Sulbactam: Dosage Recommendations for Adult Patients
Creatinine Clearance by Cockcroft-Gault Equation (mL/min)
MIC
(µg/mL)
<30
30 to <60
60 to <90
≥90
1
1 g q 12 h (1)
1 g q 12 h (1)
1 g q 8 h (1)
1 g q 6 h (1)
2
1 g q 12 h (1)
1 g q 8 h (1)
1 g q 6 h (1)
2 g q 6 h (1) or
1 g q 8 h (4)
4
1 q 8 h (1) or
1 q 12 h (4)
1 g q 8 h (1)
2 g q 6 h (1) or
1 g q 8 h (4)
1 g q 6 h (4)
8
1 q 8 h (1)
1 g q 6 h (1)
3 g q 6 h (1) or
1 g q 6 h (4)
2 g q 6 h (4)
16
2 g q 8 h (1) or
1 g q 6 h (4)
2 g q 6 h (1) or
2 g q 8 h (4)
2 g q 6 h (4)
3 g q 6 h (4)
32
3 g q 6 h (1) or
2 g q 6 h (4)
3 g q 6 h (4)
3 g q 6 h (4)
No targeted dosage*
64
12 g/day (24)**
No targeted dosage*
No targeted dosage*
No targeted dosage*
( ) Infusion time, hour
*Probability of target attainment (PTA) ≥90% and based on the studies of use as a single drug in doses up to 12 g/day
**First dose loading with 3 g, 1 h infusion, then immediately followed by 12 g 24 h infusion
Sulbactam: Dosage Recommendations for Adult Patients
▪ In case of unknown sulbactam MIC
̶ First 48 h: empirical with 3 g q 6 h, 4 h infusion; the first dose of 1 h infusion
▪ Next day: consider using sulbactam dose according to MIC
̶ If use ampicillin/sulbactam disc for susceptibility testing
▪ S consider using dose of sulbactam MIC = 4 µg/mL
▪ I consider using dose of sulbactam MIC = 8 µg/mL
▪ R consider using dose of sulbactam MIC = 16 µg/mL and should determine MIC
▪ Renal replacement therapy
̶ HD 2-3 g, 1 h infusion q 24 h
̶ SLED 2-3 g, 1 h infusion q 12 h
̶ CAPD 2-3 g, 1 h infusion q 12 h
̶ CRRT: dose according to ClCr 30 to <60
mL/min or calculated CRRT clearance if
possible
References
1. Blackwell BG, Leggett JE, Johnson CA, Zimmerman SW, Craig WA. Ampicillin and sulbactam pharmacokinetics and pharmacodynamics in continuous ambulatory peritoneal dialysis (CAPD). Perit Dial Int1990;10:221-6.
2. Gao C, Tong J, Yu K, Sun Z, An R, Du Z. Pharmacokinetics of cefoperazone/sulbactam in critically ill patients receiving continuous venovenous hemofiltration. Eur J Clin Pharmacol 2016;72:823-30.
3. Jaruratanasirikul S, Nitchot W, Wongpoowarak W, Samaeng M, Nawakitrangsan M. Population pharmacokinetics and Monte Carlo simulations of sulbactam to optimize dosage regimens in patients with ventilator-associated
pneumonia caused by Acinetobacter baumannii. Eur J Pharm Sci 2019;136:104940.
4. Jaruratanasirikul S, Wongpoowarak W, Aeinlang N, Jullangkoon M. Pharmacodynamics modeling to optimize dosage regimens of sulbactam. Antimicrob Agents Chemother 2013;57:3441-4.
5. Jaruratanasirikul S, Wongpoowarak W, Wattanavijitkul T, Sukarnjanaset W, Samaeng M, Nawakitrangsan M, et al. Population pharmacokinetics and pharmacodynamics modeling to optimize dosage regimens of sulbactam in
critically ill patients with severe sepsis caused by Acinetobacter baumannii. Antimicrob Agents Chemother 2016;60:7236-44.
6. Lorenzen JM, Broll M, Kaever V, Burhenne H, Hafer C, Clajus C, et al. Pharmacokinetics of ampicillin/sulbactam in critically ill patients with acute kidney injury undergoing extended dialysis. Clin J Am Soc Nephrol 2012;7:385-90.