Mechanism of effect
During absorption from the gastrointestinal tract, bacampicillin is hydrolyzed by esterases present in the intestinal wall. It is microbiologically active as ampicillin, and exerts a bactericidal action through the inhibition of the biosynthesis of cell wall mucopeptides
Pharmacodynamic
Bacampicillin is a prodrug of ampicillin and is microbiologically inactive
Pharmacokinetics
Absorption
Absorbed following oral administration
Absorbed following oral administration
Drug indications
For infections at the following sites: upper and lower respiratory tract; skin and soft tissue; urinary tract and acute uncomplicated gonococcal urethritis, when due to sensitive strains of the following organisms: Gram-positive: streptococci (including S. faecalis and S. pneumoniae) and nonpenicillinase-producing staphylococci; Gram-negative: H. influenzae, N. gonorrhoeae, E. coli, P. mirabilis, Salmonellae and Shigellae
Dosage
Usual Adult Dose for Upper Respiratory Tract Infection: 400 to 800 mg orally every 12 hours for 7 to 10 days, depending on the nature and severity of the infection
Usual Adult Dose for Gonococcal Infection - Uncomplicated: 1.6 g orally plus 1 g probenecid as a single dose.
Usual Adult Dose for Otitis Media: 400 to 800 mg orally every 12 hours for 10 to 14 days, depending on the nature and severity of the infection.
Usual Adult Dose for Cystitis: 400 mg orally every 12 hours for 3 to 7 days, depending on the nature and severity of the infection.
Usual Adult Dose for Pneumonia: 800 mg orally every 12 hours. Therapy should continue for 7 days if pneumococcal pneumonia is suspected or up to 21 days if other organisms are responsible.
Usual Adult Dose for Skin or Soft Tissue Infection: 400 to 800 mg orally every 12 hours for 7 to 10 days or for 3 days after acute inflammation resolves, depending on the nature and severity of the infection.
Usual Pediatric Dose for Skin and Structure Infection
Children >25 kg: 25 mg/kg/day in 2 equally divided doses at 12 hour intervals.
Usual Pediatric Dose for Pneumonia
Children >25 kg: 50 mg/kg/day in 2 equally divided doses at 12 hour intervals
Usual Adult Dose for Gonococcal Infection - Uncomplicated: 1.6 g orally plus 1 g probenecid as a single dose.
Usual Adult Dose for Otitis Media: 400 to 800 mg orally every 12 hours for 10 to 14 days, depending on the nature and severity of the infection.
Usual Adult Dose for Cystitis: 400 mg orally every 12 hours for 3 to 7 days, depending on the nature and severity of the infection.
Usual Adult Dose for Pneumonia: 800 mg orally every 12 hours. Therapy should continue for 7 days if pneumococcal pneumonia is suspected or up to 21 days if other organisms are responsible.
Usual Adult Dose for Skin or Soft Tissue Infection: 400 to 800 mg orally every 12 hours for 7 to 10 days or for 3 days after acute inflammation resolves, depending on the nature and severity of the infection.
Usual Pediatric Dose for Skin and Structure Infection
Children >25 kg: 25 mg/kg/day in 2 equally divided doses at 12 hour intervals.
Usual Pediatric Dose for Pneumonia
Children >25 kg: 50 mg/kg/day in 2 equally divided doses at 12 hour intervals
Drug contraindications
Side effects
Hypersensitivity
Besides the urticarial rash of hypersensitivity to bacampicillin, a delayed hypersensitivity maculopapular rash may occur 10 to 12 days after bacampicillin therapy is begun.
Hypersensitivity reactions have included rare cases of interstitial nephritis, Henoch-Schonlein Purpura, focal glomerulonephritis and Stevens-Johnson syndrome.
Hypersensitivity reactions occur in up to 5% of patients treated with bacampicillin. Such reactions may include urticarial rashes, edema, hypotension, fever, eosinophilia, Stevens-Johnson syndrome, and dyspnea. Anaphylaxis is rare. Bacampicillin should not be given to patients with a penicillin allergy.
Gastrointestinal
Gastrointestinal adverse effects occur in 2% to 5% of treated patients and may include diarrhea, nausea, vomiting, and abdominal cramps. Rare cases of hepatitis and pancreatitis have been reported with ampicillin, the active form of bacampicillin. Monitoring of liver function tests is recommended in patients with liver dysfunction.
Bacampicillin-associated diarrhea is usually self-limited and is likely related to alterations in the intestinal microflora. Such alterations may predispose patients to the development of diarrhea from Clostridium difficile toxin. Rare cases of transiently increased liver function tests and chronic cholestasis associated with ampicillin have been reported.
Acute pancreatitis associated with ampicillin has been reported and confirmed by rechallenge with ampicillin in a patient with no other obvious cause of pancreatitis.
Hematologic
Rare cases of thrombocytopenia, leukopenia, red cell aplasia, and anemia have been reported.
Hematologic adverse effects of bacampicillin are rare and include thrombocytopenia, red cell aplasia, and anemia
Besides the urticarial rash of hypersensitivity to bacampicillin, a delayed hypersensitivity maculopapular rash may occur 10 to 12 days after bacampicillin therapy is begun.
Hypersensitivity reactions have included rare cases of interstitial nephritis, Henoch-Schonlein Purpura, focal glomerulonephritis and Stevens-Johnson syndrome.
Hypersensitivity reactions occur in up to 5% of patients treated with bacampicillin. Such reactions may include urticarial rashes, edema, hypotension, fever, eosinophilia, Stevens-Johnson syndrome, and dyspnea. Anaphylaxis is rare. Bacampicillin should not be given to patients with a penicillin allergy.
Gastrointestinal
Gastrointestinal adverse effects occur in 2% to 5% of treated patients and may include diarrhea, nausea, vomiting, and abdominal cramps. Rare cases of hepatitis and pancreatitis have been reported with ampicillin, the active form of bacampicillin. Monitoring of liver function tests is recommended in patients with liver dysfunction.
Bacampicillin-associated diarrhea is usually self-limited and is likely related to alterations in the intestinal microflora. Such alterations may predispose patients to the development of diarrhea from Clostridium difficile toxin. Rare cases of transiently increased liver function tests and chronic cholestasis associated with ampicillin have been reported.
Acute pancreatitis associated with ampicillin has been reported and confirmed by rechallenge with ampicillin in a patient with no other obvious cause of pancreatitis.
Hematologic
Rare cases of thrombocytopenia, leukopenia, red cell aplasia, and anemia have been reported.
Hematologic adverse effects of bacampicillin are rare and include thrombocytopenia, red cell aplasia, and anemia
Interactions
Atenolol , Allopurinol , Erythromycin , Esomeprazole , Bismuth , Pantoprazole , quinapril , Sarecycline , Typhoid vaccine (live), oral , Balsalazide , Dexlansoprazole , cholera vaccine live , Anisindione , Troleandomycin , Entecavir , Magnesium hydroxide , Pemetrexed , Oxytetracycline , Demeclocycline , Magaldrate , Aluminum carbonate , Lactobacillus Acidophilus , Ethinyl Estradiol , Mycophenolic acid , Nizatidine , Dihydroxyaluminum , Mefloquine , Magnesium oxide , Warfarin , Clarithromycin , Calcium carbonate , probenecid , Didanosine , Famotidin , Lansoprazole , Minocycline , Mycophenolate mofetil , Methotrexate , Magnesium , Tetracycline , Doxycycline , Rabeprazole , Ranitidine , Cimetidine , Sodium bicarbonateallopurinol, aluminum carbonate, aluminum hydroxide, anisindione, atenolol, azithromycin,
balsalazide, bcg, bifidobacterium infantis, calcium carbonate, cholera vaccine, live, cimetidine, clarithromycin, demeclocycline, dexlansoprazole, dicumarol, didanosine,
dihydroxyaluminum sodium carbonate, dirithromycin, doxycycline, entecavir, erythromycin,
esomeprazole, estradiol, ethinyl estradiol, famotidine, guar gum, indium oxyquinoline in-111, lactobacillus acidophilus, lactobacillus reuteri, lactobacillus rhamnosus, lactobacillus rhamnosus gg, lansoprazole, magaldrate, magnesium carbonate, magnesium hydroxide,
magnesium oxide, mefloquine, methotrexate, minocycline, mycophenolate mofetil, mycophenolic acid, nizatidine, omeprazole, oxytetracycline, pantoprazole, pemetrexed,
probenecid, quinapril, rabeprazole, ranitidine, ranitidine bismuth citrate, sarecycline,
sodium bicarbonate, sodium citrate, sodium iodide i-123, sodium iodide-i-131, tetracycline,
troleandomycin, typhoid vaccine, live, warfarin
balsalazide, bcg, bifidobacterium infantis, calcium carbonate, cholera vaccine, live, cimetidine, clarithromycin, demeclocycline, dexlansoprazole, dicumarol, didanosine,
dihydroxyaluminum sodium carbonate, dirithromycin, doxycycline, entecavir, erythromycin,
esomeprazole, estradiol, ethinyl estradiol, famotidine, guar gum, indium oxyquinoline in-111, lactobacillus acidophilus, lactobacillus reuteri, lactobacillus rhamnosus, lactobacillus rhamnosus gg, lansoprazole, magaldrate, magnesium carbonate, magnesium hydroxide,
magnesium oxide, mefloquine, methotrexate, minocycline, mycophenolate mofetil, mycophenolic acid, nizatidine, omeprazole, oxytetracycline, pantoprazole, pemetrexed,
probenecid, quinapril, rabeprazole, ranitidine, ranitidine bismuth citrate, sarecycline,
sodium bicarbonate, sodium citrate, sodium iodide i-123, sodium iodide-i-131, tetracycline,
troleandomycin, typhoid vaccine, live, warfarin
Alerts
Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect
Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat
Feeling very tired or weak
Any unexplained bruising or bleeding
Fever or chills
Sore throat
Mouth irritation or mouth sores
Diarrhea is common with antibiotics. Rarely, a severe form called C diff–associated diarrhea (CDAD) may happen. Sometimes, this has led to a deadly bowel problem (colitis). CDAD may happen during or a few months after taking antibiotics. Call your doctor right away if you have stomach pain, cramps, or very loose, watery, or bloody stools. Check with your doctor before treating diarrhea
A very bad skin reaction (Stevens-Johnson syndrome/toxic epidermal necrolysis) may happen. It can cause very bad health problems that may not go away, and sometimes death. Get medical help right away if you have signs like red, swollen, blistered, or peeling skin (with or without fever); red or irritated eyes; or sores in your mouth, throat, nose, or eyes
Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat
Feeling very tired or weak
Any unexplained bruising or bleeding
Fever or chills
Sore throat
Mouth irritation or mouth sores
Diarrhea is common with antibiotics. Rarely, a severe form called C diff–associated diarrhea (CDAD) may happen. Sometimes, this has led to a deadly bowel problem (colitis). CDAD may happen during or a few months after taking antibiotics. Call your doctor right away if you have stomach pain, cramps, or very loose, watery, or bloody stools. Check with your doctor before treating diarrhea
A very bad skin reaction (Stevens-Johnson syndrome/toxic epidermal necrolysis) may happen. It can cause very bad health problems that may not go away, and sometimes death. Get medical help right away if you have signs like red, swollen, blistered, or peeling skin (with or without fever); red or irritated eyes; or sores in your mouth, throat, nose, or eyes
Points of recommendation
Tell your doctor about the allergy and what signs you had
If you have mono
If you have leukemia
If you are taking disulfiram
If you are breast-feeding or plan to breast-feed
Tell all of your health care providers that you take bacampicillin. This includes your doctors, nurses, pharmacists, and dentists
Very bad and sometimes deadly allergic side effects have rarely happened
This medicine may affect certain lab tests. Tell all of your health care providers and lab workers that you take bacampicillin
Have your blood work checked if you are on bacampicillin for a long time
Do not use longer than you have been told. A second infection may happen
Birth control pills and other hormone-based birth control may not work as well to prevent pregnancy. Use some other kind of birth control also like a condom when taking bacampicillin
Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using bacampicillin while you are pregnant
Take with or without food. Take with food if it causes an upset stomach
Take with a full glass of water
Do not take bacampicillin while lying down or right before bedtime. This helps to prevent irritation to the swallowing tube (esophagus
Keep using bacampicillin as you have been told by your doctor or other health care provider, even if you feel well
Store at room temperature
Store in a dry place. Do not store in a bathroom
If you have mono
If you have leukemia
If you are taking disulfiram
If you are breast-feeding or plan to breast-feed
Tell all of your health care providers that you take bacampicillin. This includes your doctors, nurses, pharmacists, and dentists
Very bad and sometimes deadly allergic side effects have rarely happened
This medicine may affect certain lab tests. Tell all of your health care providers and lab workers that you take bacampicillin
Have your blood work checked if you are on bacampicillin for a long time
Do not use longer than you have been told. A second infection may happen
Birth control pills and other hormone-based birth control may not work as well to prevent pregnancy. Use some other kind of birth control also like a condom when taking bacampicillin
Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using bacampicillin while you are pregnant
Take with or without food. Take with food if it causes an upset stomach
Take with a full glass of water
Do not take bacampicillin while lying down or right before bedtime. This helps to prevent irritation to the swallowing tube (esophagus
Keep using bacampicillin as you have been told by your doctor or other health care provider, even if you feel well
Store at room temperature
Store in a dry place. Do not store in a bathroom
Pregnancy level
BBacampicillin has been assigned to pregnancy category B by the FDA. Animal studies failed to reveal evidence of fetal harm. There are no controlled data in human pregnancy. Bacampicillin should only be given during pregnancy when need has been clearly established
Breast feeding warning
Bacampicillin is converted in vitro to ampicillin. Ampicillin is excreted into human milk in small amounts. Candidiasis and diarrhea have been reported in an infant exposed to ampicillin via breast milk; however, the cause was uncertain. The American Academy of Pediatrics considers some other penicillins (amoxicillin, ticarcillin) compatible with breast-feeding. The manufacturer recommends caution when administering ampicillin-class antibiotics to nursing women
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