Trade Names:Pipracil- Powder for injection (contains 1.85 mEq [42.5 mg] sodium/g) 2 g- Powder for injection 3 g- Powder for injection 4 g
Trade Names:Piperacillin- Powder for injection 40 g (bulk)
Inhibits bacterial cell wall mucopeptide synthesis.
Not absorbed orally; rapidly absorbed IM. T max is 30 min (IM) and immediately after completion (IV). C max is 412 mcg/mL (IV).
Widely distributed in human tissues and body fluids, including bone, prostate, and heart; reaches high concentrations in bile. Penetrates CSF in the presence of inflamed meninges. Protein binding is 16%. Vd is 0.23 L/kg. It crosses the placenta and distributes into breast milk.
Urine (60% to 80% unchanged), partially biliary. Serum t ½ is 36 to 72 min; elimination t ½ is 54 to 63 min.
Elimination t ½ is increased 2-fold in mild to moderate impairment, 5- to 6-fold in severe impairment.
Treatment of intra-abdominal, urinary tract, gynecologic, and lower respiratory tract infections; septicemia; skin and skin structure infections; bone and joint infections; gonococcal urethritis; surgical prophylaxis; treatment of infection caused by susceptible microorganisms, including infections caused by Streptococcus and Pseudomonas species.
Hypersensitivity to penicillins or cephalosporins.
IM / IV 3 to 4 g every 4 to 6 h (max, 24 g/day).Serious Infections (eg, Septicemia, Nosocomial Pneumonia, Intra-Abdominal, Aerobic and Anaerobic Gynecologic, Skin and Soft Tissue)Adults and children older than 12 yr of age
IV 12 to 18 g/day (200 to 300 mg/kg/day) in divided doses every 4 to 6 h (max daily dose, 24 g/day).Complicated UTIsAdults and children older than 12 yr of age
IV 8 to 16 g/day (125 to 200 mg/kg/day) in divided doses every 6 to 8 h.Uncomplicated UTIs and Most Community-Acquired PneumoniaAdults and children older than 12 yr of age
IM / IV 6 to 8 g/day (100 to 125 mg/kg/day) in divided doses every 6 to 12 h.Uncomplicated GonorrheaAdults and children older than 12 yr of age
IM 2 g as a one time dose; give 1 g of probenecid 30 min prior to injection.ProphylaxisAdults and children older than 12 yr of age Intra-Abdominal Surgery
IV 2 g just prior to surgery, 2 g during surgery, and 2 g every 6 h postsurgery for not more than 24 h.Vaginal Hysterectomy
IV 2 g just prior to surgery, 2 g 6 h later, 2 g 12 h after first dose.Cesarean Section
IV 2 g after cord is clamped, 2 g 4 h later, 2 g 8 h after first dose.Abdominal Hysterectomy
IV 2 g just prior to surgery, 2 g on return to recovery room, 2 g 6 h later.Renal Function ImpairmentCrCl 20 to 40 mL/min UTIs (complicated)
3 g every 8 h (9 g/day).Serious systemic infections
4 g every 8 h (12 g/day).CrCl less than 20 mL/min UTIs
3 g every 12 h (6 g/day).Serious systemic infections
4 g every 12 h (8 g/day).Hemodialysis
Max dose, 6 g/day (2 g every 8 h); give 1 g additional dose after each dialysis.
For IM or IV administration only. Not for intradermal, subcutaneous, or intra-arterial administration.IM
Store powder for injection at controlled room temperature (68° to 77°F). Use reconstituted solution immediately or dilute for infusion. Discard any unused portion after 24 h if stored at room temperature or after 48 h if stored in refrigerator (36° to 46°F). Do not freeze vials after reconstitution.
May inactivate aminoglycosides in vitro; do not mix in same IV solution. May be used in combination for synergy.Anticoagulants
May increase bleeding risks by prolonging bleeding time.Chloramphenicol
Synergism or antagonism may develop.Contraceptives, oral
May reduce efficacy of oral contraceptives. Use additional form of contraception during piperacillin therapy.Erythromycin
Synergism or antagonism may develop.Heparin
May increase bleeding risks of heparin by prolonging bleeding time.Methotrexate
Serum concentrations may be elevated by piperacillin, increasing the risk of toxicity.Probenecid
Piperacillin serum concentrations may be increased by probenecid.Tetracyclines
May impair bactericidal effects of piperacillin.Vecuronium
Action of vecuronium may be potentiated, producing protracted respiratory depression.
May cause false-positive urine glucose test results with Benedict solution, Fehling solution, or Clinitest tablets but not with enzyme-based tests (eg, Clinistix , Tes-tape ); false-positive direct Coombs test result in certain patient groups; positive direct antiglobulin tests; false-positive protein reactions with sulfosalicylic acid and boiling test, acetic acid test, biuret reaction and nitric acid test but not with the bromphenol blue test ( Multi-Stix ). False-positive results for Aspergillus have been reported using the Bio-Rad Laboratories' Platelia Aspergillus EIA Test with piperacillin/tazobactam.
Dizziness; fatigue; convulsions; hallucinations; lethargy; neuromuscular irritability; prolonged muscle relaxation; headache; seizures.
Diarrhea or bloody diarrhea; nausea; pseudomembranous colitis; rectal bleeding; vomiting.
Elevated creatinine or BUN; interstitial nephritis (hematuria, hyaline casts, oliguria, proteinuria, pyuria).
Agranulocytosis; eosinophilia; hemolytic anemia; leukopenia; neutropenia; prolongation of bleeding and prothrombin time; reduced Hgb or Hct; thrombocytopenia; pancytopenia.
Cholestatic hepatitis; elevated AST, ALT, LDH, and bilirubin.
Deep vein thrombosis; hematomas; hypersensitivity reactions (eg, erythema multiforme, skin rashes, urticaria, vesicular eruptions); pain and erythema at injection site; vein irritation; toxic epidermal necrolysis; Stevens-Johnson syndrome; fever; thrombophlebitis; pruritus.
Category B .
Excreted in breast milk.
Safety and efficacy not established.
Use with caution because of the greater frequency of decreased hepatic, renal, or cardiac function, and concomitant diseases or other drug therapy.
Reactions range from mild to life-threatening. Administer cautiously to cephalosporin-sensitive patients because of possible crossreactivity.
Dosage adjustment required.
May result in bacterial or fungal overgrowth of nonsusceptible organisms.
Hemorrhagic manifestations associated with abnormalities of coagulation tests (bleeding time, PT, platelet aggregation) may occur. Abnormalities should revert to normal once drug is discontinued.
May experience higher incidence of adverse reactions when treated with piperacillin.
Is unlikely to provide benefit and may increase risk of development of drug-resistant bacteria.
May occur caused by overgrowth of clostridia. Consider possibility in patients with diarrhea.
Agitation, confusion, asterixis, hallucinations, stupor, coma, seizures, hyperexcitability.
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