Piperacillin

General

Adult Dosing

  • IV: 3-4 g/dose q4-6hr; not to exceed 24 g/24hr
  • IM: 2-3 g/dose q6-12hr; not to exceed 24 g/24 hr

Pediatric Dosing

  • Neonates: 100 mg/kg IV/IM q12h
  • Infants and Children: 200-300 mg/kg/day IV/IM divided q4-6hr

Special Populations

  • Pregnancy Rating: B
  • Lactation:
  • Renal Dosing
    • Adult:
    • CrCl 20-40 mL/min: 3-4 g q8hr
    • CrCl <20 mL/min: 3-4 g q12hr
    • Pediatric
  • Hepatic Dosing
    • Adult
    • Pediatric

Contraindications

  • Allergy to class/drug
  • Caution
    • Non-anaphylactic hypersensitivity to beta-lactams
    • Asthma, cystic fibrosis
    • Recent antibiotic-associated colitis
    • Seizure disorder
    • Renal impairement
    • Sodium restriction
    • Hypokalemia
    • Bleeding risk

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life: 30-80min
  • Metabolism: Hepatic
  • Excretion: urinary
  • Mechanism of Action: Inhibits biosynthesis of cell wall mucopeptides and stage of active multiplication; has antipseudomonal activity

Antibiotic Sensitivities[1]

Group Organism Sensitivity
Gram PositiveStrep. Group A, B, C, GS
Strep. PneumoniaeS
Viridans strepI
Strep. anginosus gpS
Enterococcus faecalisS
Enterococcus faeciumI
MSSAR
MRSAR
CA-MRSAR
Staph. EpidermidisR
C. jeikeiumR
L. monocytogenesS
Gram NegativesN. gonorrhoeaeX2
N. meningitidisS
Moraxella catarrhalisI
H. influenzaeI
E. coliS
Klebsiella spS
E. coli/Klebsiella ESBL+R
E coli/Klebsiella KPC+R
Enterobacter sp, AmpC negS
Enterobacter sp, AmpC posS
Serratia spS
Serratia marcescensX1
Salmonella spS
Shigella spS
Proteus mirabilisS
Proteus vulgarisS
Providencia sp.S
Morganella sp.S
Citrobacter freundiiS
Citrobacter diversusS
Citrobacter sp.S
Aeromonas spS
Acinetobacter sp.R
Pseudomonas aeruginosaS
Burkholderia cepaciaX1
Stenotrophomonas maltophiliaI
Yersinia enterocoliticaS
Francisella tularensisX1
Brucella sp.X1
Legionella sp.R
Pasteurella multocidaS
Haemophilus ducreyiX1
Vibrio vulnificusX1
MiscChlamydophila spR
Mycoplasm pneumoniaeR
Rickettsia spX1
Mycobacterium aviumX1
AnaerobesActinomycesS
Bacteroides fragilisR
Prevotella melaninogenicaS
Clostridium difficileX2
Clostridium (not difficile)S
Fusobacterium necrophorumX1
Peptostreptococcus sp.S

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

References

  1. Sanford Guide to Antimicrobial Therapy 2014
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