Dosing and uses of Pipracil (piperacillin)
Adult dosage forms and strengths
powder for injection
- 2g
- 3g
- 4g
- 40g
Usual Dosage Range
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
Urinary Tract, Uncomplicated
6-8 g/day IV/IM (100 to 125 mg/kg/day) divided q6-12 hr
Community-Acquired Pneumonia
6-8 g/day IV/IM (100 to 125 mg/kg/day) divided q6-12 hr
Acute Cholangitis
4 g IV q6hr
Moderate Infections
2-3 g/dose IV/IM q6-12hr; not to exceed 2 g IM/site
Severe Infections
3-4 g IV/IM q4-6hr; not to exceed 24 g/24 hr
Uncomplicated Gonorrhea
2 g once with 1 g probenecid 30 min before injection
Pseudomonas Infections
4 g IV/IM q4hr
Renal Impairment
CrCl 20-40 mL/min: 3-4 g q8hr
CrCl <20 mL/min: 3-4 g q12hr
Other Indications & Uses
Extended spectrum: Acinetobacter spp., Alcaligenes xylosoxidans, Bacteroides spp., Citrobacter diversus, Citrobacter freundii, E. coli, Fusobacteriae, H. influenzae, Klebsiella spp., N. gonorrhoeae, Peptococcus spp., Peptostreptococcus spp., indole-pos. Proteus spp., Providencia spp., Pseudomonas spp., Serratia spp., Streptococcus faecalis, Yersinia enterolitica
Pediatric dosage forms and strengths
powder for injection
- 2g
- 3g
- 4g
- 40g
Usual Dosage Range
Neonates: 100 mg/kg IV/IM q12hr
Infants and Children: 200-300 mg/kg/day IV/IM divided q4-6hr
Cystic Fibrosis
350-500 mg/kg/day IV/IM divided q4-6hr
Geriatric dosage forms and strengths
Adjust dose for renal impairment
Usual dosage range
IV: 2-4 g q6-8hr
IM: 1-2 g q8-12hr
Pipracil (piperacillin) adverse (side) effects
<1%
Seizure
Rash
Hemolytic anemia
Postive Coombs reaction
Prolonged prothrombin time
Interstitial nephritis
Hypersensitivity
Anaphylaxis
Thrombophlebitis
Injection site pain
Headache
Fever
Intestinal infection due to pseudomonas
Warnings
Contraindications
Allergy to penicillins, cephalosporins, imipenem
Cautions
Risk of bleeding complications, especially in renal impairment
Monitor renal, hepatic & especially hematopoietic functions during prolonged treatment
Pregnancy and lactation
Pregnancy category: B
Lactation: distributed into breast milk at low concentrations, use caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Pipracil (piperacillin)
Mechanism of action
Inhibits biosynthesis of cell wall mucopeptides and stage of active multiplication; has antipseudomonal activity
Pharmacokinetics
Half-Life: 36-80 min, dose dependent, higher in renal insufficiency
Protein Bound: 16%
Absorption: 70-80% (IM)
Peak Plasma Time: 30-50 min (IM)
Absorption: 70-80% (IM)
Distribution: Crosses placenta
Metabolism: Liver
Excretion: Urine (primarily); feces (partially)
Administration
IV Compatibilities
Solution: compatible with common solvents
Additive: clindamycin, flucloxacillin, fluconazole, hydrocortisone, linezolid, ofloxacin, KCl, verapamiL
Syringe: heparin
Y-site (partial list): allopurinol, bivalirudin, ciprofloxacin, diltiazem, esmolol, famotidine, heparin, hydromorphone, linezolid, lorazepam, magnesium sulfate, meperidine, midazolam, morphine, ranitidine, verapamil, zidovudine
IV Incompatibilities
Solution: aminoglycosides
Additive: aminoglycosides, ciprofloxacin
Y-site: aminoglycosides, amiodarone, amphotericin B cholesteryl SO4, cisatracurium(?), filgrastim, fluconazole, gatifloxacin, gemcitabine, ondansetron, sargramostim, vinorelbine
IV/IM Preparation
IV: reconstitute each gram w/ 5 mL SWI, BWI, NS, D5W or other compatible diluents
Slight darkening does not indicate potency loss
IV/IM Administration
Slow direct inj over 3-5 min, Or
Intermittent infusion in at least 50 mL over 20-30 min
IM: upper outer quadrant of buttock
