Usage
This combination medication is prescribed for bacterial infections, especially those affecting the ear, nose, throat, skin, urinary tract, tonsillitis, bronchitis, and pneumonia. It is also used to treat sinusitis, diarrhea, bacterial vaginosis, and other bacterial infections.
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Pharmacological Classification: Antibiotic and Probiotic combination.
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Mechanism of Action: Ampicillin and Dicloxacillin are beta-lactam antibiotics that inhibit bacterial cell wall synthesis, leading to bacterial cell death. Lactobacillus is a probiotic that helps restore the balance of gut flora, which can be disrupted by antibiotic use.
Alternate Names
Ampicillin/Dicloxacillin/Lactobacillus (Regional variations may exist)
Brand Names: Ampilox-LB, Magnacillinxp, Novaclox.
How It Works
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Pharmacodynamics: Ampicillin and Dicloxacillin exert a bactericidal effect by binding to penicillin-binding proteins (PBPs) in the bacterial cell wall, inhibiting its synthesis and causing cell lysis. Lactobacillus helps maintain a healthy gut microbiome by competing with pathogenic bacteria and producing antimicrobial substances. This helps mitigate antibiotic-associated diarrhea.
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Pharmacokinetics: Ampicillin and Dicloxacillin are well-absorbed orally. Dicloxacillin is resistant to breakdown by bacterial enzymes (penicillinases). Both are primarily eliminated via renal excretion. Lactobacillus colonizes the gut.
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Mode of Action: Inhibition of bacterial cell wall synthesis by binding to PBPs, leading to cell lysis. Modulation of gut flora by Lactobacillus.
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Elimination Pathways: Renal excretion for Ampicillin and Dicloxacillin.
Dosage
Standard Dosage
Adults:
250 mg to 500 mg of Ampicillin + 250 mg to 500 mg of Dicloxacillin + Lactobacillus (containing a specified number of spores), every 6 hours. One source mentions a dose of one capsule every 6 hours for 10 days with a capsule strength of 250 mg ampicillin, 250 mg dicloxacillin, and 2.5 billion spores lactobacillus.
Children:
- <40 kg: 3.125 to 6.25 mg/kg of each antibiotic component every 6 hours.
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40 kg: Refer to the adult dosage.
- Lactobacillus dosing in children should be determined by a pediatrician.
Special Cases:
- Elderly Patients: Dosage adjustments may be necessary due to age-related decline in renal function.
- Patients with Renal Impairment: Dose reduction and/or increased dosing intervals are often required.
- Patients with Hepatic Dysfunction: Caution is advised, and dosage adjustments might be necessary.
- Patients with Comorbid Conditions: Individualized dosing should be considered based on specific comorbidities.
Clinical Use Cases
Dosage in clinical scenarios like intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations should be determined by a physician based on the specific circumstances.
Dosage Adjustments
Dose modifications may be required based on patient-specific factors such as renal/hepatic dysfunction, other metabolic disorders, or genetic polymorphisms affecting drug metabolism.
Side Effects
Common Side Effects
Nausea, vomiting, diarrhea, stomach pain, skin rash, itching, headache, dizziness, flatulence, allergic reactions.
Rare but Serious Side Effects
Severe diarrhea, anaphylactic reaction, Steven-Johnson syndrome, angioedema, seizures.
Long-Term Effects
Potential long-term effects of prolonged use are not well-documented but may include antibiotic resistance and disruption of the gut microbiome.
Adverse Drug Reactions (ADR)
Clinically significant ADRs include severe allergic reactions, Clostridium difficile infection, and antibiotic-associated colitis.
Contraindications
Penicillin or cephalosporin allergy, infectious mononucleosis, history of severe allergic reactions to antibiotics.
Drug Interactions
Allopurinol, anticoagulants (warfarin, dabigatran), oral contraceptives, methotrexate, probenecid, other antibiotics (chloramphenicol, macrolides, sulfonamides, tetracyclines). Avoid calcium-rich foods, grapefruit, and grapefruit juice.
Pregnancy and Breastfeeding
Use with caution if clearly needed. Consult a physician before use during pregnancy or breastfeeding.
Drug Profile Summary
- Mechanism of Action: Inhibition of bacterial cell wall synthesis and modulation of gut flora.
- Side Effects: Nausea, vomiting, diarrhea, rash, allergic reaction.
- Contraindications: Penicillin allergy, infectious mononucleosis.
- Drug Interactions: Allopurinol, anticoagulants, oral contraceptives, methotrexate.
- Pregnancy & Breastfeeding: Use with caution if clearly needed.
- Dosage: Varies by infection and patient; see detailed dosage section.
- Monitoring Parameters: Renal function, liver function, allergic reactions, CBC, stool consistency.
Popular Combinations
Generally not combined with other antibiotics.
Precautions
- General Precautions: Pre-screening for allergies, renal/hepatic function.
- Specific Populations: See Dosage - Special Cases and Pregnancy and Breastfeeding.
- Lifestyle Considerations: Limit alcohol intake.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ampicillin + Dicloxacillin + Lactobacillus?
A: See Dosage Section above for specifics. Dosing varies by patient, age, and infection.
Q2: What are the common side effects?
A: Nausea, vomiting, diarrhea, abdominal pain, rash, headache, dizziness are common side effects.
Q3: What are the serious side effects?
A: Severe allergic reactions (anaphylaxis, angioedema), Clostridium difficile infection, antibiotic-associated colitis.
Q4: Is it safe to use during pregnancy or breastfeeding?
A: Use with caution if the benefits clearly outweigh the risks. Consult a physician before use.
Q5: What are the contraindications?
A: Known allergy to penicillins or cephalosporins.
Q6: Are there any drug interactions?
A: Yes, see Drug Interactions section.
Q7: What should patients avoid while taking this medication?
A: Alcohol, calcium-rich foods, grapefruit and grapefruit juice.
Q8: What are the monitoring parameters?
A: Renal function, liver function, signs of allergic reaction, complete blood count (CBC), and stool consistency should be monitored.
Q9: How does Lactobacillus help in this combination?
A: It helps prevent antibiotic-associated diarrhea by maintaining a healthy gut flora.
