Pediatric Sultamicillin Dosing
Standard Dosing Recommendation
For pediatric patients with confirmed bacterial infections, sultamicillin (ampicillin/sulbactam) should be dosed at approximately 30 mg/kg/day divided into 3-4 doses, with a typical range of 25-30 mg/kg/day for oral formulations. 1, 2, 3
Weight-Based Dosing Algorithm
Oral Formulation (Sultamicillin)
- Standard dose: 25-30 mg/kg/day divided into 3-4 doses 1, 2, 3
- Dose range studied: 6.7-30 mg/kg/day, with most effective outcomes at approximately 27-30 mg/kg/day 1, 2, 4
- Administration: Given after meals to optimize absorption 4
Intravenous Formulation (Sulbactam/Ampicillin)
- Standard dose: 75-450 mg/kg/day divided into 4 doses 5
- Typical effective range: 150-300 mg/kg/day for moderate to severe infections 5
- Maximum: Up to 450 mg/kg/day for severe infections 5
Pharmacokinetic Considerations
The oral bioavailability demonstrates predictable absorption patterns:
- Peak serum concentrations occur at 1 hour post-administration for both ampicillin (1.18-5.57 mcg/mL) and sulbactam (0.97-4.66 mcg/mL) components 1, 3, 4
- Half-life: Approximately 1-2 hours for both components 1, 3, 4
- Urinary recovery: 34-77% of both components excreted within 6 hours 1, 3, 4
- Dose-proportional response: Higher doses (15 mg/kg vs 5-10 mg/kg) produce proportionally higher serum levels 1, 3, 4
Critical Consideration for Penicillin Allergy
If the patient has a confirmed penicillin allergy, sultamicillin is absolutely contraindicated as it contains ampicillin, a penicillin derivative. Alternative antibiotics must be selected based on allergy type:
For Non-Anaphylactic Penicillin Allergy
- Second or third-generation cephalosporins (cefdinir, cefuroxime) at standard pediatric doses 6, 7
- Cefdinir: 14 mg/kg/day divided into 1-2 doses 8
For Type I Hypersensitivity/Anaphylactic Allergy
- Macrolides: Azithromycin 10 mg/kg on day 1, then 5 mg/kg/day for days 2-5 7
- Clindamycin: 25-40 mg/kg/day divided every 6-8 hours 6, 8
- Fluoroquinolones (for severe infections in older children): Levofloxacin at age-appropriate dosing 6, 7
Clinical Efficacy Data
Sultamicillin demonstrates excellent clinical outcomes in pediatric infections:
- Clinical effectiveness: 96-100% cure or improvement rates across multiple studies 2, 3, 5, 4
- Bacteriologic eradication: 86-94% eradication of pathogens, including β-lactamase-producing organisms 3, 5, 4
- Effective coverage: Particularly effective against Staphylococcus aureus, Streptococcus species, E. coli, and β-lactamase-producing Haemophilus influenzae 5, 4
Treatment Duration and Monitoring
- Standard duration: 5-10 days depending on infection type and severity 2, 4
- Clinical improvement: Should be evident within 48-72 hours 6
- Reassessment: If no improvement by 48-72 hours, consider alternative pathogens or treatment failure 6, 7
Safety Profile
Adverse effects are minimal:
- Diarrhea: Most common side effect, occurring in approximately 1-7% of patients 2, 3, 4
- Rare reactions: Transient SGOT elevation, leukopenia, acute hemolytic anemia (all resolved upon treatment completion) 5
- Overall tolerability: Excellent safety profile with side effects resolving after treatment completion 5, 4
Critical Pitfall to Avoid
Never prescribe sultamicillin or any ampicillin-containing product to a patient with any documented penicillin allergy without formal allergy testing and desensitization. Cross-reactivity with penicillins is 100% as ampicillin IS a penicillin. 6, 7