What are the considerations for using ampicillin in elderly males?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: April 7, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

From the Guidelines

Ampicillin is not recommended for use in elderly men due to high rates of resistance among community-acquired E. coli. When considering the use of ampicillin in elderly men, it is essential to weigh the potential benefits against the risks, particularly in the context of community-acquired infections. The guidelines from the Surgical Infection Society and the Infectious Diseases Society of America 1 emphasize the importance of selecting antimicrobial regimens that are active against enteric gram-negative aerobic and facultative bacilli and enteric gram-positive streptococci. However, ampicillin-sulbactam is not recommended due to high resistance rates among community-acquired E. coli.

Some key points to consider when evaluating the use of ampicillin in elderly men include:

  • Age-related changes in kidney function, which may necessitate dose adjustments based on creatinine clearance 1
  • Potential drug interactions, particularly with allopurinol, which can increase the risk of rash
  • Monitoring for side effects, including diarrhea, nausea, and rash, as well as the risk of antibiotic-associated colitis
  • Resistance patterns, which have increased over time, affecting the drug's effectiveness against various infections

In general, the use of ampicillin in elderly men should be approached with caution, taking into account the potential risks and benefits, as well as alternative treatment options that may be more effective and safer. The guidelines recommend considering local microbiologic data, cost advantage, allergies, and formulary availability when selecting antimicrobial agents 1.

Given the availability of less toxic agents demonstrated to be at least equally effective, alternative treatments should be considered, especially in the context of community-acquired intra-abdominal infections. The Expert Panel's concerns regarding the broad use of certain agents, such as ertapenem, and the increasing antimicrobial resistance among B. fragilis isolates, highlight the need for careful consideration of treatment options 1.

Ultimately, the decision to use ampicillin in elderly men should be based on a thorough evaluation of the individual patient's needs and circumstances, taking into account the latest evidence and guidelines. The most recent and highest quality study recommends against the use of ampicillin-sulbactam due to high resistance rates 1.

From the FDA Drug Label

Patients with gonorrhea who also have syphilis should be given additional appropriate parenteral penicillin treatment The FDA drug label does not answer the question.

From the Research

Pharmacokinetics of Ampicillin in Elderly Men

  • The absorption and disposition of ampicillin in elderly men was studied in 1980 2, which found that plasma clearance after intravenous ampicillin was significantly decreased in the elderly, and half-life and area under the plasma level-time curve were significantly increased.
  • The study attributed the changes in drug handling noted in the elderly to a decrease in the renal elimination of ampicillin.
  • Following oral administration, a significant increase in half-life, area under the plasma level-time curve, and maximum plasma concentration of ampicillin was found in elderly subjects 2.

Considerations for Antibiotic Therapy in Elderly Patients

  • A 2020 review highlighted the need for special considerations in antibiotic prescription for elderly patients, including individualized dose selection and awareness of potential side effects and drug-drug interactions 3.
  • The review emphasized the importance of understanding the altered pharmacokinetics and pharmacodynamics of drugs in elderly patients due to co-morbid conditions and normal physiological changes associated with aging.
  • Clinicians should be aware of the major drug-drug interactions commonly observed in the elderly and potential side effects, and adjust antibiotic therapy accordingly 3.

Nephrotoxicity of Antimicrobials and Antibiotics

  • A 2020 study discussed the nephrotoxicity of antimicrobials and antibiotics, including the risk of acute kidney injury (AKI) in hospitalized patients 4.
  • The study highlighted the importance of prevention and early recognition of AKI to mitigate morbidity.
  • General risk factors for antimicrobial-induced AKI include pre-existing chronic kidney disease and concomitant use of medication with nephrotoxic potential 4.

Dosage Adjustment in Renal Insufficiency

  • A 1983 study analyzed the relationship between functional damage and transport processes in the kidney in patients with glomerulonephritis and renal failure 5.
  • The study found that dosage adjustment based on creatinine clearance is not appropriate for patients receiving drugs requiring active tubular secretion for urinary excretion, such as ampicillin and cephalexin.
  • The study suggested that a dosage adjustment method that involves both glomerular and renal tubular functions is required for patients with renal insufficiency 5.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Absorption and disposition of ampicillin in the elderly.

European journal of clinical pharmacology, 1980

4
Research

Nephrotoxicity of Antimicrobials and Antibiotics.

Advances in chronic kidney disease, 2020

5
Research

Ampicillin and cephalexin in renal insufficiency.

Clinical pharmacology and therapeutics, 1983

Related Questions

What is the recommended treatment for a 32-year-old patient with acute pyelonephritis?
What treatment is recommended for a 47-year-old female (F) patient with acute pyelonephritis, complaining of dyspepsia and bloating, and presenting with hypotension?
What antibiotics are recommended for a 90-year-old female with suspected pyelonephritis, vomiting, and allergies to sulfa and penicillin, with impaired renal function (eGFR) and currently taking duloxetine?
What is the best next step in managing a 35-year-old woman, gravida (number of times pregnant) 1, para (number of viable births) 0, at 35 weeks gestation, with persistent fever and chills, despite broad-spectrum intravenous antibiotics for acute pyelonephritis (infection of the kidney), and presenting with tachycardia (elevated heart rate), fever, and flank tenderness?
What antibiotic is recommended for a 24-year-old with mild pyelonephritis, low-grade fever, and a 4-day history of symptoms, who is allergic to Penicillin (PCN) and Amoxicillin?
When should a newly pregnant patient with an indeterminate rubella (German measles) immunity status receive a rubella vaccine booster?
Should a 69-year-old male patient with a history of diabetes, hypertension, Chronic Kidney Disease (CKD), Atrial Fibrillation (AFib), and dementia, taking Eliquis (apixaban), metoprolol, and digoxin, continue olmesartan or explore alternative medications for Impaired Renal Function and well-controlled blood pressure?
What causes recurrent epistaxis (nosebleeds), gastrointestinal (GI) bleeding, and cardiomegaly (enlarged heart)?
What is the appropriate treatment for a 73-year-old man with a urinary tract infection (UTI), whose culture shows sensitivity to ampicillin or Macrobid (nitrofurantoin), and has a creatinine clearance rate (CRCl) indicating mild impaired renal function?
What is the workup for Von Willebrand disease (VWD)?
What is the effect of insulin glargine (long-acting insulin)

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question