- Discussion:
    - for beta lactamase producing Staph aereus, Eneterococcus, H. influenza, Klebsiella, Proteus mirablis, Bacteroides
    - adult: 1.5-3 gm IM/IV q6hr (2:1 ampicillin sodium:sulbactam) adjust w/ Renal failure;
    - good diffusion from blood into CSF only with inflammation;
    - inflammed meninges: 5-10;
    - peds: Dosed as Ampicillin;
    - supplied: Powder for Injection 1.5 gm, 3.0 gm vials;
    - sulbactam:
           - is semisynthetic beta-lactamase inhibitor w/ activity against a broad range of beta-lactamases, including those produced by bacteroides,
                     Haemophilus, Klebsiella, E. coli,  and N. gonorrhoeae;
           - it is currently available as parenteral preparation in combination w/ ampicillin (Unasyn -- 2 g of ampicillin and 1.0 g of sulbactam);
           - given every six hours, combination has been successful in treatment of variety of infections, including intraabdominal & pelvic infections,
                     infections of skin, soft tissue, and bones and joints, and uncomplicated urethritis caused by pen-sensitive and pen-resistant N. gonorrhoeae;

    - cautions:
          - dosing regimens for patients with renal insufficiency;
          - dose for 70 kg Adult {gm/dosing interval in hours} CrCl >80: 1.5-3/6-8; CrCl:50-79: 1.5-3/6-8; CrCl:30-49: 1.5-3/6-8; CrCl:10-29: 1.5-3/12;
          - note prophylaxis of bacterial endocarditis: Amp 2.0gm IM or IV 30min before procedure + Gent 1.5mg/kg IM or IV 30min before procedure;
          - watch for hypersensitivity, erythematous maculopapular rash occurring 2-4 weeks after 1st dose

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