DRUGS & SUPPLEMENTS
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Ansullina is indicated for the treatment of infections due to susceptible strains of the designated microorganisms in the conditions listed below.
Skin and Skin Structure Infections caused by beta-lactamase producing strains of Staphylococcus aureus, Escherichia coli,
NOTE: For information on use in pediatric patients see PRECAUTIONS–Pediatric Use and CLINICAL STUDIES sections.
Intra-Abdominal Infections caused by beta-lactamase producing strains of Escherichia coli, Klebsiella spp. (including K. pneumoniae
Gynecological Infections caused by beta-lactamase producing strains of Escherichia coli,
While Ansullina is indicated only for the conditions listed above, infections caused by ampicillin-susceptible organisms are also amenable to treatment with Ansullina due to its ampicillin content. Therefore, mixed infections caused by ampicillin-susceptible organisms and beta-lactamase producing organisms susceptible to Ansullina should not require the addition of another antibacterial.
Appropriate culture and susceptibility tests should be performed before treatment in order to isolate and identify the organisms causing infection and to determine their susceptibility to Ansullina.
Therapy may be instituted prior to obtaining the results from bacteriological and susceptibility studies when there is reason to believe the infection may involve any of the beta-lactamase producing organisms listed above in the indicated organ systems. Once the results are known, therapy should be adjusted if appropriate.
To reduce the development of drug-resistant bacteria and maintain effectiveness of Ansullina and other antibacterial drugs, Ansullina should be used only to treat infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
The use of Ansullina is contraindicated in individuals with a history of serious hypersensitivity reactions (e.g., anaphylaxis or Stevens-Johnson syndrome) to ampicillin, sulbactam or to other beta-lactam antibacterial drugs (e.g., penicillins and cephalosporins).
Ansullina is contraindicated in patients with a previous history of cholestatic jaundice/hepatic dysfunction associated with Ansullina.
Serious and occasionally fatal hypersensitivity reactions have been reported in patients on penicillin therapy. These reactions are more apt to occur in individuals with a history of penicillin hypersensitivity and/or hypersensitivity reactions to multiple allergens. There have been reports of individuals with a history of penicillin hypersensitivity who have experienced severe reactions when treated with cephalosporins. Before therapy with a penicillin, careful inquiry should be made concerning previous hypersensitivity reactions to penicillins, cephalosporins, and other allergens. If an allergic reaction occurs, Ansullina should be discontinued and the appropriate therapy instituted.
Hepatic dysfunction, including hepatitis and cholestatic jaundice has been associated with the use of Ansullina. Hepatic toxicity is usually reversible; however, deaths have been reported. Hepatic function should be monitored at regular intervals in patients with hepatic impairment.
Ansullina may cause severe skin reactions, such as toxic epidermal necrolysis, Stevens-Johnson syndrome (SJS), dermatitis exfoliative, erythema multiforme, and acute generalized exanthematous pustulosis (AGEP). If patients develop a skin rash they should be monitored closely and Ansullina discontinued if lesions progress. (see CONTRAINDICATIONS and ADVERSE REACTIONS sections).
Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including Ansullina, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.
C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibacterial drug use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.
If CDAD is suspected or confirmed, ongoing antibacterial drug use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated.
A high percentage of patients with mononucleosis who receive ampicillin develop a skin rash. Thus, ampicillin class antibacterial should not be administered to patients with mononucleosis. In patients treated with Ansullina the possibility of superinfections with mycotic or bacterial pathogens should be kept in mind during therapy. If superinfections occur, the drug should be discontinued and/or appropriate therapy instituted.
Prescribing Ansullina in the absence of proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.
Patients should be counseled that antibacterial drugs including Ansullina should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When Ansullina is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by Ansullina or other antibacterial drugs in the future.
Diarrhea is a common problem caused by antibacterial which usually ends when the antibacterial is discontinued. Sometimes after starting treatment with antibacterial, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as two or more months after having taken the last dose of the antibacterial. If this occurs, patients should contact their physician as soon as possible.
Probenecid decreases the renal tubular secretion of ampicillin and sulbactam. Concurrent use of probenecid with Ansullina may result in increased and prolonged blood levels of ampicillin and sulbactam. The concurrent administration of allopurinol and ampicillin increases substantially the incidence of rashes in patients receiving both drugs as compared to patients receiving ampicillin alone. It is not known whether this potentiation of ampicillin rashes is due to allopurinol or the hyperuricemia present in these patients. There are no data with Ansullina and allopurinol administered concurrently. Ansullina and aminoglycosides should not be reconstituted together due to the in vitro inactivation of aminoglycosides by the ampicillin component of Ansullina.
Administration of Ansullina will result in high urine concentration of ampicillin. High urine concentrations of ampicillin may result in false positive reactions when testing for the presence of glucose in urine using Clinitest, Benedict's Solution or Fehling's Solution. It is recommended that glucose tests based on enzymatic glucose oxidase reactions be used. Following administration of ampicillin to pregnant women, a transient decrease in plasma concentration of total conjugated estriol, estriol-glucuronide, conjugated estrone and estradiol has been noted. This effect may also occur with Ansullina.
Long-term studies in animals have not been performed to evaluate carcinogenic or mutagenic potential.
Reproduction studies have been performed in mice, rats, and rabbits at doses up to ten times the human dose and have revealed no evidence of impaired fertility or harm to the fetus due to Ansullina. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. (see – PRECAUTIONS-Drug/Laboratory Test Interactions section).
Studies in guinea pigs have shown that intravenous administration of ampicillin decreased the uterine tone, frequency of contractions, height of contractions, and duration of contractions. However, it is not known whether the use of Ansullina in humans during labor or delivery has immediate or delayed adverse effects on the fetus, prolongs the duration of labor, or increases the likelihood that forceps delivery or other obstetrical intervention or resuscitation of the newborn will be necessary.
Low concentrations of ampicillin and sulbactam are excreted in the milk; therefore, caution should be exercised when Ansullina is administered to a nursing woman.
The safety and effectiveness of Ansullina have been established for pediatric patients one year of age and older for skin and skin structure infections as approved in adults. Use of Ansullina in pediatric patients is supported by evidence from adequate and well-controlled studies in adults with additional data from pediatric pharmacokinetic studies, a controlled clinical trial conducted in pediatric patients and post-marketing adverse events surveillance. (see CLINICAL PHARMACOLOGY, INDICATIONS AND USAGE, ADVERSE REACTIONS, DOSAGE AND ADMINISTRATION, and CLINICAL STUDIES sections).
The safety and effectiveness of Ansullina have not been established for pediatric patients for intra-abdominal infections.
Ansullina is generally well tolerated. The following adverse reactions have been reported in clinical trials.
Pain at IM injection site – 16%
Pain at IV injection site – 3%
Thrombophlebitis – 3%
Phlebitis – 1.2%
The most frequently reported adverse reactions were diarrhea in 3% of the patients and rash in less than 2% of the patients.
Additional systemic reactions reported in less than 1% of the patients were: itching, nausea, vomiting, candidiasis, fatigue, malaise, headache, chest pain, flatulence, abdominal distension, glossitis, urine retention, dysuria, edema, facial swelling, erythema, chills, tightness in throat, substernal pain, epistaxis and mucosal bleeding.
Available safety data for pediatric patients treated with Ansullina demonstrate a similar adverse events profile to those observed in adult patients. Additionally, atypical lymphocytosis has been observed in one pediatric patient receiving Ansullina.
Adverse laboratory changes without regard to drug relationship that were reported during clinical trials were:
Hepatic: Increased AST, ALT (SGPT), alkaline phosphatase, and LDH.
Hematologic: Decreased hemoglobin, hematocrit, RBC, WBC, neutrophils, lymphocytes, platelets and increased lymphocytes, monocytes, basophils, eosinophils, and platelets.
Blood Chemistry: Decreased serum albumin and total proteins.
Renal: Increased BUN and creatinine.
Urinalysis: Presence of RBC's and hyaline casts in urine.
In addition to adverse reactions reported from clinical trials, the following have been identified during post-marketing use of Ansullina or other products containing ampicillin. Because they are reported voluntarily from a population of unknown size, estimates of frequency cannot be made. These events have been chosen for inclusion due to a combination of their seriousness, frequency, or potential causal connection to Ansullina.
Blood and Lymphatic System Disorders: Hemolytic anemia, thrombocytopenic purpura, and agranulocytosis have been reported. These reactions are usually reversible on discontinuation of therapy and are believed to be hypersensitivity phenomena. Some individuals have developed positive direct Coombs Tests during treatment with Ansullina, as with other beta-lactam antibacterials.
Gastrointestinal Disorders: Cholestatic hepatitis, cholestasis, hyperbilirubinemia, jaundice, abnormal hepatic function, gastritis, stomatitis, black "hairy" tongue and Clostridium difficile associated diarrhea (see CONTRAINDICATIONS and WARNINGS sections).
General Disorders and Administration Site Conditions: Injection site reaction
Immune System Disorders: Serious and fatal hypersensitivity (anaphylactic) reactions (See WARNINGS section).
Nervous System Disorders: Convulsion
Renal and Urinary Disorders: Tubulointerstitial nephritis
Skin and Subcutaneous Tissue Disorders: Toxic epidermal necrolysis, Stevens-Johnson syndrome, and acute generalized exanthematous pustulosis (AGEP), urticaria, erythema multiforme, and exfoliative dermatitis (see CONTRAINDICATIONS and WARNINGS sections).
Neurological adverse reactions, including convulsions, may occur with the attainment of high CSF levels of beta-lactams. Ampicillin may be removed from circulation by hemodialysis. The molecular weight, degree of protein binding and pharmacokinetics profile of sulbactam suggest that this compound may also be removed by hemodialysis.
Data from a controlled clinical trial conducted in pediatric patients provided evidence supporting the safety and efficacy of Ansullina for the treatment of skin and skin structure infections. Of 99 pediatric patients evaluable for clinical efficacy, 60 patients received a regimen containing intravenous Ansullina, and 39 patients received a regimen containing intravenous cefuroxime. This trial demonstrated similar outcomes (assessed at an appropriate interval after discontinuation of all antimicrobial therapy) for UNASYN- and cefuroxime-treated patients:
|Therapeutic Regimen||Clinical Success||Clinical Failure|
|Ansullina||51/60 (85%)||9/60 (15%)|
|Cefuroxime||34/39 (87%)||5/39 (13%)|
Most patients received a course of oral antimicrobials following initial treatment with intravenous administration of parenteral antimicrobials. The study protocol required that the following three criteria be met prior to transition from intravenous to oral antimicrobial therapy: (1) receipt of a minimum of 72 hours of intravenous therapy; (2) no documented fever for prior 24 hours; and (3) improvement or resolution of the signs and symptoms of infection.
The choice of oral antimicrobial agent used in this trial was determined by susceptibility testing of the original pathogen, if isolated, to oral agents available. The course of oral antimicrobial therapy should not routinely exceed 14 days.
Ansullina may be administered by either the IV or the IM routes.
For IV administration, the dose can be given by slow intravenous injection over at least 10–15 minutes or can also be delivered in greater dilutions with 50–100 mL of a compatible diluent as an intravenous infusion over 15–30 minutes.
Ansullina may be administered by deep intramuscular injection..
The recommended adult dosage of Ansullina is 1.5 g (1 g ampicillin as the sodium salt plus 0.5 g sulbactam as the sodium salt) to 3 g (2 g ampicillin as the sodium salt plus 1 g sulbactam as the sodium salt) every six hours. This 1.5 to 3 g range represents the total of ampicillin content plus the sulbactam content of Ansullina, and corresponds to a range of 1 g ampicillin/0.5 g sulbactam to 2 g ampicillin/1 g sulbactam. The total dose of sulbactam should not exceed 4 grams per day.
The recommended daily dose of Ansullina in pediatric patients is 300 mg per kg of body weight administered via intravenous infusion in equally divided doses every 6 hours. This 300 mg/kg/day dosage represents the total ampicillin content plus the sulbactam content of Ansullina, and corresponds to 200 mg ampicillin/100 mg sulbactam per kg per day. The safety and efficacy of Ansullina administered via intramuscular injection in pediatric patients have not been established. Pediatric patients weighing 40 kg or more should be dosed according to adult recommendations, and the total dose of sulbactam should not exceed 4 grams per day. The course of intravenous therapy should not routinely exceed 14 days. In clinical trials, most children received a course of oral antimicrobials following initial treatment with intravenous Ansullina. (see CLINICAL STUDIES section).
In patients with impairment of renal function the elimination kinetics of ampicillin and sulbactam are similarly affected, hence the ratio of one to the other will remain constant whatever the renal function. The dose of Ansullina in such patients should be administered less frequently in accordance with the usual practice for ampicillin and according to the following recommendations:
|Creatinine Clearance |
|Ampicillin/Sulbactam Half-Life (Hours)||Recommended Ansullina Dosage|
|≥30||1||1.5–3 g q 6h–q 8h|
|15–29||5||1.5–3 g q 12h|
|5–14||9||1.5–3 g q 24h|
When only serum creatinine is available, the following formula (based on sex, weight, and age of the patient) may be used to convert this value into creatinine clearance. The serum creatinine should represent a steady state of renal function.
|Males|| weight (kg) × (140 − age) |
72 × serum creatinine
|Females||0.85 × above value|
Ansullina sterile powder is to be stored at or below 30°C (86°F) prior to reconstitution.
When concomitant therapy with aminoglycosides is indicated, Ansullina and aminoglycosides should be reconstituted and administered separately, due to the in vitro inactivation of aminoglycosides by any of the aminopenicillins.
Ansullina sterile powder for intravenous and intramuscular use may be reconstituted with any of the compatible diluents described in this insert. Solutions should be allowed to stand after dissolution to allow any foaming to dissipate in order to permit visual inspection for complete solubilization.
Ansullina sterile powder in piggyback units may be reconstituted directly to the desired concentrations using any of the following parenteral diluents. Reconstitution of Ansullina, at the specified concentrations, with these diluents provide stable solutions for the time periods indicated in the following table:.
|Diluent||Maximum Concentration |
|Sterile Water for Injection||45 (30/15)||8 hrs at 25°C|
|45 (30/15)||48 hrs at 4°C|
|30 (20/10)||72 hrs at 4°C|
|0.9% Sodium Chloride Injection||45 (30/15)||8 hrs at 25°C|
|45 (30/15)||48 hrs at 4°C|
|30 (20/10)||72 hrs at 4°C|
|5% Dextrose Injection||30 (20/10)||2 hrs at 25°C|
|30 (20/10)||4 hrs at 4°C|
|3 (2/1)||4 hrs at 25°C|
|Lactated Ringer's Injection||45 (30/15)||8 hrs at 25°C|
|45 (30/15)||24 hrs at 4°C|
|M/6 Sodium Lactate Injection||45 (30/15)||8 hrs at 25°C|
|45 (30/15)||8 hrs at 4°C|
|5% Dextrose in 0.45% Saline||3 (2/1)||4 hrs at 25°C|
|15 (10/5)||4 hrs at 4°C|
|10% Invert Sugar||3 (2/1)||4 hrs at 25°C|
|30 (20/10)||3 hrs at 4°C|
If piggyback bottles are unavailable, standard vials of Ansullina sterile powder may be used. Initially, the vials may be reconstituted with Sterile Water for Injection to yield solutions containing 375 mg Ansullina per mL (250 mg ampicillin/125 mg sulbactam per mL). An appropriate volume should then be immediately diluted with a suitable parenteral diluent to yield solutions containing 3 to 45 mg Ansullina per mL (2 to 30 mg ampicillin/1 to 15 mg sulbactam/per mL).
Ansullina in the ADD-Vantage® system is intended as a single dose for intravenous administration after dilution with the ADD-Vantage® Flexible Diluent Container containing 50 mL, 100 mL or 250 mL of 0.9% Sodium Chloride Injection, USP.
Ansullina in the ADD-Vantage® system is intended as a single dose for intravenous administration after dilution with the ADD-Vantage® Flexible Diluent Container containing 100 mL or 250 mL of 0.9% Sodium Chloride Injection, USP.
Ansullina in the ADD-Vantage® system is to be reconstituted with 0.9% Sodium Chloride Injection, USP only. See INSTRUCTIONS FOR USE OF THE ADD-Vantage® VIAL section. Reconstitution of Ansullina, at the specified concentration, with 0.9% Sodium Chloride Injection, USP provides stable solutions for the time period indicated below:
|Diluent||Maximum Concentration |
|0.9% Sodium Chloride Injection (USP)||30 (20/10)||8 hrs at 25°C|
The final diluted solution of Ansullina should be completely administered within 8 hours in order to assure proper potency.
Vials for intramuscular use may be reconstituted with Sterile Water for Injection USP, 0.5% Lidocaine Hydrochloride Injection USP or 2% Lidocaine Hydrochloride Injection USP. Consult the following table for recommended volumes to be added to obtain solutions containing 375 mg Ansullina per mL. Note: Use only freshly prepared solutions and administer within one hour after preparation.
|Ansullina Vial Size||Volume of Diluent to be Added||Withdrawal Volume |
|1.5 g||3.2 mL||4.0 mL|
|3.0 g||6.4 mL||8.0 mL|
While reversible glycogenosis was observed in laboratory animals, this phenomenon was dose- and time-dependent and is not expected to develop at the therapeutic doses and corresponding plasma levels attained during the relatively short periods of combined ampicillin/sulbactam therapy in man.
Ansullina (ampicillin sodium/sulbactam sodium) is supplied as a sterile off-white dry powder in glass vials and piggyback bottles. The following packages are available:
Vials containing 1.5 g (NDC 0049-0013-83) equivalent of Ansullina (1 g ampicillin as the sodium salt plus 0.5 g sulbactam as the sodium salt)
Vials containing 3 g (NDC 0049-0014-83) equivalent of Ansullina (2 g ampicillin as the sodium salt plus 1 g sulbactam as the sodium salt)
Bottles containing 1.5 g (NDC 0049-0022-83) equivalent of Ansullina (1 g ampicillin as the sodium salt plus 0.5 g sulbactam as the sodium salt)
Bottles containing 3 g (NDC 0049-0023-83) equivalent of Ansullina (2 g ampicillin as the sodium salt plus 1 g sulbactam as the sodium salt)
Pharmacy Bulk Package containing 15 g (NDC 0049-0024-28) equivalent of Ansullina (10 g ampicillin as the sodium salt plus 5 g sulbactam as the sodium salt)
ADD-Vantage® vials containing 1.5 g (NDC 0049-0031-83) equivalent of Ansullina (1 g ampicillin as the sodium salt plus 0.5 g sulbactam as the sodium salt) are distributed by Pfizer Inc.
ADD-Vantage® vials containing 3 g (NDC 0049-0032-83) equivalent of Ansullina (2 g ampicillin as the sodium salt plus 1 g sulbactam as the sodium salt) are distributed by Pfizer Inc.
The 1.5 g Ansullina ADD-Vantage® vials are only to be used with Abbott Laboratories' ADD-Vantage® Flexible Diluent Container containing 0.9% Sodium Chloride Injection, USP, 50 mL, 100 mL, or 250 mL sizes.
The 3 g Ansullina ADD-Vantage® vials are only to be used with Abbott Laboratories' ADD-Vantage® Flexible Diluent Container containing 0.9% Sodium Chloride Injection, USP, 100 mL or 250 mL sizes.
To Open Diluent Container: Peel overwrap from the corner and remove container. Some opacity of the plastic due to moisture absorption during the sterilization process may be observed. This is normal and does not affect the solution quality or safety. The opacity will diminish gradually.
To Assemble Vial and Flexible Diluent Container: (Use Aseptic Technique)
1. Remove the protective covers from the top of the vial and the vial port on the diluent container as follows:
a. To remove the breakaway vial cap, swing the pull ring over the top of the vial and pull down far enough to start the opening, pull the ring approximately half way around the cap and then pull straight up to remove the cap.
Note: Do not access vial with syringe.
|Figure 1||Figure 2|
b. To remove the vial port cover, grasp the tab on the pull ring, pull up to break the three tie strings, then pull back to remove the cover..
2. Screw the vial into the vial port until it will go no further. THE VIAL MUST BE SCREWED IN TIGHTLY TO ASSURE A SEAL. This occurs approximately 1/2 turn (180°) after the first audible click.. The clicking sound does not assure a seal; the vial must be turned as far as it will go.
Note: Once vial is sealed, do not attempt to remove..
3. Recheck the vial to assure that it is tight by trying to turn it further in the direction of assembly.
4. Label appropriately.
|Figure 3||Figure 4|
To Prepare Admixture
1. Squeeze the bottom of the diluent container gently to inflate the portion of the container surrounding the end of the drug vial.
2. With the other hand, push the drug vial down into the container telescoping the walls of the container. Grasp the inner cap of the vial through the walls of the container..
3. Pull the inner cap from the drug vial.. Verify that the rubber stopper has been pulled out, allowing the drug and diluent to mix.
4. Mix container contents thoroughly and use within the specified time.
|Figure 5||Figure 6|
To report SUSPECTED ADVERSE EVENTS, contact Pfizer Inc. at 1-800-438-1985 or FDA at 1-800-FDA-1088 or http://www.fda.gov/ for voluntary reporting of adverse reactions.
This product's label may have been updated. For current full prescribing information, please visit www.pfizer.com.
(ampicillin sodium/sulbactam sodium)
For IM or IV use
Division of Pfizer Inc, NY, NY 10017
1.5 g* per vial
For Intramuscular or
Depending on the reaction of the Ansullina after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Ansullina not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.Is Ansullina addictive or habit forming?
Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.
Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.
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The information was verified by Dr. Rachana Salvi, MD Pharmacology