Situation              HNE LHD ampicillin shortage fact sheet 2015

There is a global stock shortage of all intravenous (IV) ampicillin (and amoxycillin), with no clear indication as to when this shortage will be resolved. The shortage does not currently affect the supply of oral formulations, which are still available.

Recommendations

Where ampicillin IV is recommended for empirical antimicrobial treatment, cephazolin IV can usually be substituted. If enterococcal cover is specifically required, benzylpenicillin IV is likely to be of use but discuss with Infectious Diseases.

In general, piperacillin+tazobactam or ceftriaxone/cefotaxime are NOT suitable replacements for IV ampicillin.

Urinary tract infections/pyelonephritis

Use gentamicin as per Therapeutic Guidelines: Antibiotic. Use ceftriaxone only if gentamicin is contraindicated.

Note: enterococci are always resistant to gentamicin & ceftriaxone

Intra-abdominal infections

Use cephazolin 2 g IV 8 hourly (Paediatric dose: 50 mg/kg IV up to 2 g IV 8 hourly) in combination with metronidazole (12 hourly) and gentamicin.

Surgical prophylaxis

Neither ampicillin nor amoxycillin is recommended for any reason as surgical prophylaxis. Use the HNELHD surgical prophylaxis guideline:

HNELHD_CG_14_35_Surgical_Antibiotic_Prophylaxis

For further updates, cumulative antibiograms, internet links to local (HNE) and NSW guidelines, navigate to www.aimed.net.au; the Pathology North and Hunter Drug Information Service’s antimicrobial stewardship resource.

If in doubt, contact Infectious Diseases/Clinical Microbiology- see About page on this blog for contact details