Usage
Ampicillin + Cloxacillin + Lactobacillus is a combination medication primarily prescribed for the treatment of bacterial infections. It combines two beta-lactam antibiotics (ampicillin and cloxacillin) with the probiotic Lactobacillus. This combination is effective against a broad spectrum of gram-positive and gram-negative bacteria, including those producing penicillinase, an enzyme that can inactivate some penicillins. Lactobacillus is included to help maintain gut flora balance and mitigate antibiotic-associated diarrhea.
Pharmacological Classification: Antibiotic, Probiotic
Mechanism of Action: Ampicillin and cloxacillin inhibit bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs). This disrupts the cross-linking of peptidoglycans, leading to bacterial cell death. Lactobacillus helps restore the gut microbial balance that can be disrupted by antibiotics.
Alternate Names
This combination medication is often referred to by brand names specific to different manufacturers. There isn’t a universally recognized international nonproprietary name (INN) for this specific combination. However, some regional variations in brand names may exist. Some brand names include Ampoxin LB and Closap B.
How It Works
Pharmacodynamics: Ampicillin and cloxacillin exert bactericidal effects by disrupting bacterial cell wall synthesis. Lactobacillus promotes a healthy gut microbiome, aiding digestion and potentially boosting immune function.
Pharmacokinetics:
- Ampicillin and Cloxacillin: These antibiotics are well-absorbed orally. They are primarily excreted renally, with a small proportion metabolized in the liver.
- Lactobacillus: This probiotic colonizes the gastrointestinal tract. Its specific pharmacokinetic parameters are not routinely measured.
Mode of Action: Both ampicillin and cloxacillin bind to PBPs on the bacterial cell membrane, inhibiting transpeptidation and disrupting peptidoglycan synthesis, an essential component of the bacterial cell wall. This ultimately leads to cell lysis and bacterial death.
Elimination Pathways: Ampicillin and cloxacillin are primarily eliminated via renal excretion, with a smaller portion metabolized in the liver.
Dosage
Dosage guidelines for this combination are not standardized and vary depending on factors such as the severity and type of infection, patient age, weight, and renal function. The following represents general recommendations; always consult a specialist for patient-specific dosing.
Standard Dosage
Adults:
The typical adult dose ranges from 250 mg to 1 gram every 4-6 hours. Dosages up to 2 grams every 4-6 hours may be used for severe infections. The exact dose will depend on the specific formulation used.
Children:
Pediatric dosing is generally based on weight, usually ranging from 25 to 100 mg/kg/day divided into multiple doses. Consult specialized resources or a pediatrician for precise weight-based dosing in children.
Special Cases:
- Elderly Patients: Dosage adjustments may be needed based on renal function.
- Patients with Renal Impairment: Dose reductions are often required based on creatinine clearance.
- Patients with Hepatic Dysfunction: Caution is advised, and dosage adjustments may be necessary.
- Patients with Comorbid Conditions: Dosage adjustments may be required depending on the specific comorbidity.
Clinical Use Cases
Specific dosage recommendations for this combination in these clinical settings are not explicitly defined in available resources. Consultation with a specialist is crucial for determining appropriate dosages in these situations.
- Intubation: Not specifically indicated.
- Surgical Procedures: Not specifically indicated for surgical prophylaxis.
- Mechanical Ventilation: Not specifically indicated.
- Intensive Care Unit (ICU) Use: Not specifically indicated.
- Emergency Situations: Not typically used.
Dosage Adjustments
Dose modifications should be considered based on renal or hepatic impairment, and other individual factors. Consult a specialist for case-specific guidance.
Side Effects
Common Side Effects:
- Nausea
- Vomiting
- Diarrhea
- Stomach pain/bloating
- Skin rash or itching
- Headache
Rare but Serious Side Effects:
- Clostridium difficile-associated diarrhea (CDAD)
- Allergic reactions (including anaphylaxis)
- Cholestatic jaundice
- Hepatitis
- Stevens-Johnson syndrome
Long-Term Effects:
Chronic complications from prolonged use are rare but may include antibiotic resistance and disruption of gut microbiota.
Adverse Drug Reactions (ADR):
Clinically significant ADRs necessitating immediate intervention include anaphylaxis, severe skin reactions, and CDAD.
Contraindications
- Hypersensitivity to penicillins, cephalosporins, or any component of the formulation.
- History of cholestatic jaundice or hepatic dysfunction associated with penicillin use.
Drug Interactions
- Allopurinol: May increase the risk of skin reactions.
- Anticoagulants (e.g., warfarin): Effects may be enhanced by ampicillin.
- Oral contraceptives: Efficacy may be reduced.
- Methotrexate: Serum levels may be increased.
- Other antibiotics (e.g., tetracyclines): May reduce the effectiveness of ampicillin and cloxacillin.
Pregnancy and Breastfeeding
While considered generally safe during pregnancy and breastfeeding, caution is advised. Consult a specialist before prescribing or using this combination during these periods. Ampicillin is excreted in breast milk at low levels.
Drug Profile Summary
- Mechanism of Action: Inhibits bacterial cell wall synthesis; Lactobacillus supports gut health.
- Side Effects: Nausea, vomiting, diarrhea, rash, allergic reactions.
- Contraindications: Penicillin or cephalosporin allergy, history of cholestatic jaundice.
- Drug Interactions: Allopurinol, anticoagulants, oral contraceptives, methotrexate.
- Pregnancy & Breastfeeding: Generally safe, consult a specialist.
- Dosage: Varies depending on the infection and patient factors; consult a specialist.
- Monitoring Parameters: Observe for signs of infection resolution, adverse effects, and superinfections.
Popular Combinations
This combination itself is a common formulation. No additional drugs are commonly combined.
Precautions
- Assess for allergies to penicillins and cephalosporins.
- Evaluate renal and hepatic function.
- Monitor for superinfections (e.g., C. difficile).
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ampicillin + Cloxacillin + Lactobacillus?
A: Dosage is individualized based on the infection type and severity, patient age, weight, and renal function. Consult a specialist for specific recommendations.
Q2: What are the common side effects?
A: Common side effects include nausea, vomiting, diarrhea, abdominal pain, and skin rash.
Q3: What are the contraindications?
A: Known allergy to penicillins, cephalosporins, or any component of the formulation, as well as a history of cholestatic jaundice or hepatic dysfunction related to penicillin use, are contraindications.
Q4: Can this combination be used during pregnancy?
A: While generally considered safe, consult a specialist before prescribing in pregnant patients.
Q5: Does this combination interact with other medications?
A: Yes, it can interact with medications like allopurinol, anticoagulants, oral contraceptives, and other antibiotics.
Q6: How is this medication administered?
A: This combination is typically administered orally (capsules, suspension).
Q7: What is the role of Lactobacillus in this combination?
A: Lactobacillus is included to help maintain gut flora and reduce the risk of antibiotic-associated diarrhea.
Q8: What should patients be monitored for during treatment?
A: Monitor patients for clinical response to therapy, resolution of infection, and potential side effects, including allergic reactions and superinfections.
Q9: Are there any dietary restrictions while taking this medication?
A: No specific dietary restrictions are typically necessary, but taking it with food may minimize gastrointestinal upset.
