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Piperacillin sodium
Piperacillin sodium (Pipracil)
Piperacillin sodium
(pie-PER-ah-sill-in)
Pregnancy Category: B
Pipracil
(Rx)
Classification:
Antibiotic, penicillin
See Also:
See also Penicillins[.
]Action/Kinetics:
Semisynthetic, broad-spectrum penicillin for parenteral use. It is not penicillinase resistant. Penetrates CSF in the presence of inflamed meninges. Peak serum level: 244 mcg/mL. t1/2: 36-72 min. Excreted unchanged in urine and bile.
Uses:
(1) Intra-abdominal infections (including hepatobiliary and surgical infections) due to Escherichia coli, Pseudomonas aeruginosa, Clostridium sp., enterococci, anaerobic cocci, Bacteroides sp., including B. fragilis. (2) URIs due to E. coli, P. aeruginosa, Proteus sp. (including P. mirabilis and enterococci), Klebsiella sp. (3) Gynecologic infections (including endometritis, PID, pelvic cellulitis) due to Bacteroides sp. (including B. fragilis), anaerobic cocci, enterococci (Streptococcus faecalis), Neisseria gonorrhoeae. (4) Septicemia (including bacteremia) due to E. coli, P. mirabilis, S. pneumoniae, P. aeruginosa, Klebsiella sp., Enterobacter sp., Serratia sp., Bacteroides sp., anaerobic cocci. (5) Lower respiratory tract infections due to E. coli, P. aeruginosa, Haemophilus influenzae, Klebsiella sp., Enterobacter sp., Serratia sp., Bacteroides sp., anaerobic cocci. (6) Skin and skin structure infections due to E. coli, Klebsiella sp., Serratia sp., Acinetobacter sp., Enterobacter sp. P. aeruginosa, P. mirabilis, indole-positive Proteus sp., Bacteroides sp. (including B. fragilis), anaeroabic cocci, enterococci. (7) Bone and joint infections due to P. aeruginosa, Bacteroides sp., enterococci, anaerobic cocci. (8) Uncomplicated gonococcal urethritis. (9) Infections due to streptococcus species, including Group A ß-hemolytic streptococcus and S. pneumoniae. (10) Prophylaxis in surgery, including GI and biliary procedures, vaginal and abdominal hysterectomy, and cesarean section.
Special Concerns:
Possible antibiotic resistance when used to treat Pseudomonas aeruginosa infections.
Additional Side Effects:
Rarely, prolonged muscle relaxation.
Laboratory Test Alterations:
Positive Coombs' test;  (especially in infants) AST, ALT, LDH, bilirubin.
Additional Drug Interactions:
Piperacillin may prolong the neuromuscular blockade of vecuronium.
How Supplied:
Powder for injection: 2g, 3g, 4g, 40g
Dosage
•IM, IV
Serious infections, including septicemia, nosocomial pneumonia, intra-abdominal infections, aerobic and anaerobic gyn infections, and skin and soft tissue infections.
Adults, IV: 3-4 g q 4-6 hr (12-18 g/day, not to exceed 24 g/day) as a 20- to 30-min infusion. Average duration is 7 to 10 days (3 to 10 days for gynecologic infections and at least 10 days for group A ß-hemolytic streptococcal infections). If CCR is 20-40 mL/min, give 12 g/day (4 g q 8 hr); if CCR is less than 20 mL/min, give 8 g/day (4 g q 12 hr). Dosage has not been determined for children less than 12 years of age. However, use the following guidelines: Neonates, less than 36 weeks old: 75 mg/kg IV q 12 hr during the first week of life; then, q 8 hr during the second week. Full-term: 75 mg/kg IV q 8 hr during the first week of life; then, q 6 hr thereafter. Children, other conditions: 200-300 mg/kg/day, up to a maximum of 24 g/day divided q 4 to 6 hr.
Complicated UTIs.
Adults, IV: 8-16 g/day (125-200 mg/kg/day) in divided doses q 6-8 hr. If CCR is 20-40 mL/min, give 9 g/day (3 g q 8 hr); if CCR is less than 20 mL/min, give 6 g/day (3 g q 12 hr).
Uncomplicated UTIs and most community-acquired pneumonias.
Adults, IM, IV: 6-8 g/day (100-125 mg/kg/day) in divided doses q 6-12 hr. If CCR is less than 20 mL/min, give 6 g/day (3 g q 12 hr).
Uncomplicated gonorrhea infections.
2 g IM with 1 g probenecid PO 30 min before injection (both given as single dose).
Prophylaxis in surgery.
Intra-abdominal surgery: 2 g IV just prior to anesthesia, 2 g during surgery, and 2 g q 6 hr post surgery for no more than 24 hr. Vaginal hysterectomy: 2 g IV just prior to anesthesia, 2 g 6 hr after initial dose, and 2 g 12 hr after first dose. Cesarean section: 2 g IV after cord is clamped, 2 g 4 hr after initial dose, and 2 g 8 hr after first dose. Abdominal hysterectomy: 2 g IV just prior to anesthesia, 2 g on return to recovery room, and 2 g after 6 hr.
For cystic fibrosis.
350-500 mg/kg/day divided q 4-6 hr. |
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