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Drug overview for AMPICILLIN-SULBACTAM (ampicillin sodium/sulbactam sodium):
Generic name: AMPICILLIN SODIUM/SULBACTAM SODIUM (AM-pi-SIL-in/sul-BAK-tam)
Drug class: Beta-Lactams
Therapeutic class: Anti-Infective Agents
Ampicillin sodium and sulbactam sodium (ampicillin/sulbactam) is a fixed combination of the sodium salts of ampicillin (an aminopenicillin antibiotic) and sulbactam (a beta-lactam beta-lactamase inhibitor); sulbactam synergistically expands ampicillin's spectrum of activity against many strains of beta-lactamase-producing bacteria.
The fixed combination of ampicillin sodium and sulbactam sodium (ampicillin/sulbactam) is used parenterally for the treatment of skin and skin structure, intra-abdominal, and gynecologic infections caused by susceptible bacteria. The drug also has been used parenterally for the treatment of some other infections, including respiratory tract infections+ caused by susceptible bacteria. Ampicillin/sulbactam is used principally for the treatment of infections caused by, or suspected of being caused by, susceptible beta-lactamase-producing strains of staphylococci, Enterobacteriaceae, and/or Bacteroides.
Although ampicillin/sulbactam also may be effective in the treatment of infections caused by non-beta-lactamase-producing bacteria susceptible to ampicillin alone, most clinicians state that an aminopenicillin used alone is preferred to the fixed combination drug for the treatment of these infections and that ampicillin/sulbactam should be reserved for use in the treatment of infections caused by, or suspected of being caused by, beta-lactamase-producing bacteria when an aminopenicillin alone would be ineffective. Ampicillin/sulbactam may be particularly useful for empiric treatment of intra-abdominal or gynecologic infections likely to involve anaerobes (e.g., mixed aerobic-anaerobic infections) or for infections suspected of being caused by both ampicillin-resistant and ampicillin-susceptible bacteria. For most other infections caused by susceptible organisms, including Staphylococcus aureus or S.
epidermidis+, Bacteroides, Klebsiella pneumoniae, Escherichia coli, Proteus vulgaris+, Providencia rettgeri+, Morganella morganii+, Eikenella corrodens, or Pasteurella multocida+, ampicillin/sulbactam generally is considered an alternative to other anti-infectives. When used for the treatment of infections caused by Enterobacteriaceae in severely ill patients, some clinicians recommend combined therapy with ampicillin/sulbactam and an aminoglycoside. Because ampicillin/sulbactam is not active against Pseudomonas, the drug should not be used alone in infections known or suspected of being caused by Ps.
aeruginosa. Prior to initiation of therapy with ampicillin/sulbactam, appropriate specimens should be obtained for identification of the causative organism(s) and in vitro susceptibility tests. Ampicillin/sulbactam may be started pending results of susceptibility tests if the infection is believed to be caused by beta-lactamase-producing bacteria susceptible to the drug, but should be discontinued and other appropriate anti-infective therapy substituted if the organism is found to be resistant to the drug. If the infection is found to be caused by non-beta-lactamase-producing organisms susceptible to ampicillin, some clinicians suggest that therapy should be changed to an aminopenicillin alone, unless this is impractical.
Generic name: AMPICILLIN SODIUM/SULBACTAM SODIUM (AM-pi-SIL-in/sul-BAK-tam)
Drug class: Beta-Lactams
Therapeutic class: Anti-Infective Agents
Ampicillin sodium and sulbactam sodium (ampicillin/sulbactam) is a fixed combination of the sodium salts of ampicillin (an aminopenicillin antibiotic) and sulbactam (a beta-lactam beta-lactamase inhibitor); sulbactam synergistically expands ampicillin's spectrum of activity against many strains of beta-lactamase-producing bacteria.
The fixed combination of ampicillin sodium and sulbactam sodium (ampicillin/sulbactam) is used parenterally for the treatment of skin and skin structure, intra-abdominal, and gynecologic infections caused by susceptible bacteria. The drug also has been used parenterally for the treatment of some other infections, including respiratory tract infections+ caused by susceptible bacteria. Ampicillin/sulbactam is used principally for the treatment of infections caused by, or suspected of being caused by, susceptible beta-lactamase-producing strains of staphylococci, Enterobacteriaceae, and/or Bacteroides.
Although ampicillin/sulbactam also may be effective in the treatment of infections caused by non-beta-lactamase-producing bacteria susceptible to ampicillin alone, most clinicians state that an aminopenicillin used alone is preferred to the fixed combination drug for the treatment of these infections and that ampicillin/sulbactam should be reserved for use in the treatment of infections caused by, or suspected of being caused by, beta-lactamase-producing bacteria when an aminopenicillin alone would be ineffective. Ampicillin/sulbactam may be particularly useful for empiric treatment of intra-abdominal or gynecologic infections likely to involve anaerobes (e.g., mixed aerobic-anaerobic infections) or for infections suspected of being caused by both ampicillin-resistant and ampicillin-susceptible bacteria. For most other infections caused by susceptible organisms, including Staphylococcus aureus or S.
epidermidis+, Bacteroides, Klebsiella pneumoniae, Escherichia coli, Proteus vulgaris+, Providencia rettgeri+, Morganella morganii+, Eikenella corrodens, or Pasteurella multocida+, ampicillin/sulbactam generally is considered an alternative to other anti-infectives. When used for the treatment of infections caused by Enterobacteriaceae in severely ill patients, some clinicians recommend combined therapy with ampicillin/sulbactam and an aminoglycoside. Because ampicillin/sulbactam is not active against Pseudomonas, the drug should not be used alone in infections known or suspected of being caused by Ps.
aeruginosa. Prior to initiation of therapy with ampicillin/sulbactam, appropriate specimens should be obtained for identification of the causative organism(s) and in vitro susceptibility tests. Ampicillin/sulbactam may be started pending results of susceptibility tests if the infection is believed to be caused by beta-lactamase-producing bacteria susceptible to the drug, but should be discontinued and other appropriate anti-infective therapy substituted if the organism is found to be resistant to the drug. If the infection is found to be caused by non-beta-lactamase-producing organisms susceptible to ampicillin, some clinicians suggest that therapy should be changed to an aminopenicillin alone, unless this is impractical.
DRUG IMAGES
AMPICILLIN-SULBACTAM 15 GM VL
AMPICILLIN-SULBACTAM 3 GM VIAL
AMPICILLIN-SULBACTAM 1.5 GM VL
The following indications for AMPICILLIN-SULBACTAM (ampicillin sodium/sulbactam sodium) have been approved by the FDA:
Indications:
Bacteroides gynecological infections
Bacteroides peritonitis
Biliary tract infection
E. coli gynecological infections
E. coli peritonitis
Enterobacter peritonitis
Female genital tract infection
Infectious disease of abdomen
Inflammatory disease of female pelvic organs
Intra-abdominal E. coli abscess
Klebsiella pneumoniae peritonitis
Skin and skin structure Acinetobacter infection
Skin and skin structure Bacteroides fragilis infection
Skin and skin structure E. coli infection
Skin and skin structure Enterobacter infection
Skin and skin structure infection
Skin and skin structure Klebsiella infection
Skin and skin structure Proteus infection
Staphylococcus aureus skin and skin structure infection
Professional Synonyms:
Abdominal abscess due to Escherichia coli
Bacteroides species gynecologic infection
E. coli gynecologic infection
Gynecologic infection due to Bacteroides species
Gynecologic infection due to E. coli
Gynecologic infection due to Escherichia coli
Gynecologic infection
Infection of skin and/or subcutaneous tissue
Infective cholangitis
Intra-abdominal abscess due to E. coli
Intra-abdominal infection
Peritonitis due to Aerobacter
Peritonitis due to Bacteroides
Peritonitis due to Enterobacter
Peritonitis due to Escherichia coli
Peritonitis due to Klebsiella pneumoniae
Skin and skin soft tissue Acinetobacter infection
Skin and skin soft tissue Bacteroides fragilis infection
Skin and skin soft tissue Enterobacter infection
Skin and skin soft tissue Escherichia coli infection
Skin and skin soft tissue infection due to Acinetobacter
Skin and skin soft tissue infection due to Aerobacter
Skin and skin soft tissue infection due to Enterobacter
Skin and skin soft tissue infection due to Klebsiella
Skin and skin soft tissue infection due to Lingelsheimia
Skin and skin soft tissue infection from Mima-Herellea
Skin and skin soft tissue Proteus infection
Skin and skin soft tissue Staphylococcus aureus infection
Skin and soft tissue skin infection
Indications:
Bacteroides gynecological infections
Bacteroides peritonitis
Biliary tract infection
E. coli gynecological infections
E. coli peritonitis
Enterobacter peritonitis
Female genital tract infection
Infectious disease of abdomen
Inflammatory disease of female pelvic organs
Intra-abdominal E. coli abscess
Klebsiella pneumoniae peritonitis
Skin and skin structure Acinetobacter infection
Skin and skin structure Bacteroides fragilis infection
Skin and skin structure E. coli infection
Skin and skin structure Enterobacter infection
Skin and skin structure infection
Skin and skin structure Klebsiella infection
Skin and skin structure Proteus infection
Staphylococcus aureus skin and skin structure infection
Professional Synonyms:
Abdominal abscess due to Escherichia coli
Bacteroides species gynecologic infection
E. coli gynecologic infection
Gynecologic infection due to Bacteroides species
Gynecologic infection due to E. coli
Gynecologic infection due to Escherichia coli
Gynecologic infection
Infection of skin and/or subcutaneous tissue
Infective cholangitis
Intra-abdominal abscess due to E. coli
Intra-abdominal infection
Peritonitis due to Aerobacter
Peritonitis due to Bacteroides
Peritonitis due to Enterobacter
Peritonitis due to Escherichia coli
Peritonitis due to Klebsiella pneumoniae
Skin and skin soft tissue Acinetobacter infection
Skin and skin soft tissue Bacteroides fragilis infection
Skin and skin soft tissue Enterobacter infection
Skin and skin soft tissue Escherichia coli infection
Skin and skin soft tissue infection due to Acinetobacter
Skin and skin soft tissue infection due to Aerobacter
Skin and skin soft tissue infection due to Enterobacter
Skin and skin soft tissue infection due to Klebsiella
Skin and skin soft tissue infection due to Lingelsheimia
Skin and skin soft tissue infection from Mima-Herellea
Skin and skin soft tissue Proteus infection
Skin and skin soft tissue Staphylococcus aureus infection
Skin and soft tissue skin infection
The following dosing information is available for AMPICILLIN-SULBACTAM (ampicillin sodium/sulbactam sodium):
Ampicillin/sulbactam is commercially available for parenteral administration as a sterile powder containing a 2:1 ratio of ampicillin to sulbactam. The ampicillin component is provided as ampicillin sodium and the sulbactam component is provided as sulbactam sodium; potency of each component is expressed in terms of the base.
Dosage of ampicillin/sulbactam usually is expressed in terms of the total (sum) of the dosage of both components of the fixed combination (i.e., dosage of ampicillin plus dosage of sulbactam); pediatric dosage of ampicillin/sulbactam also has been expressed in terms of the ampicillin content.
The manufacturer's dosage recommendations for adults are the same for IM and IV administration; however, higher serum concentrations usually are attained with IV administration of the drug, and this route generally is preferred, especially for severe infections.
The manufacturer states that pediatric patients who weigh 40 kg or more may receive the usual adult dosage of ampicillin/sulbactam.
The American Academy of Pediatrics (AAP) suggests that pediatric patients beyond the neonatal period+ may receive a dosage of 100-200 mg/kg of ampicillin daily (as ampicillin/sulbactam) in 4 divided doses for the treatment of severe infections. A dosage of 200-400 mg/kg of ampicillin daily (as ampicillin/sulbactam) in 4 divided doses is recommended for meningitis or severe infections caused by resistant S. pneumoniae.
For the treatment of skin and skin structure infections in pediatric patients 1 year of age or older, the manufacturer recommends a dosage of 300 mg/kg daily (200 mg of ampicillin and 100 mg of sulbactam) given by IV infusion in equally divided doses every 6 hours. The manufacturer recommends that the duration of IV ampicillin/sulbactam therapy in pediatric patients not exceed 14 days; in clinical studies, most children received an oral anti-infective after an initial regimen of IV ampicillin/sulbactam.
Because the pharmacokinetics of both ampicillin and sulbactam are affected to the same degree in patients with renal impairment, the recommended 2:1 ratio of the drugs remains the same regardless of the degree of renal impairment.
The manufacturer recommends that patients with renal impairment receive the usually recommended doses of ampicillin/sulbactam, but doses should be given less frequently than usual and the dosing intervals should be based on the patient's creatinine clearance. The manufacturer recommends that patients with creatinine clearances of 30 mL/minute per 1.73 m2 or greater receive 1.5
g (1 g of ampicillin and 0.5 g of sulbactam) to 3 g (2 g of ampicillin and 1 g of sulbactam) of the drug every 6-8 hours and that patients with creatinine clearances of 15-29 or 5-14 mL/minute per 1.73 m2 receive these doses every 12 or 24 hours, respectively.
Because ampicillin and sulbactam are removed by hemodialysis, some clinicians suggest that patients undergoing hemodialysis receive 1.5 g (1 g of ampicillin and 0.5 g of sulbactam) to 3 g (2 g of ampicillin and 1 g of sulbactam) once every 24 hours and that the dose preferably should be given immediately after dialysis.
Dosage of ampicillin/sulbactam usually is expressed in terms of the total (sum) of the dosage of both components of the fixed combination (i.e., dosage of ampicillin plus dosage of sulbactam); pediatric dosage of ampicillin/sulbactam also has been expressed in terms of the ampicillin content.
The manufacturer's dosage recommendations for adults are the same for IM and IV administration; however, higher serum concentrations usually are attained with IV administration of the drug, and this route generally is preferred, especially for severe infections.
The manufacturer states that pediatric patients who weigh 40 kg or more may receive the usual adult dosage of ampicillin/sulbactam.
The American Academy of Pediatrics (AAP) suggests that pediatric patients beyond the neonatal period+ may receive a dosage of 100-200 mg/kg of ampicillin daily (as ampicillin/sulbactam) in 4 divided doses for the treatment of severe infections. A dosage of 200-400 mg/kg of ampicillin daily (as ampicillin/sulbactam) in 4 divided doses is recommended for meningitis or severe infections caused by resistant S. pneumoniae.
For the treatment of skin and skin structure infections in pediatric patients 1 year of age or older, the manufacturer recommends a dosage of 300 mg/kg daily (200 mg of ampicillin and 100 mg of sulbactam) given by IV infusion in equally divided doses every 6 hours. The manufacturer recommends that the duration of IV ampicillin/sulbactam therapy in pediatric patients not exceed 14 days; in clinical studies, most children received an oral anti-infective after an initial regimen of IV ampicillin/sulbactam.
Because the pharmacokinetics of both ampicillin and sulbactam are affected to the same degree in patients with renal impairment, the recommended 2:1 ratio of the drugs remains the same regardless of the degree of renal impairment.
The manufacturer recommends that patients with renal impairment receive the usually recommended doses of ampicillin/sulbactam, but doses should be given less frequently than usual and the dosing intervals should be based on the patient's creatinine clearance. The manufacturer recommends that patients with creatinine clearances of 30 mL/minute per 1.73 m2 or greater receive 1.5
g (1 g of ampicillin and 0.5 g of sulbactam) to 3 g (2 g of ampicillin and 1 g of sulbactam) of the drug every 6-8 hours and that patients with creatinine clearances of 15-29 or 5-14 mL/minute per 1.73 m2 receive these doses every 12 or 24 hours, respectively.
Because ampicillin and sulbactam are removed by hemodialysis, some clinicians suggest that patients undergoing hemodialysis receive 1.5 g (1 g of ampicillin and 0.5 g of sulbactam) to 3 g (2 g of ampicillin and 1 g of sulbactam) once every 24 hours and that the dose preferably should be given immediately after dialysis.
No enhanced Administration information available for this drug.
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| AMPICILLIN-SULBACTAM 1.5 GM VL | Maintenance | Adults infuse 3 gram by intravenous route every 6 hours |
| AMPICILLIN-SULBACTAM 15 GM VL | Maintenance | Adults infuse 1.5 gram by intravenous route every 6 hours |
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| AMPICILLIN-SULBACTAM 1.5 GM VL | Maintenance | Adults infuse 3 gram by intravenous route every 6 hours |
| AMPICILLIN-SULBACTAM 15 GM VL | Maintenance | Adults infuse 1.5 gram by intravenous route every 6 hours |
| AMPICILLIN-SULBACTAM 15 GM BTL | Maintenance | Adults infuse 1.5 gram by intravenous route every 6 hours |
The following drug interaction information is available for AMPICILLIN-SULBACTAM (ampicillin sodium/sulbactam sodium):
There are 1 contraindications.
These drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.
| Drug Interaction | Drug Names |
|---|---|
| Live Typhoid Vaccine/Antimicrobials SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: The antimicrobial may be active against the organism in the live-vaccine. Antimicrobial therapy may prevent the vaccine organism from replicating enough to trigger an immune response.(1) CLINICAL EFFECTS: Vaccination may be ineffective. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Do not give oral typhoid vaccine until 72 hours after the last dose of antimicrobial. If possible, to optimize vaccine effectiveness, do not start antibacterial drugs for 72 hours after the last dose of oral typhoid vaccine. A longer interval should be considered for long-acting antimicrobials, such as azithromycin.(3) DISCUSSION: Because antimicrobial therapy may prevent sufficient vaccine-organism replication to generate an immune response, the manufacturer of live-attenuated typhoid vaccine and the Centers for Disease Control (CDC) state that the vaccine should not be administered to patients receiving antimicrobial therapy.(1-3) |
VIVOTIF |
There are 3 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| Methotrexate/Penicillins SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Penicillins may compete with the renal tubular secretion of methotrexate. CLINICAL EFFECTS: The concurrent use of methotrexate and penicillins may result in elevated levels of methotrexate and methotrexate toxicity, leading to increased risk of severe neurotoxicity, stomatitis, and myelosuppression. PREDISPOSING FACTORS: Risk factors for methotrexate toxicity include: - High-dose oncology regimens - Impaired renal function, ascites, or pleural effusions PATIENT MANAGEMENT: Patients receiving concurrent therapy with methotrexate and penicillins should be monitored closely for elevated methotrexate levels and methotrexate toxicity. The dose and duration of leucovorin rescue therapy may need to be increased. DISCUSSION: Elevated methotrexate levels, signs of methotrexate toxicity, and death have been reported following the concurrent use of methotrexate (both low dose and high dose) and penicillin derivatives. In a patient being treated with high-dose methotrexate (8 G/m2), the concurrent use of amoxicillin resulted in a 56% decrease in the clearance of methotrexate and signs of methotrexate toxicity.(1) There are two cases of methotrexate toxicity following the addition of amoxicillin to low-dose methotrexate therapy (7.5 mg-10 mg weekly) for psoriasis. In another case, a patient was found to have a toxic methotrexate level 12 days after her last dose of weekly methotrexate (7.5 mg). The patient had been treated with amoxicillin followed by flucloxacillin.(2) In a case report, dicloxacillin decreased methotrexate clearance 93%.(4) Flucloxacillin was shown to increase the area-under-curve (AUC) of methotrexate by 7.3% in a study in 10 subjects.(5) In a case report, a patient on low-dose methotrexate (5 mg) developed methotrexate pneumonia following the addition of flucloxacillin to his regimen.(5) In a patient being treated with high-dose methotrexate (12 G/m2), the concurrent use of mezlocillin increased the half-life of methotrexate from 10.1 to 27.2 hours.(6) In a case report, a patient developed methotrexate toxicity following the addition of penicillin V potassium to his methotrexate (50 mg weekly).(7) In a case report, penicillin decreased methotrexate clearance 36%.(4) In one report, leucovorin rescue therapy had to be continued for 192 hours following the concurrent use of methotrexate (3 G/m2) and piperacillin. During cycles without concurrent piperacillin, leucovorin rescue therapy was only required for 72 hours.(8) There are two reports of neutropenia and death following the concurrent use of piperacillin and low-dose methotrexate (2.5 mg three times weekly in one patient, 5 mg weekly in another) for psoriasis. One of these patients also received flucloxacillin. (3) In another case report, the concurrent use of piperacillin decreased methotrexate clearance by 67%.(4) In a case report, ticarcillin decreased methotrexate clearance by 60%.(4) |
JYLAMVO, METHOTREXATE, METHOTREXATE SODIUM, OTREXUP, RASUVO, TREXALL, XATMEP |
| Cholera Vaccine Live/Selected Antibiotics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Antibiotics with activity against Vibrio cholerae may attenuate the immunization response to the live cholera vaccine.(1) CLINICAL EFFECTS: Concurrent or recent antibiotic use may make the cholera vaccine ineffective.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The manufacturer of live cholera vaccine states that it should not be administered to patients who have received antibiotics within 14 days prior to vaccination.(1) If antimalarial prophylaxis with chloroquine is required, administer the live cholera vaccine at least 10 days before beginning chloroquine.(1) Antibiotics linked to this monograph are: macrolides, quinolones, tetracyclines, ampicillin, cefprozil, chloramphenicol, furazolidone, sulfamethoxazole-trimethoprim, and sulfametrole-trimethoprim.(2,3) DISCUSSION: Antibiotics with activity against Vibrio cholerae may attenuate the immunization response to the live cholera vaccine, rendering the vaccine ineffective. |
VAXCHORA ACTIVE COMPONENT, VAXCHORA VACCINE |
| Fecal Microbiota Spores/Antibiotics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Fecal microbiota spores is a suspension of live bacterial spores, which may be compromised by concurrent use of antibiotics.(1) CLINICAL EFFECTS: Antibiotics may decrease the effectiveness of fecal microbiota spores.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Antibiotics should not be used concurrently with fecal microbiota spores. Antibacterial treatment should be completed for 2 to 4 days before initiating treatment with fecal microbiota spores.(1) DISCUSSION: Antibiotics may compromise the effectiveness of fecal microbiota spores. |
VOWST |
There are 3 moderate interactions.
The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.
| Drug Interaction | Drug Names |
|---|---|
| Oral Contraceptives/Penicillins SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Estrogens and progesterones are extensively excreted in bile, principally as glycuronide conjugates. Subsequently, they undergo enterohepatic circulation where bacterial hydrolysis occurs, allowing for reabsorption of the oral contraceptives through the bowel wall and eventual urinary excretion. Treatment with antibiotics destroys the gut flora and prevents steroid reabsorption, resulting in lower than normal concentrations of the contraceptive and excretion via the feces rather than the urine. CLINICAL EFFECTS: May observe reduced pharmacologic effects of oral contraceptives with resultant breakthrough bleeding and pregnancy. Reduced effects may be seen for several days after discontinuation of antibiotic therapy. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Current guidelines suggest that additional precautions are not necessary when non-enzyme inducing antibiotics are used concurrently with hormonal contraceptives; however, some patients may still prefer to use an additional method of contraception. DISCUSSION: Evidence for this interaction is limited and conflicting; however, the CDC and the Faculty of Sexual and Reproductive Healthcare Clinical Effectiveness Unit no longer recommend use of a backup contraceptive method during use of a non-enzyme inducing antibiotic. Reports of breakthrough bleeding and loss of contraceptive protection leading to unwanted pregnancies have occurred in women taking oral contraceptive agents who received concurrent ampicillin, amoxicillin, penicillin G, or oxacillin. Several studies have shown that the administration of ampicillin or penicillin to pregnant and nonpregnant women resulted in lowered urinary estrogen excretion, in some women as soon as three days after ampicillin therapy began. However in one small prospective study, plasma ethinyl estradiol concentrations showed a tendency to decrease during ampicillin administration on the third, fourth, and fifth morning of ampicillin administration, but were never lower than pretreatment values. In another small prospective study of women taking low dose combination contraceptives, concurrent ampicillin therapy neither altered the plasma levels nor the AUC of norethisterone and ethinyl estradiol. In addition, progesterone levels were in an anovulatory range. In another prospective study of 13 women taking long term oral contraceptive steroids, concurrent ampicillin was not associated with any significant changes in plasma concentrations of ethinyl estradiol, levonorgestrel, follicle stimulating hormone or progesterone, although lower concentrations of ethinyl estradiol were noted in two women. |
2-METHOXYESTRADIOL, AFIRMELLE, ALTAVERA, ALYACEN, AMETHIA, AMETHYST, APRI, ARANELLE, ASHLYNA, AUBRA, AUBRA EQ, AUROVELA, AUROVELA 24 FE, AUROVELA FE, AVIANE, AYUNA, AZURETTE, BALCOLTRA, BALZIVA, BEYAZ, BLISOVI 24 FE, BLISOVI FE, BRIELLYN, CAMILA, CAMRESE, CAMRESE LO, CAZIANT, CHARLOTTE 24 FE, CHATEAL EQ, CRYSELLE, CYRED, CYRED EQ, DASETTA, DAYSEE, DEBLITANE, DESOGESTR-ETH ESTRAD ETH ESTRA, DIETHYLSTILBESTROL, DOLISHALE, DROSPIRENONE-ETH ESTRA-LEVOMEF, DROSPIRENONE-ETHINYL ESTRADIOL, ELINEST, ELLA, EMZAHH, ENPRESSE, ENSKYCE, ERRIN, ESTARYLLA, ESTRADIOL, ESTRADIOL BENZOATE, ESTRADIOL CYPIONATE, ESTRADIOL HEMIHYDRATE, ESTRADIOL HEMIHYDRATE MICRO, ESTRADIOL MICRONIZED, ESTRADIOL VALERATE, ESTRIOL, ESTRIOL MICRONIZED, ESTRONE, ETHINYL ESTRADIOL, ETHYNODIOL-ETHINYL ESTRADIOL, FALMINA, FEIRZA, FEMLYV, FINZALA, GEMMILY, HAILEY, HAILEY 24 FE, HAILEY FE, HEATHER, ICLEVIA, INCASSIA, ISIBLOOM, JAIMIESS, JASMIEL, JENCYCLA, JOLESSA, JOYEAUX, JULEBER, JUNEL, JUNEL FE, JUNEL FE 24, KAITLIB FE, KALLIGA, KARIVA, KELNOR 1-35, KELNOR 1-50, KURVELO, LARIN, LARIN 24 FE, LARIN FE, LAYOLIS FE, LEENA, LESSINA, LEVONEST, LEVONORG-ETH ESTRAD ETH ESTRAD, LEVONORG-ETH ESTRAD-FE BISGLYC, LEVONORGESTREL-ETH ESTRADIOL, LEVORA-28, LO LOESTRIN FE, LO-ZUMANDIMINE, LOESTRIN, LOESTRIN FE, LOJAIMIESS, LORYNA, LOW-OGESTREL, LUTERA, LYLEQ, LYZA, MARLISSA, MERZEE, MIBELAS 24 FE, MICROGESTIN, MICROGESTIN FE, MILI, MINZOYA, MONO-LINYAH, NATAZIA, NECON, NEXTSTELLIS, NIKKI, NORA-BE, NORETHIN-ETH ESTRA-FERROUS FUM, NORETHINDRON-ETHINYL ESTRADIOL, NORETHINDRONE, NORETHINDRONE-E.ESTRADIOL-IRON, NORGESTIMATE-ETHINYL ESTRADIOL, NORTREL, NYLIA, OCELLA, ORTHO TRI-CYCLEN, ORTHO-NOVUM, PHILITH, PIMTREA, PORTIA, RECLIPSEN, RIVELSA, SAFYRAL, SETLAKIN, SHAROBEL, SIMLIYA, SIMPESSE, SLYND, SPRINTEC, SRONYX, SYEDA, TARINA 24 FE, TARINA FE, TARINA FE 1-20 EQ, TAYTULLA, TILIA FE, TRI-ESTARYLLA, TRI-LEGEST FE, TRI-LINYAH, TRI-LO-ESTARYLLA, TRI-LO-MARZIA, TRI-LO-MILI, TRI-LO-SPRINTEC, TRI-MILI, TRI-SPRINTEC, TRI-VYLIBRA, TRI-VYLIBRA LO, TRIVORA-28, TULANA, TURQOZ, TYBLUME, VALTYA, VELIVET, VESTURA, VIENVA, VIORELE, VOLNEA, VYFEMLA, VYLIBRA, WERA, WYMZYA FE, XARAH FE, XELRIA FE, YASMIN 28, YAZ, ZARAH, ZOVIA 1-35, ZUMANDIMINE |
| Selected Anticoagulants (Vit K antag)/Selected Penicillins SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Unknown. CLINICAL EFFECTS: Large doses of parenterally administered penicillins and oral amoxicillin appear to increase the risk of bleeding during concurrent administration of anticoagulants. PREDISPOSING FACTORS: Renal failure may predispose patients to penicillin-induced coagulation abnormalities. A study suggests that various inflammatory syndromes or the nature of the infection can affect INR levels. The risk for bleeding episodes may be greater in patients with additional disease-associated factors (e.g. thrombocytopenia). Drug associated risk factors include concurrent use of multiple drugs which inhibit anticoagulant/antiplatelet metabolism and/or have an inherent risk for bleeding (e.g. NSAIDs). PATIENT MANAGEMENT: Monitor patient INR for an increase in the hypoprothrombinemic response to anticoagulants during concomitant administration of penicillins. Adjust the dose of warfarin accordingly. When concurrent therapy is warranted, monitor patients receiving concurrent therapy for signs of blood loss, including decreased hemoglobin and/or hematocrit, fecal occult blood, and/or decreased blood pressure and promptly evaluate patients with any symptoms. Discontinue anticoagulation in patients with active pathologic bleeding. Instruct patients to report any signs and symptoms of bleeding, such as unusual bleeding from the gums or nose; unusual bruising; red or black, tarry stools; red, pink or dark brown urine; acute abdominal or joint pain and/or swelling. The time of highest risk for a coumarin-type drug interaction is when the precipitant drug is initiated or discontinued. Contact the prescriber before initiating, altering the dose or discontinuing either drug. DISCUSSION: High dose parenteral administration of penicillins and oral amoxicillin have been reported to cause an increase in the hypoprothrombinemic effects of warfarin producing bleeding. Significant clinical effects have been reported with combined administration of warfarin and either carbenicillin or penicillin G. There have been several case reports and retrospective reviews documenting increased acenocoumarol and warfarin effects, including bleeding, following the addition of amoxicillin, with and without clavulanic acid, to therapy. In a randomized controlled trial, adult ambulatory patients that had no recent and ongoing infectious or inflammatory conditions received warfarin to a target INR between 2 and 3 with amoxicillin-clavulanic acid (1 gram twice daily for seven days) or placebo. The results showed the mean maximum INR increase from baseline to day 10 did not differ between amoxicillin/clavulanic acid (0.22 +/- 0.3) and the placebo period (0.24 +/- 0.6, p = 0.94). No patient experienced an INR of greater than 3.5. No bleeding events were reported during the entire study. A prospective cross-sectional observational study in 120 patients evaluated warfarin drug interactions, particularly with high-dose amoxicillin/clavulanate. The study found that patients on amoxicillin/clavulanate had a relative risk of having an INR >=4 of 4.8 compared to patients not on amoxicillin/clavulanate (95% CI 2.1-11.3, p < 0.001). This risk was primarily driven by patients on high-dose amoxicillin/clavulanate, who were 5.8 times more likely to have INR >=4 (95% CI 3.5-9.6, p<0.001). Significantly more patients on high-dose than normal dose amoxicillin/clavulanate had an INR value >= 4 (87.5% v. 28.9%, respectively). Nine out of ten patients who experienced bleeding during hospitalization were prescribed amoxicillin/clavulanate. A large systematic review was performed on 72 warfarin drug-drug interactions studies that reported on bleeding, thromboembolic events, or death. Most studies were retrospective cohorts. A meta-analysis of 11 of those studies found a higher rate of clinically significant bleeding in patients on warfarin and antimicrobials (OR=1.63; 95% CI 1.45-1.83). Increased bleeding risk was also seen in subgroup analyses with penicillins (OR=1.59; 95% CI 1.14-2.20) and amoxicillin (OR=1.78; 95% CI 1.14-2.79). A case-control nested cohort study of Medicare beneficiaries with warfarin prescriptions was evaluated for antibiotic use and warfarin toxicity in older adults. An increased risk of bleeding was associated with penicillins with an adjusted odds ratio of 1.92. Parenteral penicillins linked to this monograph include: almecillin, amdinocillin, amoxicillin, ampicillin, azlocillin, bacampicillin, carbenicillin, cyclacillin, hetacillin, mezlocillin, penicillin, penicillin G, penicillin V, phenethicillin, piperacillin, and ticarcillin. Oral penicillins linked to this monograph include: amoxicillin and penicillin. |
ANISINDIONE, DICUMAROL, JANTOVEN, WARFARIN SODIUM |
| Allopurinol/Amoxicillin, Ampicillin, Bendamustine SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The exact mechanism is unknown. Allopurinol, amoxicillin, ampicillin, and bendamustine have been documented to cause cases of Stevens-Johnson syndrome (SJS), Toxic epidermal necrolysis (TEN), and Drug reaction with eosinophilia and systemic symptoms (DRESS).(1) CLINICAL EFFECTS: Concurrent administration of allopurinol with amoxicillin, ampicillin or bendamustine may result in an increased incidence of rash which may be severe. PREDISPOSING FACTORS: Patients who are HLA-B*58:01 positive may be at increased risk. PATIENT MANAGEMENT: Consider an alternative to amoxicillin, ampicillin, or bendamustine in patients with a history of serious skin rashes, such as SJS, TEN, or DRESS. Discontinue allopurinol at the first appearance of skin rash or other signs which may indicate a hypersensitivity reaction when used with amoxicillin or ampicillin or bendamustine. Instruct patients to seek medical attention for any peeling skin rash or blisters.(1) DISCUSSION: In the Boston Collaborative Drug Surveillance Program, drug rash was seen in 22.4% of 67 hospitalized patients (relative risk 3.0) receiving concurrent allopurinol and ampicillin compared to 7.5% of 1257 patients receiving only ampicillin and 2.1% of 283 patients rceiving only allopurinol.(4) A hospital drug monitoring program found the observed risk of developing an exanthema with concurrent use is as follows: aminopenicillin without allopurinol 10.1%, aminopenicillin combined with allopurinol 7.2%, allopurinol without aminopenicillin 3.0%, or neither of the two drugs 1.5%.(6) A case-control study did not find a statistically significant increased risk of SJS with concurrent use of allopurinol and amoxicillin or ampicillin (allopurinol alone 4.4% vs. with amoxicillin 6.8%; allopurinol alone 0.1% vs. with ampicillin 2.7% at 1 month)(allopurinol alone 4.4% vs. with amoxicillin 5.7% or allopurinol alone 0.2% vs. with ampicillin 2.9% at 3 months).(8) In a retrospective study looking at mortality data, records were screened for administration of high risk drugs associated with SJS. Allopurinol and ampicillin was one of the drug combinations listed as contributing to mortality in patients (p = 0.049).(9) |
ALLOPURINOL, ALLOPURINOL SODIUM, ALOPRIM, DUZALLO, ZYLOPRIM |
The following contraindication information is available for AMPICILLIN-SULBACTAM (ampicillin sodium/sulbactam sodium):
Drug contraindication overview.
No enhanced Contraindications information available for this drug.
No enhanced Contraindications information available for this drug.
There are 0 contraindications.
There are 3 severe contraindications.
Adequate patient monitoring is recommended for safer drug use.
| Severe List |
|---|
| Cholestatic hepatitis |
| Clostridioides difficile infection |
| Kidney disease with reduction in glomerular filtration rate (GFr) |
There are 0 moderate contraindications.
The following adverse reaction information is available for AMPICILLIN-SULBACTAM (ampicillin sodium/sulbactam sodium):
Adverse reaction overview.
No enhanced Common Adverse Effects information available for this drug.
No enhanced Common Adverse Effects information available for this drug.
There are 50 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. |
Anaphylaxis Dyspnea Serum sickness |
| Rare/Very Rare |
|---|
|
Acute coronary syndrome Acute generalized exanthematous pustulosis Acute pancreatitis Agranulocytosis Allergic dermatitis Anemia Angioedema Cholestasis Cholestatic hepatitis Clostridioides difficile infection DRESS syndrome Edema Enterocolitis Eosinophilia Eosinophilic pneumonia Erythema multiforme Exfoliative dermatitis Hemolytic anemia Hepatitis Hepatocellular damage Hyperbilirubinemia Hypersensitivity angiitis Hypersensitivity drug reaction Hypotension Increased alanine transaminase Increased alkaline phosphatase Increased aspartate transaminase Increased risk of bleeding due to coagulation disorder Interstitial nephritis Jaundice Kidney disease with reduction in glomerular filtration rate (GFr) Kounis syndrome Leukopenia Linear immunoglobulin A bullous dermatosis Multiple organ failure Non-infective meningitis Obstructive hyperbilirubinemia Pancytopenia Qualitative platelet disorder Seizure disorder Stevens-johnson syndrome Symmetrical drug-related intertriginous and flexural exanthema Thrombocytopenic disorder Thrombocytosis Thrombophlebitis Thrombotic thrombocytopenic purpura Toxic epidermal necrolysis |
There are 39 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Diarrhea Gastrointestinal irritation Headache disorder Loose stools Oral candidiasis Vulvovaginal candidiasis |
Constipation Insomnia Nausea Phlebitis after infusion Pruritus of skin Skin rash Urticaria Vomiting |
| Rare/Very Rare |
|---|
|
Acute abdominal pain Acute cognitive impairment Agitation Back pain Black tarry stools Chills Crystalluria Dental discoloration Dizziness Dysgeusia Dyspepsia Fever Flatulence Furred tongue Gastritis Glossitis Hematuria Injection site sequelae Malaise Mucocutaneous candidiasis Myalgia Stomatitis Symptoms of anxiety Tremor Vaginitis |
The following precautions are available for AMPICILLIN-SULBACTAM (ampicillin sodium/sulbactam sodium):
No enhanced Pediatric Use information available for this drug.
Contraindicated
Severe Precaution
Management or Monitoring Precaution
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
There are no adequate or controlled studies using ampicillin/sulbactam in pregnant women. Reproduction studies in mice, rats, and rabbits using ampicillin and sulbactam doses up to 10 times the usual human dose have not revealed evidence of impaired fertility or harm to the fetus due to ampicillin/sulbactam. Because animal reproduction studies are not always predictive of human response, ampicillin/sulbactam should be used during pregnancy only when clearly needed.
Although the clinical importance is unclear, administration of ampicillin alone to pregnant women has resulted in a transient decrease in plasma concentrations of total conjugated estriol, estriol glucuronide, conjugated estrone, and estradiol; this effect also may occur following administration of ampicillin/sulbactam. IV administration of ampicillin to guinea pigs has resulted in decreased uterine tone and decreased frequency, height, and duration of uterine contractions. It is not known whether use of ampicillin/sulbactam in humans during labor or delivery could have any immediate or delayed adverse effects on the fetus, prolong the duration of labor, or increase the likelihood of forceps delivery, other obstetrical intervention, or resuscitation of the neonate.
Although the clinical importance is unclear, administration of ampicillin alone to pregnant women has resulted in a transient decrease in plasma concentrations of total conjugated estriol, estriol glucuronide, conjugated estrone, and estradiol; this effect also may occur following administration of ampicillin/sulbactam. IV administration of ampicillin to guinea pigs has resulted in decreased uterine tone and decreased frequency, height, and duration of uterine contractions. It is not known whether use of ampicillin/sulbactam in humans during labor or delivery could have any immediate or delayed adverse effects on the fetus, prolong the duration of labor, or increase the likelihood of forceps delivery, other obstetrical intervention, or resuscitation of the neonate.
Because ampicillin and sulbactam are distributed into milk in low concentrations, ampicillin/sulbactam should be used with caution in nursing women.
No enhanced Geriatric Use information available for this drug.
The following prioritized warning is available for AMPICILLIN-SULBACTAM (ampicillin sodium/sulbactam sodium):
No warning message for this drug.
No warning message for this drug.
The following icd codes are available for AMPICILLIN-SULBACTAM (ampicillin sodium/sulbactam sodium)'s list of indications:
| Bacteroides gynecological infections | |
| B96.6 | Bacteroides fragilis [b. fragilis] as the cause of diseases classified elsewhere |
| N70 | Salpingitis and oophoritis |
| N70.0 | Acute salpingitis and oophoritis |
| N70.01 | Acute salpingitis |
| N70.02 | Acute oophoritis |
| N70.03 | Acute salpingitis and oophoritis |
| N70.1 | Chronic salpingitis and oophoritis |
| N70.11 | Chronic salpingitis |
| N70.12 | Chronic oophoritis |
| N70.13 | Chronic salpingitis and oophoritis |
| N70.9 | Salpingitis and oophoritis, unspecified |
| N70.91 | Salpingitis, unspecified |
| N70.92 | Oophoritis, unspecified |
| N70.93 | Salpingitis and oophoritis, unspecified |
| N71 | Inflammatory disease of uterus, except cervix |
| N71.0 | Acute inflammatory disease of uterus |
| N71.1 | Chronic inflammatory disease of uterus |
| N71.9 | Inflammatory disease of uterus, unspecified |
| N72 | Inflammatory disease of cervix uteri |
| N73 | Other female pelvic inflammatory diseases |
| N73.0 | Acute parametritis and pelvic cellulitis |
| N73.1 | Chronic parametritis and pelvic cellulitis |
| N73.2 | Unspecified parametritis and pelvic cellulitis |
| N73.3 | Female acute pelvic peritonitis |
| N73.4 | Female chronic pelvic peritonitis |
| N73.5 | Female pelvic peritonitis, unspecified |
| N73.6 | Female pelvic peritoneal adhesions (postinfective) |
| N73.8 | Other specified female pelvic inflammatory diseases |
| N73.9 | Female pelvic inflammatory disease, unspecified |
| N75.1 | Abscess of bartholin's gland |
| N76.4 | Abscess of vulva |
| N76.82 | Fournier disease of vagina and vulva |
| Bacteroides peritonitis | |
| B96.6 | Bacteroides fragilis [b. fragilis] as the cause of diseases classified elsewhere |
| K65.0 | Generalized (acute) peritonitis |
| K65.2 | Spontaneous bacterial peritonitis |
| T85.71 | Infection and inflammatory reaction due to peritoneal dialysis catheter |
| T85.71xA | Infection and inflammatory reaction due to peritoneal dialysis catheter, initial encounter |
| Biliary tract infection | |
| K83.0 | Cholangitis |
| K83.09 | Other cholangitis |
| E. coli gynecological infections | |
| B96.2 | Escherichia coli [e. coli ] as the cause of diseases classified elsewhere |
| B96.20 | Unspecified escherichia coli [e. coli] as the cause of diseases classified elsewhere |
| B96.29 | Other escherichia coli [e. coli] as the cause of diseases classified elsewhere |
| N70 | Salpingitis and oophoritis |
| N70.0 | Acute salpingitis and oophoritis |
| N70.01 | Acute salpingitis |
| N70.02 | Acute oophoritis |
| N70.03 | Acute salpingitis and oophoritis |
| N70.1 | Chronic salpingitis and oophoritis |
| N70.11 | Chronic salpingitis |
| N70.12 | Chronic oophoritis |
| N70.13 | Chronic salpingitis and oophoritis |
| N70.9 | Salpingitis and oophoritis, unspecified |
| N70.91 | Salpingitis, unspecified |
| N70.92 | Oophoritis, unspecified |
| N70.93 | Salpingitis and oophoritis, unspecified |
| N71 | Inflammatory disease of uterus, except cervix |
| N71.0 | Acute inflammatory disease of uterus |
| N71.1 | Chronic inflammatory disease of uterus |
| N71.9 | Inflammatory disease of uterus, unspecified |
| N72 | Inflammatory disease of cervix uteri |
| N73 | Other female pelvic inflammatory diseases |
| N73.0 | Acute parametritis and pelvic cellulitis |
| N73.1 | Chronic parametritis and pelvic cellulitis |
| N73.2 | Unspecified parametritis and pelvic cellulitis |
| N73.3 | Female acute pelvic peritonitis |
| N73.4 | Female chronic pelvic peritonitis |
| N73.5 | Female pelvic peritonitis, unspecified |
| N73.6 | Female pelvic peritoneal adhesions (postinfective) |
| N73.8 | Other specified female pelvic inflammatory diseases |
| N73.9 | Female pelvic inflammatory disease, unspecified |
| N75.1 | Abscess of bartholin's gland |
| N76.4 | Abscess of vulva |
| N76.82 | Fournier disease of vagina and vulva |
| E. coli peritonitis | |
| B96.2 | Escherichia coli [e. coli ] as the cause of diseases classified elsewhere |
| B96.20 | Unspecified escherichia coli [e. coli] as the cause of diseases classified elsewhere |
| B96.29 | Other escherichia coli [e. coli] as the cause of diseases classified elsewhere |
| K65.0 | Generalized (acute) peritonitis |
| K65.2 | Spontaneous bacterial peritonitis |
| T85.71 | Infection and inflammatory reaction due to peritoneal dialysis catheter |
| T85.71xA | Infection and inflammatory reaction due to peritoneal dialysis catheter, initial encounter |
| Enterobacter peritonitis | |
| B96.89 | Other specified bacterial agents as the cause of diseases classified elsewhere |
| K65.0 | Generalized (acute) peritonitis |
| K65.2 | Spontaneous bacterial peritonitis |
| T85.71 | Infection and inflammatory reaction due to peritoneal dialysis catheter |
| T85.71xA | Infection and inflammatory reaction due to peritoneal dialysis catheter, initial encounter |
| Female genital tract infection | |
| N70 | Salpingitis and oophoritis |
| N70.0 | Acute salpingitis and oophoritis |
| N70.01 | Acute salpingitis |
| N70.02 | Acute oophoritis |
| N70.03 | Acute salpingitis and oophoritis |
| N70.1 | Chronic salpingitis and oophoritis |
| N70.11 | Chronic salpingitis |
| N70.12 | Chronic oophoritis |
| N70.13 | Chronic salpingitis and oophoritis |
| N70.9 | Salpingitis and oophoritis, unspecified |
| N70.91 | Salpingitis, unspecified |
| N70.92 | Oophoritis, unspecified |
| N70.93 | Salpingitis and oophoritis, unspecified |
| N71 | Inflammatory disease of uterus, except cervix |
| N71.0 | Acute inflammatory disease of uterus |
| N71.1 | Chronic inflammatory disease of uterus |
| N71.9 | Inflammatory disease of uterus, unspecified |
| N72 | Inflammatory disease of cervix uteri |
| N73.8 | Other specified female pelvic inflammatory diseases |
| N73.9 | Female pelvic inflammatory disease, unspecified |
| N74 | Female pelvic inflammatory disorders in diseases classified elsewhere |
| N75.0 | Cyst of bartholin's gland |
| N75.1 | Abscess of bartholin's gland |
| N76 | Other inflammation of vagina and vulva |
| N76.0 | Acute vaginitis |
| N76.1 | Subacute and chronic vaginitis |
| N76.2 | Acute vulvitis |
| N76.3 | Subacute and chronic vulvitis |
| N76.4 | Abscess of vulva |
| N76.5 | Ulceration of vagina |
| N76.6 | Ulceration of vulva |
| N76.8 | Other specified inflammation of vagina and vulva |
| N76.81 | Mucositis (ulcerative) of vagina and vulva |
| N76.89 | Other specified inflammation of vagina and vulva |
| Infectious disease of abdomen | |
| A51.1 | Primary anal syphilis |
| K35 | Acute appendicitis |
| K35.2 | Acute appendicitis with generalized peritonitis |
| K35.20 | Acute appendicitis with generalized peritonitis, without abscess |
| K35.200 | Acute appendicitis with generalized peritonitis, without perforation or abscess |
| K35.201 | Acute appendicitis with generalized peritonitis, with perforation, without abscess |
| K35.209 | Acute appendicitis with generalized peritonitis, without abscess, unspecified as to perforation |
| K35.21 | Acute appendicitis with generalized peritonitis, with abscess |
| K35.210 | Acute appendicitis with generalized peritonitis, without perforation, with abscess |
| K35.211 | Acute appendicitis with generalized peritonitis, with perforation and abscess |
| K35.219 | Acute appendicitis with generalized peritonitis, with abscess, unspecified as to perforation |
| K35.3 | Acute appendicitis with localized peritonitis |
| K35.30 | Acute appendicitis with localized peritonitis, without perforation or gangrene |
| K35.31 | Acute appendicitis with localized peritonitis and gangrene, without perforation |
| K35.32 | Acute appendicitis with perforation, localized peritonitis, and gangrene, without abscess |
| K35.33 | Acute appendicitis with perforation, localized peritonitis, and gangrene, with abscess |
| K35.8 | Other and unspecified acute appendicitis |
| K35.80 | Unspecified acute appendicitis |
| K35.89 | Other acute appendicitis |
| K35.890 | Other acute appendicitis without perforation or gangrene |
| K35.891 | Other acute appendicitis without perforation, with gangrene |
| K65.0 | Generalized (acute) peritonitis |
| K65.2 | Spontaneous bacterial peritonitis |
| Inflammatory disease of female pelvic organs | |
| N70 | Salpingitis and oophoritis |
| N70.0 | Acute salpingitis and oophoritis |
| N70.01 | Acute salpingitis |
| N70.02 | Acute oophoritis |
| N70.03 | Acute salpingitis and oophoritis |
| N70.1 | Chronic salpingitis and oophoritis |
| N70.11 | Chronic salpingitis |
| N70.12 | Chronic oophoritis |
| N70.13 | Chronic salpingitis and oophoritis |
| N70.9 | Salpingitis and oophoritis, unspecified |
| N70.91 | Salpingitis, unspecified |
| N70.92 | Oophoritis, unspecified |
| N70.93 | Salpingitis and oophoritis, unspecified |
| N71 | Inflammatory disease of uterus, except cervix |
| N71.0 | Acute inflammatory disease of uterus |
| N71.1 | Chronic inflammatory disease of uterus |
| N71.9 | Inflammatory disease of uterus, unspecified |
| N72 | Inflammatory disease of cervix uteri |
| N73 | Other female pelvic inflammatory diseases |
| N73.0 | Acute parametritis and pelvic cellulitis |
| N73.1 | Chronic parametritis and pelvic cellulitis |
| N73.2 | Unspecified parametritis and pelvic cellulitis |
| N73.3 | Female acute pelvic peritonitis |
| N73.4 | Female chronic pelvic peritonitis |
| N73.5 | Female pelvic peritonitis, unspecified |
| N73.8 | Other specified female pelvic inflammatory diseases |
| N73.9 | Female pelvic inflammatory disease, unspecified |
| Intra-abdominal e. coli abscess | |
| B96.2 | Escherichia coli [e. coli ] as the cause of diseases classified elsewhere |
| B96.20 | Unspecified escherichia coli [e. coli] as the cause of diseases classified elsewhere |
| B96.29 | Other escherichia coli [e. coli] as the cause of diseases classified elsewhere |
| D73.3 | Abscess of spleen |
| K35.21 | Acute appendicitis with generalized peritonitis, with abscess |
| K35.210 | Acute appendicitis with generalized peritonitis, without perforation, with abscess |
| K35.211 | Acute appendicitis with generalized peritonitis, with perforation and abscess |
| K35.219 | Acute appendicitis with generalized peritonitis, with abscess, unspecified as to perforation |
| K35.33 | Acute appendicitis with perforation, localized peritonitis, and gangrene, with abscess |
| K50.014 | Crohn's disease of small intestine with abscess |
| K50.114 | Crohn's disease of large intestine with abscess |
| K50.814 | Crohn's disease of both small and large intestine with abscess |
| K50.914 | Crohn's disease, unspecified, with abscess |
| K51.014 | Ulcerative (chronic) pancolitis with abscess |
| K51.214 | Ulcerative (chronic) proctitis with abscess |
| K51.314 | Ulcerative (chronic) rectosigmoiditis with abscess |
| K51.414 | Inflammatory polyps of colon with abscess |
| K51.514 | Left sided colitis with abscess |
| K51.814 | Other ulcerative colitis with abscess |
| K51.914 | Ulcerative colitis, unspecified with abscess |
| K57.0 | Diverticulitis of small intestine with perforation and abscess |
| K57.00 | Diverticulitis of small intestine with perforation and abscess without bleeding |
| K57.01 | Diverticulitis of small intestine with perforation and abscess with bleeding |
| K57.2 | Diverticulitis of large intestine with perforation and abscess |
| K57.20 | Diverticulitis of large intestine with perforation and abscess without bleeding |
| K57.21 | Diverticulitis of large intestine with perforation and abscess with bleeding |
| K57.4 | Diverticulitis of both small and large intestine with perforation and abscess |
| K57.40 | Diverticulitis of both small and large intestine with perforation and abscess without bleeding |
| K57.41 | Diverticulitis of both small and large intestine with perforation and abscess with bleeding |
| K57.8 | Diverticulitis of intestine, part unspecified, with perforation and abscess |
| K57.80 | Diverticulitis of intestine, part unspecified, with perforation and abscess without bleeding |
| K57.81 | Diverticulitis of intestine, part unspecified, with perforation and abscess with bleeding |
| K63.0 | Abscess of intestine |
| K65.1 | Peritoneal abscess |
| K68.1 | Retroperitoneal abscess |
| K68.11 | Postprocedural retroperitoneal abscess |
| K68.12 | Psoas muscle abscess |
| K68.19 | Other retroperitoneal abscess |
| K75.0 | Abscess of liver |
| N15.1 | Renal and perinephric abscess |
| N34.0 | Urethral abscess |
| N41.2 | Abscess of prostate |
| Klebsiella pneumoniae peritonitis | |
| B96.1 | Klebsiella pneumoniae [k. pneumoniae] as the cause of diseases classified elsewhere |
| K65.0 | Generalized (acute) peritonitis |
| K65.2 | Spontaneous bacterial peritonitis |
| T85.71 | Infection and inflammatory reaction due to peritoneal dialysis catheter |
| T85.71xA | Infection and inflammatory reaction due to peritoneal dialysis catheter, initial encounter |
| Skin and skin structure acinetobacter infection | |
| B96.89 | Other specified bacterial agents as the cause of diseases classified elsewhere |
| L08.9 | Local infection of the skin and subcutaneous tissue, unspecified |
| Skin and skin structure bacteroides fragilis infection | |
| B96.6 | Bacteroides fragilis [b. fragilis] as the cause of diseases classified elsewhere |
| L08.9 | Local infection of the skin and subcutaneous tissue, unspecified |
| Skin and skin structure e. coli infection | |
| B96.2 | Escherichia coli [e. coli ] as the cause of diseases classified elsewhere |
| B96.20 | Unspecified escherichia coli [e. coli] as the cause of diseases classified elsewhere |
| B96.29 | Other escherichia coli [e. coli] as the cause of diseases classified elsewhere |
| L08.9 | Local infection of the skin and subcutaneous tissue, unspecified |
| Skin and skin structure enterobacter infection | |
| B96.89 | Other specified bacterial agents as the cause of diseases classified elsewhere |
| L08.9 | Local infection of the skin and subcutaneous tissue, unspecified |
| Skin and skin structure infection | |
| H05.01 | Cellulitis of orbit |
| H05.011 | Cellulitis of right orbit |
| H05.012 | Cellulitis of left orbit |
| H05.013 | Cellulitis of bilateral orbits |
| H05.019 | Cellulitis of unspecified orbit |
| H60.1 | Cellulitis of external ear |
| H60.10 | Cellulitis of external ear, unspecified ear |
| H60.11 | Cellulitis of right external ear |
| H60.12 | Cellulitis of left external ear |
| H60.13 | Cellulitis of external ear, bilateral |
| K12.2 | Cellulitis and abscess of mouth |
| L03 | Cellulitis and acute lymphangitis |
| L03.0 | Cellulitis and acute lymphangitis of finger and toe |
| L03.01 | Cellulitis of finger |
| L03.011 | Cellulitis of right finger |
| L03.012 | Cellulitis of left finger |
| L03.019 | Cellulitis of unspecified finger |
| L03.03 | Cellulitis of toe |
| L03.031 | Cellulitis of right toe |
| L03.032 | Cellulitis of left toe |
| L03.039 | Cellulitis of unspecified toe |
| L03.1 | Cellulitis and acute lymphangitis of other parts of limb |
| L03.11 | Cellulitis of other parts of limb |
| L03.111 | Cellulitis of right axilla |
| L03.112 | Cellulitis of left axilla |
| L03.113 | Cellulitis of right upper limb |
| L03.114 | Cellulitis of left upper limb |
| L03.115 | Cellulitis of right lower limb |
| L03.116 | Cellulitis of left lower limb |
| L03.119 | Cellulitis of unspecified part of limb |
| L03.2 | Cellulitis and acute lymphangitis of face and neck |
| L03.21 | Cellulitis and acute lymphangitis of face |
| L03.211 | Cellulitis of face |
| L03.22 | Cellulitis and acute lymphangitis of neck |
| L03.221 | Cellulitis of neck |
| L03.3 | Cellulitis and acute lymphangitis of trunk |
| L03.31 | Cellulitis of trunk |
| L03.311 | Cellulitis of abdominal wall |
| L03.312 | Cellulitis of back [any part except buttock] |
| L03.313 | Cellulitis of chest wall |
| L03.314 | Cellulitis of groin |
| L03.315 | Cellulitis of perineum |
| L03.316 | Cellulitis of umbilicus |
| L03.317 | Cellulitis of buttock |
| L03.319 | Cellulitis of trunk, unspecified |
| L03.8 | Cellulitis and acute lymphangitis of other sites |
| L03.81 | Cellulitis of other sites |
| L03.811 | Cellulitis of head [any part, except face] |
| L03.818 | Cellulitis of other sites |
| L03.9 | Cellulitis and acute lymphangitis, unspecified |
| L03.90 | Cellulitis, unspecified |
| L08.9 | Local infection of the skin and subcutaneous tissue, unspecified |
| N48.22 | Cellulitis of corpus cavernosum and penis |
| Skin and skin structure klebsiella infection | |
| B96.1 | Klebsiella pneumoniae [k. pneumoniae] as the cause of diseases classified elsewhere |
| L08.9 | Local infection of the skin and subcutaneous tissue, unspecified |
| Skin and skin structure proteus infection | |
| B96.4 | Proteus (mirabilis) (morganii) as the cause of diseases classified elsewhere |
| L08.9 | Local infection of the skin and subcutaneous tissue, unspecified |
| Staphylococcus aureus skin and skin structure infection | |
| B95.6 | Staphylococcus aureus as the cause of diseases classified elsewhere |
| H60.1 | Cellulitis of external ear |
| H60.10 | Cellulitis of external ear, unspecified ear |
| H60.11 | Cellulitis of right external ear |
| H60.12 | Cellulitis of left external ear |
| H60.13 | Cellulitis of external ear, bilateral |
| J34.0 | Abscess, furuncle and carbuncle of nose |
| L02 | Cutaneous abscess, furuncle and carbuncle |
| L02.0 | Cutaneous abscess, furuncle and carbuncle of face |
| L02.02 | Furuncle of face |
| L02.03 | Carbuncle of face |
| L02.1 | Cutaneous abscess, furuncle and carbuncle of neck |
| L02.12 | Furuncle of neck |
| L02.13 | Carbuncle of neck |
| L02.2 | Cutaneous abscess, furuncle and carbuncle of trunk |
| L02.22 | Furuncle of trunk |
| L02.221 | Furuncle of abdominal wall |
| L02.222 | Furuncle of back [any part, except buttock] |
| L02.223 | Furuncle of chest wall |
| L02.224 | Furuncle of groin |
| L02.225 | Furuncle of perineum |
| L02.226 | Furuncle of umbilicus |
| L02.229 | Furuncle of trunk, unspecified |
| L02.23 | Carbuncle of trunk |
| L02.231 | Carbuncle of abdominal wall |
| L02.232 | Carbuncle of back [any part, except buttock] |
| L02.233 | Carbuncle of chest wall |
| L02.234 | Carbuncle of groin |
| L02.235 | Carbuncle of perineum |
| L02.236 | Carbuncle of umbilicus |
| L02.239 | Carbuncle of trunk, unspecified |
| L02.3 | Cutaneous abscess, furuncle and carbuncle of buttock |
| L02.32 | Furuncle of buttock |
| L02.33 | Carbuncle of buttock |
| L02.4 | Cutaneous abscess, furuncle and carbuncle of limb |
| L02.42 | Furuncle of limb |
| L02.421 | Furuncle of right axilla |
| L02.422 | Furuncle of left axilla |
| L02.423 | Furuncle of right upper limb |
| L02.424 | Furuncle of left upper limb |
| L02.425 | Furuncle of right lower limb |
| L02.426 | Furuncle of left lower limb |
| L02.429 | Furuncle of limb, unspecified |
| L02.43 | Carbuncle of limb |
| L02.431 | Carbuncle of right axilla |
| L02.432 | Carbuncle of left axilla |
| L02.433 | Carbuncle of right upper limb |
| L02.434 | Carbuncle of left upper limb |
| L02.435 | Carbuncle of right lower limb |
| L02.436 | Carbuncle of left lower limb |
| L02.439 | Carbuncle of limb, unspecified |
| L02.5 | Cutaneous abscess, furuncle and carbuncle of hand |
| L02.52 | Furuncle hand |
| L02.521 | Furuncle right hand |
| L02.522 | Furuncle left hand |
| L02.529 | Furuncle unspecified hand |
| L02.53 | Carbuncle of hand |
| L02.531 | Carbuncle of right hand |
| L02.532 | Carbuncle of left hand |
| L02.539 | Carbuncle of unspecified hand |
| L02.6 | Cutaneous abscess, furuncle and carbuncle of foot |
| L02.62 | Furuncle of foot |
| L02.621 | Furuncle of right foot |
| L02.622 | Furuncle of left foot |
| L02.629 | Furuncle of unspecified foot |
| L02.63 | Carbuncle of foot |
| L02.631 | Carbuncle of right foot |
| L02.632 | Carbuncle of left foot |
| L02.639 | Carbuncle of unspecified foot |
| L02.8 | Cutaneous abscess, furuncle and carbuncle of other sites |
| L02.82 | Furuncle of other sites |
| L02.821 | Furuncle of head [any part, except face] |
| L02.828 | Furuncle of other sites |
| L02.83 | Carbuncle of other sites |
| L02.831 | Carbuncle of head [any part, except face] |
| L02.838 | Carbuncle of other sites |
| L02.9 | Cutaneous abscess, furuncle and carbuncle, unspecified |
| L02.92 | Furuncle, unspecified |
| L02.93 | Carbuncle, unspecified |
| L03.01 | Cellulitis of finger |
| L03.011 | Cellulitis of right finger |
| L03.012 | Cellulitis of left finger |
| L03.019 | Cellulitis of unspecified finger |
| L03.03 | Cellulitis of toe |
| L03.031 | Cellulitis of right toe |
| L03.032 | Cellulitis of left toe |
| L03.039 | Cellulitis of unspecified toe |
| L03.1 | Cellulitis and acute lymphangitis of other parts of limb |
| L03.11 | Cellulitis of other parts of limb |
| L03.111 | Cellulitis of right axilla |
| L03.112 | Cellulitis of left axilla |
| L03.113 | Cellulitis of right upper limb |
| L03.114 | Cellulitis of left upper limb |
| L03.115 | Cellulitis of right lower limb |
| L03.116 | Cellulitis of left lower limb |
| L03.119 | Cellulitis of unspecified part of limb |
| L03.2 | Cellulitis and acute lymphangitis of face and neck |
| L03.21 | Cellulitis and acute lymphangitis of face |
| L03.211 | Cellulitis of face |
| L03.22 | Cellulitis and acute lymphangitis of neck |
| L03.221 | Cellulitis of neck |
| L03.3 | Cellulitis and acute lymphangitis of trunk |
| L03.31 | Cellulitis of trunk |
| L03.311 | Cellulitis of abdominal wall |
| L03.312 | Cellulitis of back [any part except buttock] |
| L03.313 | Cellulitis of chest wall |
| L03.314 | Cellulitis of groin |
| L03.315 | Cellulitis of perineum |
| L03.316 | Cellulitis of umbilicus |
| L03.317 | Cellulitis of buttock |
| L03.319 | Cellulitis of trunk, unspecified |
| L03.8 | Cellulitis and acute lymphangitis of other sites |
| L03.81 | Cellulitis of other sites |
| L03.811 | Cellulitis of head [any part, except face] |
| L03.818 | Cellulitis of other sites |
| L03.9 | Cellulitis and acute lymphangitis, unspecified |
| L03.90 | Cellulitis, unspecified |
| L08.89 | Other specified local infections of the skin and subcutaneous tissue |
| L08.9 | Local infection of the skin and subcutaneous tissue, unspecified |
| N48.22 | Cellulitis of corpus cavernosum and penis |
Formulary Reference Tool