Bacampicillin

Antibiotic Class

Penicillin (aminopenicillin)

Antimicrobial Spectrum

Gram positive bacteria:  Streptococcus spp., Enterococcus, Listeria monocytogenes

Gram negative bacteria:  H. influenzae, E. coli, Proteus mirabilis, Salmonella spp., Shigella spp.

Mechanism of Action

Exerts bactericidal activity via inhibition of bacterial cell wall synthesis by binding one or more of the penicillin binding proteins (PBPs).  Exerts bacterial autolytic effect by inhibition of certain PBPs related to the activation of a bacterial autolytic process.

Pharmacodynamics

Penicillins produce time-dependent killing

Pharmacokinetics

Oral bioavailability: 98%; Total protein binding: 17 to 20%; Metabolism:  Rapidly hydrolyzed to ampicillin (active metabolite); extensive metabolism in intestinal wall; Excretion:  predominant renal excretion (73%); Volume of distribution:  27 L

Adverse Effects

Hematologic:  anemia, thrombocytopenia, neutropenia, agranulocytosis

CNS:  seizures

Renal:  nephrotoxicity

Hepatic:  transient increases in transaminases

Other:  Jarisch-Herxheimer Reaction (fever, chills, sweating, tachycardia, hyperventilation, flushing, and myalgia)

Dosage

Adult: ³ 25 kg:  Upper respiratory tract infections, Urinary tract infections, skin infections:

400 mg q12h; treat for a minimum of 48-72 hours after the patient becomes asymptomatic

                            Severe infections:

800 mg q12h; treat for a minimum of 48-72 hours after the patient

becomes asymptomatic

Pediatric:  Upper respiratory tract infections, Urinary tract infections, skin infections:

25 mg/kg/day in two divided doses q12h; treat for a minimum of 48-72 hours after the patient becomes asymptomatic

     Severe infections:

50 mg/kg/day in two divided doses q12h; treat for a minimum of 48-72 hours after the patient becomes asymptomatic

Disease state based dosing:

Renal failure:  CrCl > 50 mL/min:  dosing interval is every 6 hours

                        CrCl 10 to 50 mL/min:  dosing interval is every 6 to 12 hours

                        CrCl < 10 mL/min:  dosing interval is every 12 to 24 hours

Hepatic failure:  No dosing adjustment necessary

Contraindications/Warnings/Precautions

Contraindications

Anaphylaxis to bacampicillin or other penicillins

Precautions

Cephalosporin hypersensitivity

Patients with mononucleosis are more likely to develop a skin rash

Drug Interactions

Contraceptives - decreased contraceptive effectiveness

Live Typhoid Vaccine - decreased immunological response to the typhoid vaccine

Probenecid - increased bacampicillin levels

Pregnancy

Category B: No evidence of risk in humans but studies inadequate.

Monitoring Requirements

Therapeutic:  Culture and sensitivities, signs and symptoms of infection

Toxic:  Periodic CBC, urinalysis, BUN, SCr, AST and ALT

Brand names/Manufacturer