Piperacillin

Indications
 Intravenous
Severe infections
Adult: As sodium: 200-300 mg/kg daily in divided doses or 3-4 g every 4 or 6 hr. For life-threatening conditions especially those caused by Pseudomonas or Klebsiella spp: At least 16 mg/day. Usual max dose: 24 g/day.
Child: As sodium: 1 mth-12 yr: 100-300 mg/kg daily in 3-4 divided doses. Neonate: <7 days or <2 kg: 150 mg/kg daily in 3 divided doses; >7 days and >2 kg: 300 mg/kg in 3-4 divided doses. IV route is preferred for infants and children. Single doses >500 mg should not be given via IM inj.
Renal impairment: Moderate-severe: Dose reduction is necessary.
Parenteral
Mild or uncomplicated infections
Adult: As sodium: 100-125 mg/kg daily. Usual dose: if given via IV inj/infusion, 2 g every 6 or 8 hr or 4 g every 12 hr; if given via IM inj, 2 g every 8 or 12 hr.
Child: As sodium: 1 mth-12 yr: 100-300 mg/kg daily in 3-4 divided doses. Neonate: <7 days or <2 kg: 150 mg/kg daily in 3 divided doses; >7 days and >2 kg: 300 mg/kg in 3-4 divided doses. IV route is preferred for infants and children. Single doses >500 mg should not be given via IM inj.
Renal impairment: Moderate-severe: Dose reduction is necessary.
Parenteral
Prophylaxis of infection during surgery
Adult: As sodium: 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 at intervals of 4 or 6 hr within 24 hr of procedure.
Renal impairment: Moderate-severe: Dose reduction is necessary.
Intramuscular
Uncomplicated gonorrhoea
Adult: As sodium: 2 g as a single dose in combination with 1 g oral dose of probenecid given 30 min before the inj.
Renal impairment: Moderate-severe: Dose reduction is necessary.

Special Populations: Reduce dose in patients with moderate to severe renal impairment.
Contraindications
 Hypersensitivity.
Warnings / Precautions
 Renal impairment; heart failure. Pregnancy. Prolonged treatment may increase risk of superinfection, leukopenia, neutropenia and bleeding manifestations. Increased risk of fever and rash in cystic fibrosis patients. Monitor renal, hepatic and haematological functions during prolonged and high-dose therapy.
Adverse Reactions
 GI disturbances; hypersensitivity reactions; eosinophilia, hyponatraemia, hypokalaemia. Injection-site related reactions such as pain, erythema and induration.
Potentially Fatal: Anaphylactic reactions; prolongation of bleeding time; CNS toxicity.
Drug Interactions
 Clearance reduced by probenecid. May prolong bleeding time when used with anticoagulants. Increased risk of aminoglycoside-associated nephrotoxicity when used together. Concurrent use may increase risk of methotrexate toxicity due to reduced clearance. Increased neuromuscular block when used with neuromuscular blockers.
See Below for More piperacillin Drug Interactions
Lab Interactions
 Interferes with urinary glucose using copper sulfate and false-positive results in urinary or serum protein, uric acid and urinary test.
Mechanism of Actions
 Piperacillin inhibit septum and cell wall synthesis and has an antimicrobial activity against a wide range of gm-ve organisms including K. pneumoniae, P. aeruginosa, Enterobacteriaceae and against Garm-positive organisms eg, E. faecalis and B. fragilis.
Absorption: Not absorbed when given orally. IM: well absorbed with peak plasma concentrations after 30-50 min.
Distribution: Widely distributed into body tissues and fluids, CSF (small amounts except when the meninges are inflamed), bile (high concentrations); crosses the placenta and enters the breast milk. Protein-binding: 20%
Excretion: Via the urine by glomerular filtration and tubular secretion (60-80% unchanged), via the bile (20%); may be removed by dialysis. Elimination half-life: 1 hr; 4-6 hr (end-stage renal failure), 3-fold increase (severe renal insufficiency), prolonged in neonates and in renal and hepatic impairment.
Storage Conditions
 Intramuscular: Store at 20-25 °C. Intravenous: Store at 20-25 °C. Parenteral: Store at 20-25 °C.
ATC Classification
 J01CA12 - piperacillin ; Belongs to the class of penicillins with extended spectrum. Used in the systemic treatment of infections.
Storage
 Intramuscular: Store at 20-25 °C. Intravenous: Store at 20-25 °C. Parenteral: Store at 20-25 °C.
Available As
  • Piperacillin 1000 mg
  • Piperacillin Sodium 1000 mg
  • Piperacillin Sodium 2000 mg
  • Piperacillin 2000 mg
  • Piperacillin Sodium 400 mg
  • Piperacillin 4000 mg
  • Piperacillin Sodium 4000 mg

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