Tuesday, January 17, 2017

Acinetobacter : Oral vs Parenteral Unasyn

  • T. Unasyn 375mg(sultamicillin- ampicillin 220mg, Sulbactam 147mg)
  • Inj Unasyn 1.5g (ampicillin 1g, Sulbactam 0.5g )
Sensitivity
  • β-Lactamase inhibitors, including sulbactam, bind to β-lactamase, thereby increasing the susceptibility of the microorganism to co-administered β-lactam antibiotics.
  • most β-lactamase inhibitors do not exert antimicrobial activity if given alone
  • Sulbactam, however, has been demonstrated to have antimicrobial properties, including against A. baumannii, which are thought to be mediated by binding to penicillin binding-proteins
  • Although the available evidence suggests that sulbactam-based therapies can be effective for the treatment of A. baumannii infection, there is little evidence to suggest that sulbactam-based therapies are more or less effective than alternative therapies
Dose
  • Ranges from 3g QID to 3g 3 hourly (suspected MDR pathogens)
Coversions to Oral dose
  • No supporting evidence or guidelines on use of oral Unasyn for eradication therapy
  • No guides on dose equivalence/conversion of IV to oral for management of Acinetobacter
  • As A baumannii is intrinsically multidrug resistant, it is highly recommended to achieve sufficient levels by using therapeutic doses of IV Unasyn ( compared to Oral/ which may not achieve the required sulbacam doses based on usual IV to Oral conversions)
References:
3.   Guide to Antimicrobial Therapy in Adults 2012
5.   http://emedicine.medscape.com/article/236891-medication

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