Piperacillin


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IV Severe infections 3-4 g 4-6 hrly. Life-threatening conditions: At least 16 mg/day. Max: 24 g/day. IV/IM Mild or uncomplicated infections IV: 2 g 6-8 hrly or 4 g 12 hrly; IM: 2 g 8-12 hrly. Surgical prophylaxis 2 g just before procedure or when the umbilical cord is clamped in caesarean section, then at least 2 doses of 2 g 4-6 hrly w/in 24 hr of procedure. IM Mild or uncomplicated infections 2 g 8-12 hrly. Uncomplicated gonorrhoea 2 g as a single dose (w/ oral probenecid 30 min before the inj).
Dosage Details
Intramuscular
Uncomplicated gonorrhoea
Adult: 2 g as a single dose in combination w/ 1 g oral dose of probenecid given 30 min before the inj.

Intravenous
Severe infections
Adult: 200-300 mg/kg daily in divided doses or 3-4 g 4-6 hrly, via inj over 3-5 min or infusion over 20-30 min. For life-threatening conditions esp those caused by Pseudomonas or Klebsiella spp: At least 16 mg daily. Max: 24 g daily.
Child: ≥1 mth 300-400 mg/kg daily in 4-6 divided doses.

Parenteral
Mild or uncomplicated infections
Adult: 100-125 mg/kg daily. IV: 2 g 6-8 hrly or 4 g 12 hrly. IM: 2 g 8-12 hrly.
Child: ≥1 mth 200 mg/kg daily in 3-4 divided doses.

Parenteral
Prophylaxis of infection during surgery
Adult: 2 g just before the procedure or when the umbilical cord is clamped in caesarean section, followed by at least 2 doses of 2 g 4-6 hrly w/in 24 hr of procedure.
Renal Impairment
Haemodialysis patients: 2 g 8 hrly, w/ an additional dose of 1 g given after each haemodialysis run.
CrCl Dosage
<20 4 g 12 hrly.
20-40 4 g 8 hrly.
Reconstitution
Intravenous:
Reconstitute each gram w/ at least 5 mL of a suitable diluent. For infusion, reconstituted soln may be further diluted to the desired vol (e.g. 50 mL or 100 mL) w/ suitable IV soln and admixtures.
Intramuscular:
Reconstitute each gram w/ 2 mL of a suitable diluent to achieve a concentration of 1 g/2.5 mL.
Incompatibility
Aminoglycoside, Na bicarbonate, amiodarone, amphotericin B cholesteryl sulfate complex, filgrastim, gemcitabine, sargramostim, tobramycin, vinorelbine.
Contraindications
Hypersensitivity to piperacillin or other penicillins.
Special Precautions
Patient w/ history of β-lactam hypersensitivity. Moderate to severe renal impairment. Pregnancy and lactation.
Adverse Reactions
Pain, erythema, induration at inj site; diarrhoea, vomiting, nausea, increases in liver enzymes (LDH, AST, ALT), hyperbilirubinaemia, cholestatic hepatitis, hypersensitivity reactions (e.g. rash, pruritus, vesicular eruptions, erythema multiforme, urticaria, Stevens-Johnson syndrome), elevation of creatinine or BUN, renal failure, interstitial nephritis, headache, dizziness, fatigue, seizures, haemolytic anaemia, agranulocytosis, pancytopenia, prolonged bleeding time, reversible leucopenia, neutropenia, thrombocytopenia, eosinophilia, hypokalaemia, prolonged muscle relaxation, fever, superinfection (e.g. candidiasis), haemorrhagic manifestations.
Potentially Fatal: Anaphylactic reactions, Clostridium difficile-associated diarrhoea (CDAD).
IM/IV/Parenteral: B
MonitoringParameters
Observe for signs and symptoms of anaphylaxis during 1st dose. Monitor electrolytes and cardiac status, serum creatinine, BUN, hepatic function and CBC.
Overdosage
Symptoms: Neuromuscular hyperirritability or convulsive seizures. Management: Symptomatic and supportive treatment. May be removed by haemodialysis.
Drug Interactions
May prolong the neuromuscular blocking effect of vecuronium when used perioperatively. May enhance the anticoagulant effect of vit K antagonists (e.g. warfarin). May increase the risk of methotrexate toxicity. Probenecid may increase the peak serum level of piperacillin.
Lab Interference
May result in false-positive reaction for glucose in the urine using a copper-reduction method.
Action
Description: Piperacillin inhibits bacterial cell wall synthesis by binding to 1 or more of the penicillin-binding proteins (PBPs) which in turn inhibit the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.
Pharmacokinetics:
Absorption: Well absorbed after IM inj. Time to peak plasma concentration: 30-50 min.
Distribution: Widely distributed in body tissues and fluids. Crosses the placenta into the foetal circulation and enters breast milk (small amounts). Plasma protein binding: Approx 20%.
Excretion: Via urine (approx 60-80%) as unchanged drug and bile (up to 20%). Plasma half-life: Approx 1 hr.
Chemical Structure

Chemical Structure Image
Piperacillin

Source: National Center for Biotechnology Information. PubChem Database. Piperacillin, CID=43672, https://pubchem.ncbi.nlm.nih.gov/compound/Piperacillin (accessed on Jan. 22, 2020)

Storage
Dry powd: Store between 20-25°C. Reconstituted soln: Store between 20-25°C (stable for 24 hr) or between 2-8°C (stable for 48 hr).
MIMS Class
References
Anon. Piperacillin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 27/06/2014.

Buckingham R (ed). Piperacillin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 27/06/2014.

Pipracil Injection, Powder, Lyophilized, For Solution (Wyeth Pharmaceuticals, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 27/06/2014.

Disclaimer: This information is independently developed by MIMS based on Piperacillin 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 © 2020 MIMS. All rights reserved. Powered by MIMS.com
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