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Pipracil
Overview
What is Pipracil?
PIPRACIL, sterile piperacillin sodium, is a semisynthetic
broad-spectrum penicillin for parenteral use derived from D(-)-α-aminobenzylpenicillin.
The chemical name of piperacillin sodium is sodium (2,5,6)-6-[()-2-(4-ethyl-2,3-dioxo-1-piperazinecarboxamido)-2-phenylacetamido]-3,-3-dimethyl-7-oxo-4-thia-1-azabicyclo[3.2.0]heptane-2-carboxylate.
The chemical formula is CHNNaOS, and the molecular weight is 539.54. Its structural formula
is:
Piperacillin sodium powder is a white to off-white
solid having the characteristic appearance of products prepared by
freeze-drying. It is freely soluble in water and in alcohol. The pH
of an aqueous solution containing 400 milligrams per milliliter ranges
from 5.5 to 7.5. One g contains 1.85 mEq (42.5 mg)
of sodium (Na).
What does Pipracil look like?
What are the available doses of Pipracil?
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What should I talk to my health care provider before I take Pipracil?
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How should I use Pipracil?
Therapeutic:
Intra-Abdominal
Infections
E. coli
Pseudomonas aeruginosa
Clostridium
Bacteroides
B. fragilis.
Urinary Tract Infections
E. coli
Klebsiella
P. aeruginosa
Proteus
P. mirabilis
Gynecologic Infections
Bacteroides
B. fragilis
Neisseria gonorrhoeae
E. faecalis
Septicemia
E. coli
Klebsiella
Enterobacter
Serratia
P. mirabilis
S. pneumoniae
P. aeruginosa
Bacteroides
Lower RespiratoryTract Infections
E. coli
Klebsiella
Enterobacter
P
aeruginosa
Serratia
H. influenzae
Bacteroides
Skin and Skin Structure Infections
E. coli
Klebsiella
Serratia
Acinetobacter
Enterobacter
P. aeruginosa
Morganella morganii
Providencia rettgeri
Proteus vulgaris
P. mirabilis
Bacteroides
B. fragilis
Bone and Joint Infections
P. aeruginosa
Bacteroides
Uncomplicated Gonococcal Urethritis caused by
PIPRACIL has also been shown to be clinically effective for the treatment
of infections at various sites caused by species including and ; however, infections caused by these organisms are ordinarily treated
with more narrow spectrum penicillins. Because of its broad spectrum
of bactericidal activity against gram-positive and gram-negative aerobic
and anaerobic bacteria, PIPRACIL is particularly useful for the treatment
of mixed infections and presumptive therapy prior to the identification
of the causative organisms.
Also, PIPRACIL
may be administered as single drug therapy in some situations where
normally two antibiotics might be employed.
Piperacillin has been successfully used with aminoglycosides, especially
in patients with impaired host defenses. Both drugs should be used
in full therapeutic doses.
Appropriate cultures
should be made for susceptibility testing before initiating therapy
and therapy adjusted, if appropriate, once the results are known.
Prophylaxis:
The prophylactic use of piperacillin should be stopped within 24
hours, since continuing administration of any antibiotic increases
the possibility of adverse reactions, but in the majority of surgical
procedures, does not reduce the incidence of subsequent infections.
If there are signs of infection, specimens for culture and susceptibility
testing should be obtained for identification of the causative microorganism
so that appropriate therapy can be instituted.
To reduce the development of drug-resistant bacteria and maintain
the effectiveness of PIPRACIL and other antibacterial drugs, PIPRACILshould only be used to treat or prevent infections that are proven
or strongly suspected to be caused by susceptible bacteria. When culture
and susceptibility information are available, they should be considered
in selecting or modifying antibacterial therapy. In the absence of
such data, local epidemiology and susceptibility patterns may contribute
to the empiric selection of therapy.
PIPRACIL may be administered by the intramuscular
route (see NOTE) or intravenously as a three- to five-minute intravenous
injection or as a 20- to 30-minute infusion. The usual dosage of PIPRACIL
for serious infections is 3 to 4 g given every four to six
hours as a 20- to 30-minute infusion. For serious infections, the
intravenous route should be used.
PIPRACIL should
not be mixed with an aminoglycoside in a syringe or infusion bottle
since this can result in inactivation of the aminoglycoside.
The maximum daily dose for adults is usually 24 g/day,
although higher doses have been used.
Intramuscular
injections (see NOTE) should be limited to 2 g per injection site.
This route of administration has been used primarily in the treatment
of patients with uncomplicated gonorrhea and urinary tract infections.
The average duration of PIPRACIL treatment is from
seven to ten days, except in the treatment of gynecologic infections,
which is from three to ten days; the duration should be guided by
the patient's clinical and bacteriological progress. For most
acute infections, treatment should be continued for at least 48 to
72 hours after the patient becomes asymptomatic. Antibiotic therapy
for infections
should be maintained for at least ten days to reduce the risk of rheumatic
fever.
When PIPRACIL is given concurrently with
aminoglycosides, both drugs should be used in full therapeutic doses.
What interacts with Pipracil?
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What are the warnings of Pipracil?
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What are the precautions of Pipracil?
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What are the side effects of Pipracil?
PIPRACIL is generally well tolerated. The most common
adverse reactions have been local in nature, following intravenous
or intramuscular injection. The following adverse reactions may occur:
Local Reactions
Gastrointestinal
Hypersensitivity
Reactions
Rash was noted in 1% of patients. Other
less frequent findings included pruritus, vesicular eruptions, and
positive Coombs tests.
Other dermatologic manifestations,
such as erythema multiforme, urticaria, toxic epidermal necrolysis
and Stevens-Johnson syndrome, have been reported.
Renal
Central Nervous System
Hemic and Lymphatic
Serum Electrolytes
Skeletal
Other
Piperacillin therapy has been associated with an increased
incidence of fever and rash in cystic fibrosis patients.
What should I look out for while using Pipracil?
PIPRACIL is contraindicated in patients with a history
of allergic reactions to any of the betalactams, including penicillins
and/or cephalosporins.
SERIOUS AND OCCASIONALLY FATAL HYPERSENSITIVITY (ANAPHYLACTIC/ANAPHYLACTOID)
REACTIONS HAVE BEEN REPORTED IN PATIENTS ON PENICILLIN THERAPY. THESE
REACTIONS ARE MORE LIKELY TO OCCUR IN INDIVIDUALS WITH A HISTORY OF
PENICILLIN HYPERSENSITIVITY AND/OR A HISTORY OF SENSITIVITY TO MULTIPLE
ALLERGENS. THERE HAVE BEEN REPORTS OF INDIVIDUALS WITH A HISTORY OF
PENICILLIN HYPERSENSITIVITY WHO HAVE EXPERIENCED SEVERE REACTIONS
WHEN TREATED WITH CEPHALOSPORINS. BEFORE INITIATING THERAPY WITH PIPRACIL,
CAREFUL INQUIRY SHOULD BE MADE CONCERNING PREVIOUS HYPERSENSITIVITY
REACTIONS TO PENICILLINS, CEPHALOSPORINS OR OTHER ALLERGENS. IF AN
ALLERGIC REACTION OCCURS, PIPRACIL SHOULD BE DISCONTINUED AND APPROPRIATE
THERAPY INSTITUTED.
Clostridium difficile
C. difficile
C. difficile
C. difficile
If CDAD is suspected or confirmed, ongoing
antibiotic use not directed against may need to be discontinued. Appropriate fluid
and electrolyte management, protein supplementation, antibiotic treatment
of , and surgical
evaluation should be instituted as clinically indicated.
What might happen if I take too much Pipracil?
There is no specific information on overdose with
PIPRACIL. Other penicillin-class drugs in overdosage, however, have
the potential to cause neuromuscular hyperirritability or convulsive
seizures. In case of overdosage, discontinue medication, treat symptomatically,
and institute supportive measures as required. Piperacillin can be
removed by hemodialysis but not peritoneal dialysis.
How should I store and handle Pipracil?
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Clinical Information
Chemical Structure
No Image foundClinical Pharmacology
In healthy adult volunteers, mean serum piperacillin
concentrations immediately after a two‑to three‑minute
intravenous injection of 2, 4, or 6 g were 305, 412, and 775 μg/mL,
respectively. Serum concentrations lack dose proportionality.
A 30-minute infusion of 6 g every 6 h
gave, on the fourth day, a mean peak serum concentration of 420 μg/mL.
Non-Clinical Toxicology
PIPRACIL is contraindicated in patients with a history of allergic reactions to any of the betalactams, including penicillins and/or cephalosporins.SERIOUS AND OCCASIONALLY FATAL HYPERSENSITIVITY (ANAPHYLACTIC/ANAPHYLACTOID) REACTIONS HAVE BEEN REPORTED IN PATIENTS ON PENICILLIN THERAPY. THESE REACTIONS ARE MORE LIKELY TO OCCUR IN INDIVIDUALS WITH A HISTORY OF PENICILLIN HYPERSENSITIVITY AND/OR A HISTORY OF SENSITIVITY TO MULTIPLE ALLERGENS. THERE HAVE BEEN REPORTS OF INDIVIDUALS WITH A HISTORY OF PENICILLIN HYPERSENSITIVITY WHO HAVE EXPERIENCED SEVERE REACTIONS WHEN TREATED WITH CEPHALOSPORINS. BEFORE INITIATING THERAPY WITH PIPRACIL, CAREFUL INQUIRY SHOULD BE MADE CONCERNING PREVIOUS HYPERSENSITIVITY REACTIONS TO PENICILLINS, CEPHALOSPORINS OR OTHER ALLERGENS. IF AN ALLERGIC REACTION OCCURS, PIPRACIL SHOULD BE DISCONTINUED AND APPROPRIATE THERAPY INSTITUTED.
Clostridium difficile
C. difficile
C. difficile
C. difficile
If CDAD is suspected or confirmed, ongoing antibiotic use not directed against may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of , and surgical evaluation should be instituted as clinically indicated.
Bleeding manifestations have occurred in some patients receiving β-lactam antibiotics, including piperacillin. These reactions have sometimes been associated with abnormalities of coagulation tests such as clotting time, platelet aggregation, and prothrombin time and are more likely to occur in patients with renal failure.
If bleeding manifestations occur, the antibiotic should be discontinued and appropriate therapy instituted.
The possibility of the emergence of resistant organisms which might cause superinfections should be kept in mind, particularly during prolonged treatment. If this occurs, appropriate measures should be taken.
As with other penicillins, patients may experience neuromuscular excitability or convulsions if higher than recommended doses are given intravenously.
PIPRACIL is a monosodium salt containing 1.85 mEq of Na per g (42.5 mg of Na per g). This should be considered when treating patients requiring restricted salt intake. Periodic electrolyte determinations should be made in patients with low potassium reserves, and the possibility of hypokalemia should be kept in mind with patients who have potentially low potassium reserves and who are receiving cytotoxic therapy or diuretics.
Leukopenia and neutropenia may occur during prolonged therapy.
As with other semisynthetic penicillins, PIPRACIL therapy has been associated with an increased incidence of fever and rash in cystic fibrosis patients.
Prescribing PIPRACIL in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.
PIPRACIL is generally well tolerated. The most common adverse reactions have been local in nature, following intravenous or intramuscular injection. The following adverse reactions may occur:
Local Reactions
Gastrointestinal
Hypersensitivity Reactions
Rash was noted in 1% of patients. Other less frequent findings included pruritus, vesicular eruptions, and positive Coombs tests.
Other dermatologic manifestations, such as erythema multiforme, urticaria, toxic epidermal necrolysis and Stevens-Johnson syndrome, have been reported.
Renal
Central Nervous System
Hemic and Lymphatic
Serum Electrolytes
Skeletal
Other
Piperacillin therapy has been associated with an increased incidence of fever and rash in cystic fibrosis patients.
Reference
This information is obtained from the National Institute of Health's Standard Packaging Label drug database.
"https://dailymed.nlm.nih.gov/dailymed/"
While we update our database periodically, we cannot guarantee it is always updated to the latest version.
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