From the Guidelines
A person can take ampicillin with ceftriaxone in certain clinical situations, such as infective endocarditis caused by aminoglycoside-resistant enterococcal strains, as recommended by the American Heart Association 1. This combination is sometimes prescribed intentionally as a form of combination antibiotic therapy. Both medications are beta-lactam antibiotics, with ampicillin being a penicillin and ceftriaxone being a third-generation cephalosporin. They work by inhibiting bacterial cell wall synthesis but target slightly different penicillin-binding proteins. Some key points to consider when taking this combination include:
- The combination may be used for synergistic effects against certain infections like enterococcal endocarditis, as supported by the American Heart Association guidelines 1.
- The recommended duration of therapy is six weeks if ampicillin plus ceftriaxone is selected as the treatment regimen, regardless of symptom duration 1.
- This combination should only be taken under direct medical supervision as it can increase the risk of side effects such as diarrhea, rash, or allergic reactions.
- If you have a penicillin allergy, you should inform your healthcare provider before taking this combination.
- The specific dosing and duration will depend on the type and severity of infection being treated, as well as your kidney and liver function. While taking these medications, it's essential to complete the full prescribed course even if symptoms improve before the medication is finished, as recommended by the guidelines 1.
From the Research
Combination Therapy of Ampicillin and Ceftriaxone
- The combination of ampicillin and ceftriaxone has been studied for the treatment of Enterococcus faecalis infective endocarditis, with results showing it to be as effective as ampicillin plus gentamicin 2.
- This combination therapy has been found to have a lower risk of adverse events, such as renal failure, compared to ampicillin plus gentamicin 2, 3.
- Studies have also shown that ampicillin and ceftriaxone can be used together safely, with low rates of renal failure (0%-33%) 3.
- The efficacy of ampicillin plus ceftriaxone has been demonstrated in various studies, including a qualitative systematic review that found similar rates of clinical cure compared to ampicillin and gentamicin 3.
Safety and Efficacy
- Ceftriaxone has been found to be safe for use in patients with penicillin allergy, with no increased risk of allergic reaction 4.
- The combination of ampicillin and ceftriaxone has been shown to be effective against Enterococcus faecalis infections, including endocarditis, with similar activities to other combination therapies such as ampicillin-cefepime and ampicillin-ceftaroline 5.
- However, one study found that the AC24 regimen (once-daily high-dose administration of ceftriaxone) had an unexpected rate of failures, suggesting that the delivery of the combination therapy may need to be optimized 6.
Clinical Implications
- The use of ampicillin and ceftriaxone combination therapy may be considered for patients with Enterococcus faecalis infection who are at high risk for nephrotoxicity or have aminoglycoside-resistant pathogens 3.
- Clinicians should be aware of the potential risks and benefits of using ampicillin and ceftriaxone combination therapy and consider the individual patient's needs and circumstances when making treatment decisions.