Source: FDA, National Drug Code (US) Revision Year: 2021
UNASYN is indicated for the treatment of infections due to susceptible strains of the designated microorganisms in the conditions listed below.
Skin and Skin Structure Infections caused by beta-lactamase producing strains of Staphylococcus aureus, Escherichia coli,2 Klebsiella spp.2 (including K. pneumoniae2), Proteus mirabilis,2 Bacteroides fragilis,2 Enterobacter spp.,2 and Acinetobacter calcoaceticus2.
NOTE: For information on use in pediatric patients (see PRECAUTIONS-Pediatric Use and CLINICAL STUDIES sections).
Intra-Abdominal Infections caused by beta-lactamase producing strains of Escherichia coli, Klebsiella spp. (including K. pneumoniae2), Bacteroides spp. (including B. fragilis), and Enterobacter spp.2
Gynecological Infections caused by beta-lactamase producing strains of Escherichia coli,2 and Bacteroides spp.2 (including B. fragilis2).
While UNASYN is indicated only for the conditions listed above, infections caused by ampicillin-susceptible organisms are also amenable to treatment with UNASYN due to its ampicillin content. Therefore, mixed infections caused by ampicillin-susceptible organisms and beta-lactamase producing organisms susceptible to UNASYN should not require the addition of another antibacterial.
Appropriate culture and susceptibility tests should be performed before treatment in order to isolate and identify the organisms causing infection and to determine their susceptibility to UNASYN.
Therapy may be instituted prior to obtaining the results from bacteriological and susceptibility studies when there is reason to believe the infection may involve any of the beta-lactamase producing organisms listed above in the indicated organ systems. Once the results are known, therapy should be adjusted if appropriate.
To reduce the development of drug-resistant bacteria and maintain effectiveness of UNASYN and other antibacterial drugs, UNASYN should be used only to treat infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
2 Efficacy for this organism in this organ system was studied in fewer than 10 infections
The pharmacy bulk package is for preparation of solutions for IV infusion only. UNASYN should be administered by slow intravenous injection over at least 10-15 minutes or can also be delivered in greater dilutions with 50-100 mL of a compatible diluent as an intravenous infusion over 15-30 minutes.
The recommended adult dosage of UNASYN is 1.5 g (1 g ampicillin as the sodium salt plus 0.5 g sulbactam as the sodium salt) to 3 g (2 g ampicillin as the sodium salt plus 1 g sulbactam as the sodium salt) every six hours. This 1.5 to 3 g range represents the total of ampicillin content plus the sulbactam content of UNASYN, and corresponds to a range of 1 g ampicillin/0.5 g sulbactam to 2 g ampicillin/1 g sulbactam. The total dose of sulbactam should not exceed 4 grams per day.
The recommended daily dose of UNASYN in pediatric patients is 300 mg per kg of body weight administered via intravenous infusion in equally divided doses every 6 hours. This 300 mg/kg/day dosage represents the total ampicillin content plus the sulbactam content of UNASYN, and corresponds to 200 mg ampicillin/100 mg sulbactam per kg per day. The safety and efficacy of UNASYN administered via intramuscular injection in pediatric patients have not been established. Pediatric patients weighing 40 kg or more should be dosed according to adult recommendations, and the total dose of sulbactam should not exceed 4 grams per day. The course of intravenous therapy should not routinely exceed 14 days. In clinical trials, most children received a course of oral antimicrobials following initial treatment with intravenous UNASYN (see CLINICAL STUDIES section).
In patients with impairment of renal function the elimination kinetics of ampicillin and sulbactam are similarly affected, hence the ratio of one to the other will remain constant whatever the renal function. The dose of UNASYN in such patients should be administered less frequently in accordance with the usual practice for ampicillin and according to the following recommendations:
Table 3. UNASYN Dosage Guide for Patients with Renal Impairment:
| Creatinine Clearance (mL/min/1.73m2) | Ampicillin/Sulbactam Half-Life (Hours) | Recommended UNASYN Dosage |
|---|---|---|
| ≥30 | 1 | 1.5-3 g q 6h-q 8h |
| 15–29 | 5 | 1.5-3 g q 12h |
| 5–14 | 9 | 1.5-3 g q 24h |
When only serum creatinine is available, the following formula (based on sex, weight, and age of the patient) may be used to convert this value into creatinine clearance. The serum creatinine should represent a steady state of renal function.
| Males | weight (kg) × (140 – age) 72 × serum creatinine |
| Females | 0.85 × above value |
When concomitant therapy with aminoglycosides is indicated, UNASYN and aminoglycosides should be reconstituted and administered separately, due to the in vitro inactivation of aminoglycosides by any of the aminopenicillins.
UNASYN sterile powder for intravenous use may be reconstituted with any of the compatible diluents described in this insert. Solutions should be allowed to stand after dissolution to allow any foaming to dissipate in order to permit visual inspection for complete solubilization.
UNASYN concentrations between 3 and 45 mg (2 to 30 mg ampicillin/1 to 15 mg sulbactam/mL) are recommended for intravenous use.
The 15 gram vial may be reconstituted with either 92 mL Sterile Water for Injection or 0.9% Sodium Chloride Injection. The diluent should be added in two separate aliquots in a suitable work area, such as a laminar flow hood. Add 50 mL of solution, shake to dissolve. Then add an additional 42 mL and shake. The solution should be allowed to stand after dissolution to allow any foaming to dissipate in order to permit visual inspection for complete solubilization. The resultant solution will have a final concentration of approximately 100 mg/mL ampicillin and 50 mg/mL sulbactam. The closure may be penetrated only one time after reconstitution, if needed, using a suitable sterile transfer device or dispensing set that allows for measured dispensing of the contents.
After reconstitution, use within two hours if stored at room temperature, or within four hours if stored under refrigeration.
Reconstituted Bulk Solution Should Not be Used For Direct Infusion
If the reconstituted bulk solution is stored for less than one hour at room temperature (20°C/68°F) prior to further dilution, the use periods indicated in Table 4 apply for the diluted solutions.
If the bulk solution is stored for one to two hours at room temperature (20°C/68°F) and then diluted with Sterile Water for Injection or 0.9% Sodium Chloride Injection to the following concentrations, the use periods indicated in Table 5 apply.
Any unused portions of solution that remain after the indicated time periods should be discarded.
Table 4:
| Diluent | Maximum Concentration (mg/mL) UNASYN (Ampicillin/Sulbactam) | Use Periods |
|---|---|---|
| Sterile Water for Injection | 45 (30/15) 45 (30/15) 30 (20/10) | 8 hrs at 21°C 48 hrs at 4°C 72 hrs at 4°C |
| 0.9% Sodium Chloride Injection | 45 (30/15) 45 (30/15) 30 (20/10) | 8 hrs at 21°C 48 hrs at 4°C 72 hrs at 4°C |
| 5% Dextrose Injection | 30 (20/10) 30 (20/10) 3 (2/1) | 2 hrs at 21°C 4 hrs at 4°C 2 hrs at 21°C |
| Lactated Ringer’s Injection | 45 (30/15) 45 (30/15) | 8 hrs at 21°C 24 hrs at 4°C |
| M/6 Sodium Lactate Injection | 45 (30/15) 45 (30/15) | 8 hrs at 21°C 12 hrs at 4°C |
| 5% Dextrose in 0.45% Saline | 3 (2/1) 15 (10/5) | 4 hrs at 21°C 4 hrs at 4°C |
| 10% Invert Sugar | 3 (2/1) 30 (20/10) | 4 hrs at 21°C 3 hrs at 4°C |
Table 5:
| IV Solution | Maximum Concentration (mg/mL) UNASYN (Ampicillin/Sulbactam) | Use Period |
|---|---|---|
| Sterile Water for Injection, USP | 45 (30/15) 45 (30/15) | 4 hrs at 21°C 24 hrs at 4°C |
| 0.9% Sodium Chloride Injection, USP | 45 (30/15) 45 (30/15) | 4 hrs at 21°C 24 hrs at 4°C |
Neurological adverse reactions, including convulsions, may occur with the attainment of high CSF levels of beta-lactams. Ampicillin may be removed from circulation by hemodialysis. The molecular weight, degree of protein binding and pharmacokinetics profile of sulbactam suggest that this compound may also be removed by hemodialysis.
UNASYN sterile powder is to be stored at or below 30°C (86°F) prior to reconstitution.
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