Sultamicillin Dosing Per Kilogram
For pediatric patients, sultamicillin should be administered at 50 mg/kg/day divided into 2 doses (25 mg/kg twice daily), which provides effective therapy for community-acquired respiratory, urinary tract, and skin/soft tissue infections. 1
Standard Pediatric Dosing Regimens
The recommended dose is 50 mg/kg/day divided into 2 doses for outpatient treatment of common pediatric infections including otitis media, respiratory tract infections, urinary tract infections, and skin/soft tissue infections 1
Clinical studies have used doses ranging from 27.1 mg/kg/day to 30 mg/kg/day divided into 2-4 doses, with excellent clinical outcomes in pharyngitis, tonsillitis, pneumonia, impetigo, and urinary tract infections 2, 3
The typical dosing schedule is 375-750 mg twice daily for adults, which translates to approximately 10-15 mg/kg per dose in pediatric patients 1, 2
Pharmacokinetic Considerations
After oral administration of 10 mg/kg or 15 mg/kg, peak plasma levels of ampicillin reach 2.34 and 5.57 mcg/ml respectively, with similar levels for sulbactam (1.87 and 4.66 mcg/ml) 2
Peak concentrations occur at 1 hour post-administration, with mean half-lives of approximately 1.1-1.9 hours for both ampicillin and sulbactam components 2, 3
Urinary recovery rates are 33.9-64.8% for ampicillin and 38.1-76.6% for sulbactam within 6 hours, indicating excellent renal excretion 3
Dose-response relationships are linear, with plasma levels and AUCs proportional to administered doses 2
Clinical Efficacy by Infection Type
For respiratory tract infections (otitis media, pneumonia, bronchitis), the 50 mg/kg/day regimen achieves cure or improvement rates exceeding 95% 1, 2
For skin and soft tissue infections (impetigo, furuncle, abscess), the standard pediatric dose demonstrates excellent efficacy against both beta-lactamase-producing and non-producing organisms 2, 3
For urinary tract infections, sultamicillin at 50 mg/kg/day achieves bacterial eradication rates of 92.2% for E. coli and 91.1% overall 4
Important Clinical Context
Sultamicillin is particularly appropriate for otitis media in infants and children given the high incidence of beta-lactamase-producing Haemophilus influenzae and Branhamella catarrhalis 1
The combination provides complementary penicillin-binding protein binding by ampicillin and sulbactam, enhancing activity even against ampicillin-sensitive organisms 1
Beta-lactamase-producing organisms are effectively eradicated at standard doses, with no significant difference in eradication rates between high and low beta-lactamase producers 3, 4
Safety Profile
The most common adverse effect is diarrhea/loose stools, which is typically mild to moderate and rarely requires discontinuation 1, 2
Transient laboratory abnormalities (elevated SGOT, leukopenia) may occur but resolve upon treatment completion 5
No evidence of systemic toxicity has been observed with extensive laboratory parameter testing 1
Administration Guidelines
Sultamicillin should be administered just after meals to optimize absorption 2
Treatment duration is typically 3-9 days depending on infection type and severity 2, 4
For acute uncomplicated infections, 3-5 days of therapy is usually sufficient 4
Common Pitfalls to Avoid
Underdosing below 50 mg/kg/day may result in suboptimal plasma concentrations and treatment failure, particularly for beta-lactamase-producing organisms 1, 2
Failure to divide doses appropriately (should be twice daily, not once daily) reduces efficacy due to the relatively short half-life of both components 2, 3
Not considering sultamicillin for otitis media when beta-lactamase-producing organisms are prevalent in the community represents a missed opportunity for optimal therapy 1