Trade names Pipracil Routes of
administration IV, IM Molar mass 517.555 g/mol Protein binding 30% | Pregnancy
category B ATC code J01CA12 (WHO) CAS ID 66258-76-2 | |
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AHFS/Drugs.com Consumer Drug Information Legal status UK: POM (Prescription only)
US: ℞-only | ||
Piperacillin is a broad-spectrum β-lactam antibiotic of the ureidopenicillin class. The chemical structure of piperacillin and other ureidopenicillins incorporates a polar side chain that enhances penetration into Gram negative bacteria and reduces susceptibility to cleavage by Gram negative beta lactamase enzymes. These properties confer activity against the important hospital pathogen Pseudomonas aeruginosa. Thus piperacillin is sometimes referred to as an "anti-pseudomonal penicillin".
Contents
When used alone, piperacillin lacks strong activity against the Gram positive pathogens such as Staphylococcus aureus, as the beta-lactam ring is hydrolyzed by the bacteria's beta-lactamase.
Piperacillin is most commonly used in combination with the beta-lactamase inhibitor tazobactam (Piperacillin/Tazobactam) (tradename "Zosyn" or "Tazocin"), which enhances piperacillin's effectiveness by inhibiting many beta lactamases to which it is susceptible. The co-administration of tazobactam does not confer activity against MRSA, however, as penicillins (and most other beta lactams) do not avidly bind to the penicillin-binding proteins of this pathogen.
Medical uses
Piperacillin is used almost exclusively in combination with the beta lactamase inhibitor tazobactam for the treatment of serious, hospital-acquired infections. This combination is among the most widely used drug therapies in United States non-Federal hospitals, accounting for $388M in spending in spite of being a low-cost generic drug.
Piperacillin-tazobactam is recommended as part of a three drug regimen for the treatment of hospital-acquired pneumonia suspected as being due to infection by multi-drug resistant pathogens. It is also one of several antibacterials recommended for the treatment of infections known to be caused by anaerobic Gram negative rods.
Piperacillin-tazobactam is recommended by the National Institute for Health and Care Excellence as initial empiric treatment for people with suspected neutropenic sepsis.
Adverse effects
The most common adverse effects associated with piperacillin-tazobactam are diarrhea, constipation, nausea, headache and insomnia. Less commonly, severe adverse effects may include anaphylaxis, Stevens-Johnson syndrome, and Clostridium difficile associated diarrhea.
Administration
Piperacillin is not absorbed orally, and must therefore be given by intravenous or intramuscular injection. It has been shown that the bactericidal actions of the drug do not increase with concentrations of piperacillin higher than 4-6 x MIC, which means that the drug is concentration-independent in terms of its actions. Piperacillin has instead shown to offer higher bactericidal activity when its concentration remains above the MIC for longer periods of time (50% time>MIC showing the highest activity). This higher activity present in continuous dosing has not been directly linked to clinical outcomes, but however does show promise of lowering possibility of resistance and decreasing mortality.