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Piperacillin
Pham P and Bartlett JG
03-17-2008
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Available formulation in Zambia: IV: 2 g, 4 g/vial
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Pseudomonas pneumonia: piperacillin 300 mg/kg/d divided q4h (3 gm IV q4h) plus gentamicin.
Zambia Information Author: Paul A. Pham Pharm.D.
- Bone and joint infections
- Gonococcal infections
- Gynecologic infections
- Intra-abdominal infections
- Lower respiratory tract infections
- Septicemia
- Skin and skin structure infections
- Surgical prophylaxis (intra-abdominal procedure, vaginal hysterectomy, abdominal hysterectomy, c-section)
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Urinary tract infections
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
| Piperacillin | Piperacillin | ~Various | IV
vial
3g | $13.00 |
|
|
|
| IV
vial
4g | $17.00 |
|
|
|
| IV
vial
40g | $161 |
|
|
|
| IV
vial
2g | $8.00 |
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
Moderate to severe infections: 3gm IV q4-6h (up to 24 Gm a day). Pneumonia and pseudomonal infections: 3gm IV q4h or 4gm IV q6h.
GFR >40 mL/min: 3Gm q6h. Use 3Gm q4h or 4Gm q6h for severe infections or Pseudomonas.
GFR 20-40 mL/min: 2Gm q6h. For severe infection or Pseudomonas 4Gm q8h.
GFR <20 mL/min: 2Gm q8h or 3Gm q12h. Use 4Gm q12h for severe infections or Pseudomonas.
2 Gm q8h plus 1 Gm post-dialysis. For severe infections 3Gm q8h plus 1Gm post dialysis.
2Gm q8h. For severe infection 3Gm q8h.
CVVH: 2 Gm q6h. CVVHD: 2-3 Gm q6h.
- Generally well tolerated.
- GI intolerance
- Phlebitis at infusion sites
- Jarisch-Herxheimer reaction (with syphilis or other spirochetal infections)
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C. difficile colitis
- LFTs elevations with rare cases of clinical hepatitis
- Hypersensitivity reactions
- Rash
- Drug fever
- Coombs' test positive w/ hemolytic anemia
- Interstitial nephritis
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Neutropenia and thrombocytopenia
- Abnormal platelet aggregation with bleeding diathesis
- CNS: seizures and twitching ( with high doses in patients with renal failure)
- Hepatitis
- Anaphylaxis
- Tetracyclines: in vitro antagonism when co-administered. Bactericidal effect of penicillins may be diminished in vivo. Management recommendation: avoid concurrent administration. In two studies involving a total of 79 patients with pneumococcal meningitis treated with either penicillin plus tetracyclines or penicillin monotherapy resulted in a higher mortality rate (79-85%) in the combination therapy compared to penicillin monotherapy (30-33%) [Arch Intern Med 1951:88:489, Ann Intern Med 1961; 55:545]. However there was not a difference in mortality between penicillin monotherapy and penicillin plus tetracycline in the treatment of pneumococcal pneumonia [Arch Intern Med 1953; 91:197].
- Probenecid may prolong piperacillin half-life. May be result in significant accumulation in renal failure.
- Methotrexate serum concentrations may be increased. Monitor with methotrexate-induced toxicity.
Parenteral anti-pseudomonal penicillin with superior enterococcal coverage compared to ticarcillin. Due to the high prevalence of plasmid-mediated beta-lactamases produced by gram-negative bacteria, piperacillin without tazobactam is not recommended empirically for nosocomial infections. May be preferred over piperacillin-tazobactam for P. aeruginosa monotherapy as the tazobactam does not add activity against pseudomonas.
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