Composition:
Each capsule contains:
Ampicillin (as trihydrate) 250 mg
Dicloxacillin (as sodium monohydrate) 250 mg

Each vial contains :
Dipenacid 125/125 mg :
Ampicillin (as sodium) 125 mg
Dicloxacillin (as sodium) 125 mg

Dipenacid 250/250 mg:
Ampicillin (as sodium) 250 mg
Dicloxacillin (as sodium) 250 mg

Dipenacid 500/500 mg:
Ampicillin (as sodium) 500 mg
Dicloxacillin (as sodium) 500 mg

Pharmacological Properties:
Dipenacid is a broad – spectrum antibiotic composed of the two bactericidal agents ampicillin and dicloxacillin. Both compounds act by interfering with bacterial cell wall synthesis. it exerts an effective bactericidal action against a wide range of Gram- positive and Gram- negative organisms.
Dicloxacillin is added to provide activity against penicillinase producing bacteria that resist action of ampicillin. So, this achieve a wider spectrum of activity to include Streptococci, Staphylococci (including penicillinase producing strains), Neisseria spp, H-influenzae, Escherichia coli, Proteus mirabilis, Salmonella spp, Shigella spp, and enterococci.

Pharmacokinetics :
Absorption : well absorbed from the gastrointestinal tract, but absorption can be interfered with food so doses should be preferably taken at least 30 minutes before meals . Peak plasma concentration for ampicilin is 1 to 2 hours after oral dose and 1 hour after I/M dose and for Dicloxacillin is 1 hour after oral dose
Distribution : widely distributed and therapeutic concentration can be achieved in ascetic , pleura and joint fluid , there is little diffusion into the CSF except when meninges are inflamed .
Elimination : For ampicillin 20 to 40 % of oral dose excreted unchanged in urine and 60 to 80 % of Parenteral dose is excreted in urine . High concentration is reached in bile and some is excreted in feces .
Dicloxacillin is metabolized to a limited extent , unchanged drug and metabolites are excreted in the urine and only small amount is excreted in the bile .

Indications & usage:
* Dipenacid is indicated in the treatment of all infections caused by
susceptible micro-organism mainly :
Respiratory tract infections: bronchitis, pharyngitis, sinusitis, uncomplicated community-acquired pneumonia, otitis media and H- influenza infection.
Gastrointestinal tract infections: enteritis ,bacillary dysentery, abdominal typhoid and paratyphoid, invasive salmonellosis.
Genitourinary tract infections: cystitis, pyelonephritis, prostatitis, urethritis and gonorrhea.
Listerial meningitis (in combination with other antibiotic).
Skin and soft tissue infection: pyoderma, erysipelas, cellulitis and wound infections.
Bone and joint infections: osteomyelitis.
Toxic shock syndrome.
Bacterial endocarditis.

* For patients at high risks of bacterial endocarditis as in the following cases:
Prior to dental procedures and oral/respiratory tract surgery.
Before genitourinary/gastrointestinal tract procedures.
It's advisable to administer Dipenacid Parenteral form as prophylaxis therapy

N.B. * Dipenacid can also be used alone or as adjunct in the treatment of whooping cough, and Helicobacter pylori infections and to protect patients against preterm premature rupture of the membranes in preterm labor.

Contra-indications :
History of hypersensitivity to penicillins or cephalosporins.

Side effects:
Hypersensitivity reactions like skin rashes and urticaria may occur.
Diarrhea and antibiotic-associated colitis may rarely occur.

Drug interactions:
Allopurinol: increase risk of developing skin rashes.
Bacteriostatic antibiotics (I.e.: tetracycline, erythromycin): diminish
the bactericidal effect of ampicillin.
Estrogen-containing oral contraceptives: ampicillin may decrease the contraceptive effect .

Probenecid: blocks the renal tubular excretion of ampicillin and prolong its blood level.

Warnings & precautions:
* Caution is required when using Dipenacid in the following cases:
Known history of allergy.
Patients with cytomegalovirus infection since they are susceptible to
ampicillin-induced skin rashes.
Patients with impaired renal function (dose should be reduced).
Patients with acute or chronic lymphocytic leukemia.

* SGOT and SGPT should be measured during therapy to monitor for
liver function abnormalities.

* Pregnancy and lactation:
Dipenacid is not known to be harmful during pregnancy or lactation but, rarely
it may lead to sensitization of infant during lactation.

Dosage & administration:
(the dose is calculated as ampicillin)
By mouth :
- 0.25- 1 gm every 6 hrs, at least 30 minutes before food. child under 10 years, half adult dose
- For urinary tract infections: 500 mg every 8 hrs; child under 10 years, half adult dose.

By intramuscular injection or intravenous injection or infusion :
500 mg every 4-6 hours. child under 10 years, half adult dose
Endocarditis ,

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