Risk of underdosing of ampicillin/sulbactam in patients with acute kidney injury undergoing extended daily dialysis--a single case

Nephrol Dial Transplant. 2009 Jul;24(7):2283-5. doi: 10.1093/ndt/gfp060. Epub 2009 Feb 18.


The fixed antibacterial combination of ampicillin and sulbactam is frequently used for various infections. The normal kidneys eliminate approximately 60% of ampicillin (371.39 Da) and sulbactam (255.22 Da). Concomitant with the decline in renal function, the terminal elimination half-life increases from 1 up to 24 h in patients with ESRD. Patients on three times weekly low flux haemodialysis exhibit a half-life of 2.3 h on and 17.4 h off dialysis. In contrast, in the present observation the elimination half-life in a single patient with acute kidney injury undergoing extended daily dialysis (EDD) with a polysulphone membrane was 1.5 h, indicating that the current dosing regimen for haemodialysis outpatients (ampicillin/sulbactam 2.0/1.0 g/day) would result in a significant underdosing for patients undergoing EDD.

Publication types

  • Case Reports

MeSH terms

  • Acute Kidney Injury / therapy*
  • Aged
  • Ampicillin / administration & dosage
  • Anti-Bacterial Agents / administration & dosage*
  • Enterococcus faecalis*
  • Gram-Positive Bacterial Infections / drug therapy*
  • Humans
  • Male
  • Renal Dialysis*
  • Risk Factors
  • Sulbactam / administration & dosage
  • Urinary Tract Infections / drug therapy*


  • Anti-Bacterial Agents
  • sultamicillin
  • Ampicillin
  • Sulbactam