Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For penicillins, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to any of the penicillins, cephalosporins, or beta-lactamase inhibitors. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Diet—Tell your doctor if you are on a low-sodium (low-salt) diet. Some of these medicines contain enough sodium to cause problems in some people.

Pregnancy—Penicillins and beta-lactamase inhibitors have not been studied in pregnant women. However, penicillins have not been shown to cause birth defects or other problems in animal studies.

Breast-feeding—Penicillins and sulbactam, a beta-lactamase inhibitor, pass into the breast milk. Even though only small amounts may pass into breast milk, allergic reactions, diarrhea, fungus infections, and skin rash may occur in nursing babies.

Children—Penicillins and beta-lactamase inhibitors have been used in children and, in effective doses, are not expected to cause different side effects or problems in children than they do in adults.

Some strengths of the chewable tablets and oral suspensions of amoxicillin and clavulanate combination contain aspartame, which is changed by the body to phenylalanine, a substance that is harmful to patients with phenylketonuria.

Older adults—Penicillins and beta-lactamase inhibitors have been used in the elderly and have not been shown to cause different side effects or problems in older people than they do in younger adults.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking a penicillin and beta-lactamase inhibitor combination, it is especially important that your health care professional know if you are taking any of the following:

• Anticoagulants (blood thinners) or
• Dipyridamole (e.g., Persantine) or
• Divalproex (e.g., Depakote) or
• Heparin (e.g., Panheprin) or
• Inflammation or pain medicine (except narcotics) or
• Pentoxifylline (e.g., Trental) or
• Plicamycin (e.g., Mithracin) or
• Sulfinpyrazone (e.g., Anturane) or
• Valproic acid (e.g., Depakene)—Use of these medicines with piperacillin and tazobactam combination or with ticarcillin and clavulanate combination may increase the chance of bleeding

• Oral contraceptives (birth control pills)—Use of penicillins and beta-lactamase inhibitors may prevent oral contraceptives from working properly, increasing the chance for pregnancy

• Probenecid (e.g., Benemid)—Probenecid causes penicillins, sulbactam, and tazobactam to build up in the blood. This may increase the chance of side effects. However, your doctor may want to give you probenecid with a penicillin and beta-lactamase inhibitor combination to treat some infections

Other medical problems—The presence of other medical problems may affect the use of penicillin and beta-lactamase inhibitor combinations. Make sure you tell your doctor if you have any other medical problems, especially:

• Allergies or a history of allergies, such as asthma, eczema, hay fever, or hives—Patients with a history of allergies may be more likely to have a severe allergic reaction to a penicillin and beta-lactamase inhibitor combination

• Bleeding problems, history of—Patients with a history of bleeding problems may be more likely to have bleeding when receiving piperacillin and tazobactam combination or ticarcillin and clavulanate combination

• Congestive heart failure (CHF) or
• High blood pressure—Large doses of ticarcillin and clavulanate combination may make these conditions worse, because this medicine contains a large amount of salt

• Cystic fibrosis—Patients with cystic fibrosis may have an increased chance of fever and skin rash when receiving piperacillin and tazobactam combination

• Kidney disease—Patients with kidney disease may have an increased chance of side effects

• Liver disease (active or a history of)—Penicillins and beta-lactamase inhibitor combinations may cause this condition to recur or become worse

• Mononucleosis (“mono”)—Patients with mononucleosis may have an increased chance of skin rash when receiving ampicillin and sulbactam combination

• Phenylketonuria—Some strengths of the amoxicillin and clavulanate combination chewable tablets and oral suspension contain aspartame, which is changed by the body to phenylalanine.

• Stomach or intestinal disease, history of (especially colitis, including colitis caused by antibiotics)—Patients with a history of stomach or intestinal disease may be more likely to develop colitis while taking penicillins and beta-lactamase inhibitors