ampitrex | Arcocillin | Binotal | Flamicina | Lufracilina | Pen am | Pencil | Pentrexyl | Plumericin | Ragocilina | Servicillin | Standacillin;
  • (EC) Ecuador: Ampecu | Ampi-Infant | Ampibex | Ampicher | Ampicilina | Ampicilina g.a. | Ampicilina Genfar | Ampicilina genfar | Ampicilina MK | Ampicilina mk | Ampigeme | Ampil | Ampilan | Ampistar | Binotal | Deripen | Exactum | Julphapen | Libracilina | Novencil | Pentrexyl | Servicillin;
  • (EE) Estonia: Ampicillin | Ampicillinum | Pamecil | Pentrexyl | Standacillinum;
  • (EG) Egypt: Ampicid | Ampicillin | Ampicilline | Ampicinal | Epicocillin;
  • (ES) Spain: Ampicilina llorente | Antibiopen | Britapen | Electopen | Gobemicina | Maxicilina duplex | Retarpen | Ultrapenil;
  • (ET) Ethiopia: Ampicillin | Ascillin | Epicocillin;
  • (FI) Finland: A-pen | Adipenin | Ampicillin mylan | Ampicillin Strides | Doktacillin | Dumopen | Pentrexyl;
  • (FR) France: Ampicilline Dakota | Ampicilline gnr | Ampicilline panpharma | Negmapen | Rosampline;
  • (GB) United Kingdom: Ampicillin | Ampicillin arrow | Ampicillin berk | Ampicillin cox | Ampicillin dc | Ampicillin kent | Ampicillin sandoz | Ampilar | Ampitrin | Britcin | Flu-amp | Kap amp | Penbritin | Rimacillin | Vidopen;
  • (GR) Greece: Ampicillin | Isticilline | Pentrexyl | Xanline;
  • (HK) Hong Kong: Ampiciller | Ampicillin | Ampicin | Ampik | Ampisol | Ampisul | Amprexyl | Ancillina | Besteillin | Dhacillin | Euro-ampicillin | Neo-Britin | Nice ampi | Pamecil | Penbritin | Pentrexyl | Polecillin | Quali-Amp | Reichlin | Servicillin | Syntocil | U cillin | Unicillin;
  • (HR) Croatia: Ampicilin Sandoz;
  • (HU) Hungary: Ampicillin | Huma-ampicillin | Penbritin | Penstabil | Pentrexyl | Standacillin;
  • (ID) Indonesia: Aktoralin | Ambiopi | Amcillin | Amfipen | Ampex | Ampi | Ampicen | Ampicil | Ampicillin | Ampicilline | Ampipen | Arcocillin | Bannsipen | Binotal | Biopenam | Biopensyn | Bremcillin | Brodacillin | Camicilline | Cetacillin | Corsacillin | Dancillin | Decapen | Dexypen | Erphacillin | Etabiotic | Gunabiotik | Hopacillin | Ikacillin | Indopen | Itrapen | Kalpicilin | Kemocil | Lactapen | Megapen | Mepropen | Metacillin | Mycill | Omnipen | Opicillin | Oracipen | Parpicillin | Penbiotic | Penbritin | Pencil | Phapin | Pharocillin | Polypen | Primacillin | Primapen | Rampicillin | Ronexol | Sambritin | Sanpicillin | Scancipen | Standacillin | Ultrapen | Viccillin | Xepacillin | Yekacillin;
  • (IE) Ireland: Ampicillin | Clonamp | Novapen | Penbritin | Rimacillin;
  • (IL) Israel: Penibrin;
  • (IN) India: Amcin | Amp | Ampdec | Ampicillin | Ampik | Ampilin | Ampillin | Ampilon | Ampisyn | Ampurin | Antilin | Antillin | Aristocillin | Bacipen | Biocilin | Biocillin | Blucillin | Broacil | Broadicilin | Campicilin | Cincillin | Conampi | Dynacil | Elcillin | Gercillin | Impen | J P Cillin | J.p.cillin | Labcillin | Lupillin | Monacilin | Natcocillin | Nepocil | Pharampicillin | Piracillin | Polypen | Pressilin | Raympillin | Roscillin | Saincillin | Sterpen | Suziclox | Synthocilin | Uniamp | Versatillin | Zcil;
  • (IT) Italy: Ampicillina | Ampicillina biopharma | Ampilux | Ampiplus Simplex | Amplital | Amplizer | Ibimicyn;
  • (JO) Jordan: Amibel | Ampicent | Ampidar | Ampipharm | Pamecil | Penbritin | Pentrexil | Standacillin | Ultracillin;
  • (JP) Japan: Adobacillin | Amipenix | Ampicillin amel | Ampicillin fujimoto | Ampicillin merck hoei | Ampicillin nichiiko | Ampicillin otsuka | Ampicillin pfizer | Ampicillin sanko | Ampicillin sawai | Ampicillin showa | Ampicillin taisho | Ampicillin tatumi | Ampicillin teikoku | Ampicillin towa | Ampicillin tsuruhara | Bonapicilin | Cilleral | Domicillin | Extopen | Iwacillin | Marisilan | Nccilin | Ohtecin | Penbritin | Penimic | Pentrex | Pharcillin | Saicilin | Sod.ampicillin fujo | Sod.ampicillin taisho | Solcillin | Synpenin | Tokiocillin | Totacillin | Viccillin;
  • (KE) Kenya: Ampecin | Ampicen | Ampicillin | Ampik | Ampilin | Ascillin | Biopen | Curecillin | Gestacillin | Lacillin | Pcillin;
  • (KR) Korea, Republic of: Amcillin | Ampi | Ampicillin | Campi | Mpisen | Penbrex;
  • (KW) Kuwait: Penbritin;
  • (LB) Lebanon: Ampicillin | Ampicilline | Penbritin | Pentrexyl;
  • (LT) Lithuania: Ampicilina | Ampicillin | Apo ampi | Campicillin | Pan ampicillin | Penbritin | Penstabil | Pentrexyl | Standacillin;
  • (LU) Luxembourg: Fortapen | Penbritin | Pentrexyl;
  • (LV) Latvia: Ampicillin | Ampicillin ratiopharm | Ampicillin trihydras | Apo ampi | Campicillin | Pamecil | Pan ampicillin | Penbritin | Penibrin | Penstabil | Pentrexyl | Standacillin;
  • (MA) Morocco: Amblosin | Ampicilline llorente | Apo-ampi | Opticilline | Standacillin | Totapen;
  • (MX) Mexico: Acilmed | Ambidrin | Ampi quim | Ampi quim pediatrico | Ampi tecno | Ampi-quim | Ampicidar | Ampicilina | Ampicilina gi | Ampicilina gi diba | Ampicilina gi ivax | Ampicilina gi pisa | Ampicilina gi serr | Ampicilina hormona | Ampicilina keyer | Ampimex | Amsapen | Anglopen | Aristocilin | Binotal | Bremicina | Brupen | Coltapen | Deamcilina | Dibacilina | Expicin | Flamicina | Gramipen F | Iqfacilina | Lampicin | Lixilina | Marovilina | Meprizina | Mexapin | Mibiot | Mobiot | Omnipen | Penbritin | Pentiver | Pentrexyl | Promecilina | Raphilina tri | Sinaplin;
  • (MY) Malaysia: Amcin | Amillin | Ampicap | Ampicap-T | Ampicilla | Ampicillin | Ampicyn | Ampigran | Ampilin | Ampillin | Ampisol | Biocil | Dhacillin | Kampibiotic | Pamecil | Penbritin | Pricillin | Setcillin | Standacillin | Synamin;
  • (NG) Nigeria: Aframpi | Cikacillin | Climpicillin | Evans ampicillin | Mirapicin | Nemecillin | Vitacillin;
  • (NL) Netherlands: Pentrexyl;
  • (NO) Norway: Ampicillin | Ampicillin mylan | Ampicillin pcd | Ampicillin ratiopharm | Ampicillin stada | Ampicillin Strides | Doktacillin | Pentrexyl;
  • (PE) Peru: Ab ambromox | Ab broncol nf 1200 | Ab broncol nf 300 | Ab broncol nf 600 | Ampicilina | Ampicilina lusa | Ampicilina markos | Ampicilina trifarma | Ampicilina uqp | Ampiflex | Ampisint | Amplibin | Binotal | Dentacilina | Hiperbiotico | Ipcacillin | Julphapen | Magnapen | Neo-terbocilin | Omnipen | Penbritin | Roscillin | Sintelin;
  • (PH) Philippines: Aldribid | Altozin | Amdricil | Ampedia | Ampi 1 | Ampicillin | Ampicin | Ampico | Ampin | Ampinex | Ampisan | Ampitrex | Ampivex | Amplivacil | Angypex | Apamacin | Bactimed | Bactropen | Biogenerics ampicillin | Biostacil | Boie ampicillin | Bridopen | Clovillin | Dancin | Dincil | Dli-ampicillin | Eurocin | Eurotrexil | Excillin | Gramcil | Knolicin | Leoplex | Liferzin | Mapciril | May ampicillin | Medic aid ampicillin | Meljimar | Obocil | Panacta | Penbritin | Pensyn | Pentrexyl | Polypen | Rotocin | Shinapen | Sodampen | Sumpilin | Vatacil | Vonpicin | Yss ampicillin sodium | Zerrucillin;
  • (PK) Pakistan: Amicil | Ampicil | Ampicillin | Ampillin | Ampilo | Ampimaz | Ampin | Ampistal | Ampiwil | Amplipen | Amplox | Anglocillin | Empecil | Epocillin | Epoclox | Fedropen | Hizopen | M-cil | Maxibiotic | Medicillin | Novocillin | Nuvapen | Omnipen | Penbritin | Pencipen | Pexopen | Polycillin | Standacillin | Ultrapen | Zampicillin | Zyncillin;
  • (PL) Poland: Ampicillin | Penstabil;
  • (PR) Puerto Rico: Ampicillin | Omnipen | Polycillin | Principen | Totacillin-n;
  • (PT) Portugal: Ampicilina | Amplifar | Hiperbiotico | Hiperbiotico retard;
  • (PY) Paraguay: Ampi bis | Ampicilina | Ampicilina genfar | Ampicilina klonal | Ampicilina millet | Ampicilina sodica sanderson | Ampicilina veinfar | Ampicilina vivele | Ampimedin | Cilimpil | Cilimpil retard | Norake;
  • (RO) Romania: Ampicilina | Ampicilina antibiotice | Ampicilina arena | Ampicilina forte | Ampicilina forte lph | Ampicilina sandoz | Ampidar | Ampisina | Ephicilin | Epicocillin | Standacillin;
  • (RU) Russian Federation: Ampic | Ampicillin | Ampicillin Akos | Ampicillin akos | Ampicillin ferein | Ampicillin forte | Ampicillin sodium salt | Ampicillin sodium salt vial | Ampiox natrii | Ampirex | Ampisid | Standacillin | Upsampi | Zetsyl;
  • (SA) Saudi Arabia: Ampidar | Epicocillin | Penbritin | Pentrexyl | Standacillin | Ultracillin;
  • (SE) Sweden: Doktacillin;
  • (SG) Singapore: Amcillin | Amillin | Ampicap | Ampicillin | Ampillin | Apo-Ampicillin | Dhacillin | Ficillin | Pamecil | Penbritin | Pricillin | Standacillin | Syntocil;
  • (SI) Slovenia: Ampicilina | Ampicillin | Ampicillin ratiopharm | Gobemicina | Pan ampicillin | Penbritin;
  • (SK) Slovakia: Ampicillin | Penstabil | Pentrexyl;
  • (SL) Sierra Leone: Ampicin | Sino ampi;
  • (TH) Thailand: Ambicillin | Amcillin | Amcipen | Amilin | Amlin | Ampac | Ampat | Ampexin | Ampi | Ampi sol | Ampicillin | Ampicillin pharmacia | Ampicillin stada | Ampicin | Ampico | Ampicyn | Ampilin | Ampillin | Ampimycin | Ampin | Ampipen | Ampipen n.l. | Ampisil | Ampitrex | Ampolene | Ampolin | Ampota | Ampra mh | Amprexyl | Ampro | Amroycillin | Amtrex | Anbicillin | Bacin | Eracillin | Greatcillin | Indexil | Kempicin | Medicillin | Metro-am | Nadicillin | Neocillin | Overcillina | Pamecil | Penbritin | Pencotrex | Pentrexyl | Phihacillin | Phihamox | Picillin | Principen | Roscillin | Sanicillin | Siampicil | Specillin | Sumapen | Syntocil | Utocillin | Vacillin | Viccillin | Zampin;
  • (TN) Tunisia: Ampicil | Ampicyn | Opticilline | Pamecil | Penbritin | Rosampline | Sinapen | Totapen | Ultracilline;
  • (TR) Turkey: Alfasilin | Ampisina | Negopen | Penbisin | Seskasilin | Silina;
  • (TW) Taiwan: Ampicillin | Ampicyn | Ampiland | Ampimycin | Ampolin | Ancillin | Ancillina | Gobemicina | Hiperbiotico | Li cillin | Linpemycin | Pelitin | Penbritin | Pentrexyl | Servicillin | Standacillin | Tokiocillin | Winpicillin;
  • (UA) Ukraine: Amopen | Ampicil | Ampicillin | Brodaccillin | Novo Ampicillin | Standacillin;
  • (UG) Uganda: Agocilin | Agocillin | Ampecin | Ampilin | Ampiren | Ampirone | Ascillin | Kam ampi | Lacillin | Lampy | Milcillin | Spamcil | Swisscillin;
  • (UY) Uruguay: Ampicilina | Ampicyn | Binotal | Fada Ampicilina | Grampenil | Librampi | Maxicilina | Principen | Servicillin | Standacillin;
  • (VE) Venezuela, Bolivarian Republic of: Alampen | Ampenina | Ampicilina | Ampilan | Ampisod | Arcocilin | Bonasyl | Intrapen;
  • (ZA) South Africa: Acupillin | Ampicillin | Ampicillin unimed | Ampicillin-blp | Ampicillin-fresenius | Ampipen | Auro ampicillin | Be-ampicil | Penbritin | Penrite | Petercillin | Ranamp | Rolab-ampicillin | Spectracil;
  • (ZM) Zambia: Ampicap | Ampicillin | Ampifil | Ampik | Ampikant | Ampishel | Apcillin | Ar ampi | Famicillin | Ipcacillin | Medampi | Petercillin | Spamcil | Zcil;
  • (ZW) Zimbabwe: Ampicelo | Ampicillin fresenius
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