Sultamicillin at an adult dose of 375-750 mg twice daily or a pediatric dose of 50 mg/kg/d provides effective outpatient/office
therapy for
community-acquired infections of the upper and lower respiratory tract, urinary tract, and skin/soft tissue structures. Given the incidence of Haemophilus influenzae and Branhamella catarrhalis in
otitis media and the frequent occurrence of
beta-lactamase-producing strains, it is particularly appropriate for the
therapy of
otitis media in infants and children. The increasing prevalence of
beta-lactamase-producing pathogens in these
infections, coupled with the fact that diagnostic bacteriology is often not available or practical in office practice, suggests that the broad use of
sultamicillin might be desirable. Several factors support such usage: 1) the superiority of
sultamicillin compared with the
ampicillin commercial
dosage form as a delivery system for
ampicillin; 2) the possible occurrence at the
infection site of
beta-lactamase-producing organisms, not themselves pathogens, which nevertheless impair the activity of the
beta-lactam antibiotic against sensitive pathogens; 3) the complementary binding of
penicillin-binding proteins by
ampicillin and
sulbactam in
ampicillin-sensitive organisms; 4) the lack of resistance development following repeated exposure of strains sensitive to
sulbactam/
ampicillin suggested by in vitro studies; and 5) the inability of
sulbactam to induce
beta-lactamase production. In addition to broad use in
community-acquired infections, oral
therapy with
sultamicillin should also provide convenient outpatient follow-up for initial parenteral
sulbactam/
ampicillin therapy. Extensive testing of various laboratory parameters has revealed no evidence of systemic toxicity with
sultamicillin. The only significant side effect of
sultamicillin is
diarrhea/loose stools, which, although a frequent complaint in some studies, is of mild to moderate severity and results in a low discontinuation rate.