Ampicillin

 Risk Factor: B
 Class: ANTI-INFECTIVES / Penicillins

Contents of this page:

Fetal Risk Summary
Breast Feeding Summary
References
Questions and Answers

Fetal Risk Summary

Ampicillin is a penicillin antibiotic (see also Penicillin G). The drug rapidly crosses the placenta into the fetal circulation and amniotic fluid (1,2,3,4,5 and 6). Fetal serum levels can be detected within 30 minutes and equilibrate with maternal serum in 1 hour. Amniotic fluid levels can be detected in 90 minutes, reaching 20% of the maternal serum peak in about 8 hours. The pharmacokinetics of ampicillin during pregnancy have been reported (7,8).

Ampicillin depresses both plasma-bound and urinary excreted estriol by inhibiting steroid conjugate hydrolysis in the gut (9,10,11,12 and 13). Urinary estriol was formerly used to assess the condition of the fetoplacental unit, depressed levels being associated with fetal distress. This assessment is now made by measuring plasma unconjugated estriol, which is not usually affected by ampicillin. An interaction between ampicillin and oral contraceptives resulting in pregnancy has been suspected (14,15). Two studies, however, failed to confirm this interaction and concluded that alternate contraceptive methods were not necessary during ampicillin therapy (16,17).

The use of ampicillin in early pregnancy was associated with a prevalence ratio estimate of 3.3 (90% confidence intervals [CI] 1.38.1, p=0.02) for congenital heart disease in a retrospective study (18). A specific defect, transposition of the great arteries, had a risk of 7.7 (90% CI 1.338) based on exposure in 2 of the 29 infants with the anomaly. The investigators did note, however, that the results had to be viewed cautiously because the data were subject to recall bias (drug histories were taken by questionnaire or telephone up to a year after presumed exposure) and the study could not distinguish between the fetal effects of the drug versus those of the infectious agent(s) for which the drugs were used. Others have also shared this concern (19). Other reports linking the use of ampicillin with congenital defects have not been located.

The Collaborative Perinatal Project monitored 50,282 mother-child pairs, 3,546 of whom had 1st trimester exposure to penicillin derivatives (20, pp. 297313). For use anytime during pregnancy, 7,171 exposures were recorded (20, p. 435). In neither group was evidence found to suggest a relationship to large categories of major or minor malformations or to individual defects. Based on these data, it is unlikely that ampicillin is teratogenic.

In a surveillance study of Michigan Medicaid recipients involving 229,101 completed pregnancies conducted between 1985 and 1992, 10,011 newborns had been exposed to ampicillin during the 1st trimester (F. Rosa, personal communication, FDA, 1993). A total of 441 (4.4%) major birth defects were observed (426 expected). Specific data were available for six defect categories, including (observed/expected) 116/100 cardiovascular defects, 13/16 oral clefts, 6/8 spina bifida, 36/29 polydactyly, 9/17 limb reduction defects, and 27/24 hypospadias. These data do not support an association between the drug and the defects.

Ampicillin is often used in the last half of pregnancies in which either the woman or her fetus is at risk for infections because of premature rupture of the membranes or other risk factors (21,22 and 23). In one report, a mother with ruptured membranes at 40 weeks' gestation had an anaphylactic reaction to ampicillin (24). A markedly distressed infant was delivered with severe metabolic acidosis (arterial cord blood pH 6.71). Multifocal clonic seizures and brain edema occurred during the neonatal period and pronounced neurologic abnormalities were evident at 6 months of age.

Breast Feeding Summary

Ampicillin is excreted into breast milk in low concentrations. Milk:plasma ratios have been reported up to 0.2 (25,26). Candidiasis and diarrhea were observed in one infant whose mother was receiving ampicillin (27). Other reports of this effect have not been located. Although adverse effects are apparently rare, three potential problems exist for the nursing infant: modification of bowel flora, direct effects on the infant (e.g., allergic response or sensitization), and interference with the interpretation of culture results if a fever workup is required.

References

1. Bray R, Boc R, Johnson W. Transfer of ampicillin into fetus and amniotic fluid from maternal plasma in late pregnancy. Am J Obstet Gynecol 1966;96:93842.
2. MacAulay M, Abou-Sabe M, Charles D. Placental transfer of ampicillin. Am J Obstet Gynecol 1966;96:94350.
3. Biro L, Ivan E, Elek E, Arr M. Data on the tissue concentration of antibiotics in man. Tissue concentrations of semi-synthetic penicillins in the fetus. Int Z Klin Pharmakol Ther Toxikol 1970;4:3214.
4. Elek E, Ivan E, Arr M. Passage of penicillins from mother to foetus in humans. Int J Clin Pharmacol Ther Toxicol 1972;6:2238.
5. Kraybill EN, Chaney NE, McCarthy LR. Transplacental ampicillin: inhibitory concentrations in neonatal serum. Am J Obstet Gynecol 1980;138:7936.
6. Jordheim O, Hagen AG. Study of ampicillin levels in maternal serum, umbilical cord serum and amniotic fluid following administration of pivampicillin. Acta Obstet Gynecol Scand 1980;59:3157.
7. Philipson A. Pharmacokinetics of ampicillin during pregnancy. J Infect Dis 1977;136:3706.
8. Noschel VH, Peiker G, Schroder S, Meinhold P, Muller B. Untersuchungen zur pharmakokinetik von antibiotika und sulfanilamiden in der schwangerschaft und unter der geburt. Zentralbl Gynakol 1982;104:15148.
9. Willman K, Pulkkinen M. Reduced maternal plasma and urinary estriol during ampicillin treatment. Am J Obstet Gynecol 1971;109:8936.
10. Boehn F, DiPietro D, Goss D. The effect of ampicillin administration on urinary estriol and serum estradiol in the normal pregnant patient. Am J Obstet Gynecol 1974;119:98101.
11. Sybulski S, Maughan G. Effect of ampicillin administration on estradiol, estriol and cortisol levels in maternal plasma and on estriol levels in urine. Am J Obstet Gynecol 1976;124:37981.
12. Aldercreutz H, Martin F, Lehtinen T, Tikkanen M, Pulkkinen M. Effect of ampicillin administration on plasma conjugated and unconjugated estrogen and progesterone levels in pregnancy. Am J Obstet Gynecol 1977;128:26671.
13. Van Look PFA, Top-Huisman M, Gnodde HP. Effect of ampicillin or amoxycillin administration on plasma and urinary estrogen levels during normal pregnancy. Eur J Obstet Gynecol Reprod Biol 1981;12:22533.
14. Dossetor J. Drug interactions with oral contraceptives. Br Med J 1975;4:4678.
15. DeSano EA Jr, Hurley SC. Possible interactions of antihistamines and antibiotics with oral contraceptive effectiveness. Fertil Steril 1982;37:8534.
16. Friedman CI, Huneke AL, Kim MH, Powell J. The effect of ampicillin on oral contraceptive effectiveness. Obstet Gynecol 1980;55:337.
17. Back DJ, Breckenridge AM, MacIver M, Orme M, Rowe PH, Staiger C, Thomas E, Tjia J. The effects of ampicillin on oral contraceptive steroids in women. Br J Clin Pharmacol 1982;14:438.
18. Rothman KJ, Fyler DC, Goldblatt A, Kreidberg MB. Exogenous hormones and other drug exposures of children with congenital heart disease. Am J Epidemiol 1979;109:4339.
19. Zierler S. Maternal drugs and congenital heart disease. Obstet Gynecol 1985;65:15565.
20. Heinonen OP, Slone D, Shapiro S. Birth Defects and Drugs in Pregnancy. Littleton, MA:Publishing Sciences Group, 1977.
21. Boyer KM, Gotoff SP. Prevention of early-onset neonatal group B streptococcal disease with selective intrapartum chemoprophylaxis. N Engl J Med 1986;314:16659.
22. Amon E, Lewis SV, Sibai BM, Villar MA, Arheart KL. Ampicillin prophylaxis in preterm premature rupture of the membranes: a prospective randomized study. Am J Obstet Gynecol 1988;159:53943.
23. Morales WJ, Angel JL, O'Brien WF, Knuppel RA. Use of ampicillin and corticosteroids in premature rupture of membranes: a randomized study. Obstet Gynecol 1989;73:7216.
24. Heim K, Alge A, Marth C. Anaphylactic reaction to ampicillin and severe complication in the fetus. Lancet 1991;337:859.
25. Wilson J, Brown R, Cherek D, Dailey JW, Hilman B, Jobe PC, Manno BR, Manno JE, Redetzki HM, Stewart JJ. Drug excretion in human breast milk: principles, pharmacokinetics and projected consequences. Clin Pharmacol Ther 1980;5:166.
26. Knowles J. Excretion of drugs in milka review. J Pediatr 1965;66:106882.
27. Williams M. Excretion of drugs in milk. Pharm J 1976;217:219.
    
    

Questions and Answers

i am 15 weeks pregnant and have a UTI doc prescribed ampicillin 500mg 4 times a day for 7 days. i am afraid of

taking meds when not pregnant, so now that i am pregnant i am terrified of taking this antibiotic. Has anyone else had a uti and prescribed the same thing. thanks.

I took ampicillin at 36wks for an ear infection and was also given the same during labor because my water had been broke for more than 24hrs. Having an untreated UTI can cause preterm labor and miscarriage. Your body decides that the baby is safer out then in because of how dangerous infection is. The extremely small risk is worth it.

Can a pregnant woman of over four months take ampicillin tablets?

First of all antibiotics shouldn't be taken if not prescribed by a doctor!
But if that's the case there should be no problem.

"PREGNANCY: Ampicillin is considered safe during pregnancy.

NURSING MOTHERS: Ampicillin is excreted in breast milk. No side effects have been reported in nursing infants whose mothers have taken ampicillin. Concern for side effects such as allergic reactions, of course, exist. Thus, physicians weigh the potential risk of allergy versus the benefits.

SIDE EFFECTS: Allergic reactions are relatively common side effects during therapy with any of the penicillins. These reactions can range from rashes to anaphylaxis, a severe condition in which there may be shock and even death. Rashes occur more frequently with ampicillin than with the other penicillins. The incidence of rash with ampicillin seems to be higher in patients with viral illnesses, such as mononucleosis. Patients with a history of allergic reaction to any other penicillin should not receive ampicillin. Persons who are allergic to the cephalosporin class of antibiotics which is more distantly related to the penicillins (e.g., Ceclor, Keflex, Cefzil) may or may not be allergic to penicillins.

Nausea, vomiting, loss of appetite, diarrhea, and abdominal pain are commonly reported gastrointestinal side effects during ampicillin therapy, but are rarely severe. Diarrhea appears to occur more frequently with ampicillin than with the other penicillins." (http://www.medicinenet.com/ampicillin/ar...

pregnant getting over flu, I wheeze when I lay down just finished ampicillin, still coughing white sputum?

I am 20 weeks pregnant I have been sick for over two weeks , just finished ampicillin cause I was sick with flu stuff for too long the md said, now I have a cough with white sputum and wheezy when I lay down I cough so hard sometimes I drip urine nasal drainage is clear any ideas of what can be causing this or what I should do????

antibiotics don't help the flu. you must've developed some kind of respiratory condition which is why the ampicillin for a pregnant woman. the prblem is that you're preggers and there are very few things you can take to alleviate the symptoms which is all you can really do for the flu. macrobid is an antibiotic that pregnant women can take but it doesn't work as well with respir problems as it does with urinary problems. call your doc and ask for a longer schedule of ampicillin. you can take it twice a day for up to 14 days. a more suitable drug would be augmentin (amoxicillin/clavulanate potassium) which i am fairly certain has low pregnancy risks and is teh better choice to fight the nasal conditon and the lung congestion. ampicillin doesn't cross the membranes necessary to fight sinusitis which means you'll continue to drain into your lungs and that will never clea up either. look up augmentin, ampicillin, and amoxicillin on rxlist.com for more info.

am 9 weeks pregnant and i was wondring is it safe to take Ampicillin 500mg?

Not unless your doctor says it is okay. It seems like you think you need it, but have not been prescribed it for this instance. Pregnancy is not the time to take chances.

Call your doctor, or get a doctor, whatever you need to do to get sound medical advice.

Did you have UTI when you were pregnant?

Were you prescribed with Ampicillin?
How much dosage were you taking and how many times did you have to take it daily? Is my baby safe with it?

UTI's are very common in pregnancy. Many women have several throughout their pregnancy and are without symptoms. Ampicillin is usually prescribed 4 times a day and is totally safe with pregnancy.

am 9 weeks pregnant and spotting blood so today i went to the doctor and they gave me a shot to prevent?

misscarige also they gave me a baby asprin and Ampicillin to take for one week is this safe? i already saw the heartbeat and the baby is doing good.

Your baby is fine just do what your doctor said. With my second son I ended up with a bacterial infection where I would bleed off and on and they put me on ampicillin to clear it up. Just try to relax.

10weeks pregnant and got a flu?

i have the worse flu and ear infection. the doc gave me ampicillin but it turns my stomach and makes me sick! will the baby be suffering to if i am not eating much? any remedies

I got a list of medications from my Dr. that are safe to take while pregnant and you CAN take tylenol cold/flu which wil help tremendously! Also try to drink powerade or gatorade as much as possible. Lots of rest and fluids. I really feel for you. I am 9 weeks 2 days pregnant. Best Wishes