No

Antibiotic, Penicillin

Treatment of susceptible infections such as septicemia, acute and chronic respiratory tract infections, skin and soft tissue infections, and urinary tract infections due to susceptible strains of Pseudomonas, Proteus, and Escherichia coli and Enterobacter; active against some streptococci and some anaerobic bacteria

B

Hypersensitivity to piperacillin or any component or penicillins

Dosage modification required in patients with impaired renal function; history of seizure activity; use with caution in patients with a history of beta-lactam allergy

Percentage unknown: Convulsions, confusion, drowsiness, fever, rash, electrolyte imbalance, hemolytic anemia, positive Coombs' reaction, abnormal platelet aggregation and prolonged PT (high doses), thrombophlebitis, myoclonus, acute interstitial nephritis, hypersensitivity reactions, anaphylaxis, Jarisch-Herxheimer reaction

Symptoms of penicillin overdose include neuromuscular hypersensitivity (agitation, hallucinations, asterixis, encephalopathy, confusion, and seizures) and electrolyte imbalance with potassium or sodium salts, especially in renal failure

Hemodialysis may be helpful to aid in the removal of the drug from the blood, otherwise most treatment is supportive or symptom directed

Decreased effect: Tetracyclines may decrease penicillin effectiveness; aminoglycosides physical inactivation of aminoglycosides in the presence of high concentrations of piperacillin and potential toxicity in patients with mild to moderate renal dysfunction; decreased efficacy of oral contraceptives is possible

Increased effect:

Probenecid may increase penicillin levels

Neuromuscular blockers may increase duration of blockade

Aminoglycosides synergistic efficacy

Heparin with high-dose parenteral penicillins may result in increased risk of bleeding

Reconstituted solution is stable (I.V. infusion) in NS or D₅W for 24 hours at room temperature, 7 days when refrigerated or 4 weeks when frozen; after freezing, thawed solution is stable for 24 hours at room temperature or 48 hours when refrigerated; 40 g bulk vial should not be frozen after reconstitution; incompatible with aminoglycosides

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin binding proteins (PBPs); which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

Absorption: I.M.: 70% to 80%

Distribution: Crosses the placenta; distributes into milk at low concentrations

Protein binding: 22%

Half-life: Dose-dependent; prolonged with moderately severe renal or hepatic impairment:

Neonates: 1-5 days: 3.6 hours; >6 days: 2.1-2.7 hours

Children: 1-6 months: 0.79 hour; 6 months to 12 years: 0.39-0.5 hour

Adults: 36-80 minutes

Time to peak serum concentration: I.M.: Within 30-50 minutes

Elimination: Principally in urine and partially in feces (via bile)

Neonates: 100 mg/kg every 12 hours

Infants and Children: I.M., I.V.: 200-300 mg/kg/day in divided doses every 4-6 hours

Higher doses have been used in cystic fibrosis: 350-500 mg/kg/day in divided doses every 4-6 hours

Adults: I.M., I.V.:

Moderate infections (urinary tract infections): 2-3 g/dose every 6-12 hours; maximum: 2 g I.M./site

Serious infections: 3-4 g/dose every 4-6 hours; maximum: 24 g/24 hours

Uncomplicated gonorrhea: 2 g I.M. in a single dose accompanied by 1 g probenecid 30 minutes prior to injection

Dosing adjustment in renal impairment: Adults: I.V.:

Cl_cr 20-40 mL/minute: Administer 3-4 g every 8 hours

Cl_cr <20 mL/minute: Administer 3-4 g every 12 hours

Moderately dialyzable (20% to 50%)

Continuous arteriovenous or venovenous hemodiafiltration (CAVH) effects: Dose as for Cl_cr 10-50 mL/minute

Observe for signs and symptoms for anaphylaxis during first dose

May interfere with urinary glucose tests using cupric sulfate (Benedict's solution, Clinitest®); may inactivate aminoglycosides in vitro; false-positive urinary and serum proteins, positive Coombs' test [direct]

May cause drowsiness or confusion; penicillins reported to cause apprehension, illusions, hallucinations, depersonalization, agitation, encephalopathy, and insomnia

None reported

No information available to require special precautions

Prolonged use of penicillins may lead to development of oral candidiasis

This medication will be administered I.V. or I.M. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). If being treated for sexually transmitted disease, partner will also need to be treated. Small frequent meals, frequent mouth care, sucking lozenges, or chewing gum may reduce nausea or dry mouth. Important to maintain good oral and vaginal hygiene to reduce incidence of opportunistic infection. Diabetics should use serum glucose testing while on this medication. If diabetic, drug may cause false tests with Clinitest® urine glucose monitoring; use of glucose oxidase methods (Clinistix®) or serum glucose monitoring is preferable. This drug may interfere with oral contraceptives; an alternate form of birth control should be used. Report persistent diarrhea, fever, chills, unhealed sores, bloody urine or stool, muscle pain, mouth sores, or difficulty breathing.

Administer one hour apart from aminoglycosides; extended spectrum includes Pseudomonas aeruginosa; dosage modification required in patients with impaired renal function; can be administered I.V. push over 3-5 minutes at a maximum concentration of 200 mg/mL or I.V. intermittent infusion over 30-60 minutes at a final concentration less than or equal to 20 mg/mL

Monitor serum electrolytes, bleeding time especially in patients with renal impairment, periodic tests of renal, hepatic and hematologic function

Powder for injection, as sodium: 2 g, 3 g, 4 g, 40 g

Capellier G, Cornette C, Boillot A, et al, "Removal of Piperacillin in Critically Ill Patients Undergoing Continuous Veno-Venous Hemofiltration," Crit Care Med, 1998, 26(1):88-91.

Donowitz GR and Mandell GL, "Beta-Lactam Antibiotics," N Engl J Med, 1988, 318(7):419-26 and 318(8):490-500.

Keller E, Bohler J, Busse-Grawitz A, et al, "Single Dose Kinetics of Piperacillin During Continuous Arteriovenous Hemodialysis in Intensive Care Patients," Clin Nephrol, 1995, 43(Suppl 1):S20-3.

Placzek M, Whitelaw A, Want S, et al, "Piperacillin in Early Neonatal Infection," Arch Dis Child, 1983, 58(12):1006-9.

Prince AS and Neu HC, "Use of Piperacillin, A Semisynthetic Penicillin, in the Therapy of Acute Exacerbations of Pulmonary Disease in Patients With Cystic Fibrosis," J Pediatr, 1980, 97(1):148-51.

Tan JS and File TM Jr, "Antipseudomonal Penicillins," Med Clin North Am, 1995, 79(4):679-93.

Thirumoorthi MC, Asmar BI, Buckley JA, et al, "Pharmacokinetics of Intravenously Administered Piperacillin in Preadolescent Children," J Pediatr, 1983, 102(6):941-6.

Wright AJ, "The Penicillins," Mayo Clin Proc, 1999, 74(3):290-307.

Yoshikawa TT, "Antimicrobial Therapy for the Elderly Patient," J Am Geriatr Soc, 1990, 38(12):1353-72.