Pivmecillinam


Generic Medicine Info
Indications and Dosage
Oral
Acute uncomplicated cystitis
Adult: 200 mg bid for 7 days or 200 mg tid for 5 days. Alternatively, an initial dose of 400 mg followed by 200 mg tid for 8 doses may be used.

Oral
Chronic or recurrent bacteriuria
Adult: 400 mg 3-4 times daily.
Child: >40 kg: Same as adult dose.

Oral
Urinary tract infection
Child: <40 kg: 20-40 mg/kg daily in 3-4 divided doses.
Contraindications
Hypersensitivity to penicillins and/or cephalosporins. Impaired transit through the oesophagus, genetic metabolism anomalies causing severe carnitine deficiency (e.g. propionic acidaemia, carnitine transporter defect, methylmalonic aciduria).
Special Precautions
Patient with porphyria. Renal impairment. Children. Pregnancy and lactation. Concomitant use with valproate products.
Adverse Reactions
Significant: Fungal or bacterial superinfection (prolonged use); carnitine deficiency (prolonged or recurrent use); acute porphyria.
Blood and lymphatic system disorders: Thrombocytopenia.
Ear and labyrinth disorders: Vertigo.
Gastrointestinal disorders: Nausea, diarrhoea, vomiting, abdominal pain, oesophageal ulcer, dyspepsia, oesophagitis, mouth ulceration.
General disorders and admin site conditions: Fatigue.
Infections and infestations: Vulvovaginal mycotic infection.
Metabolism and nutrition disorders: Porphyria.
Nervous system disorders: Headache, dizziness.
Skin and subcutaneous tissue disorders: Rash, pruritus, urticaria.
Potentially Fatal: Hypersensitivity reactions (e.g. anaphylaxis); Clostridium difficile infection, pseudomembranous colitis.
Monitoring Parameters
Perform culture and susceptibility tests prior to treatment initiation; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Monitor renal function, LFTs, and plasma levels.
Overdosage
Symptoms: Nausea, vomiting, diarrhoea, abdominal pain. Management: Supportive and symptomatic treatment.
Drug Interactions
Increased risk of adverse toxic effect particularly carnitine deficiency with valproate products. May increase the serum concentration of methotrexate. Increased serum concentration with probenecid. Diminished therapeutic efficacy with erythromycin and tetracyclines.
Lab Interference
May cause false-positive urinary glucose with tests using reducing substances.
Action
Description: Pivmecillinam is the pivaloyloxymethyl ester of mecillinam. It interferes with the bacterial cell wall with its high specificity against the penicillin-binding protein 2 (PBP-2) making it different from other penicillins.
Synonym: amdinocillin pivoxil.
Pharmacokinetics:
Absorption: Well absorbed from the gastrointestinal tract. Bioavailability: 60-70%. Time to peak plasma concentration: 1-1.5 hours (mecillinam).
Distribution: Crosses the placenta and enters breast milk. Plasma protein binding: 5-10%.
Metabolism: Rapidly hydrolysed via non-specific esterases in the blood to its active form, mecillinam.
Excretion: Mainly via urine (approx. 60-70% as mecillinam); via bile. Elimination half-life: Approx 1 hour.
Chemical Structure

Chemical Structure Image
Pivmecillinam

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 115163, Pivmecillinam. https://pubchem.ncbi.nlm.nih.gov/compound/Pivmecillinam. Accessed July 27, 2021.

Storage
Store between 15-30°C. Protect from moisture.
MIMS Class
Penicillins
ATC Classification
J01CA08 - pivmecillinam ; Belongs to the class of penicillins with extended spectrum. Used in the systemic treatment of infections.
References
Anon. Pivmecillinam (Amdinocillin Pivoxil). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 15/07/2021.

Buckingham R (ed). Pivmecillinam. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 15/07/2021.

Joint Formulary Committee. Pivmecillinam Hydrochloride. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 15/07/2021.

Pivmecillinam Hydrochloride 200 mg Film-Coated Tablets (Milpharm Limited). MHRA. https://products.mhra.gov.uk. Accessed 15/07/2021.

Selexid 200 mg Film-Coated Tablets (Karo Pharma AB). MHRA. https://products.mhra.gov.uk. Accessed 15/07/2021.

Disclaimer: This information is independently developed by MIMS based on Pivmecillinam from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2021 MIMS. All rights reserved. Powered by MIMS.com
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