piperacillin sodium

pi·per·a·cil·lin sodium (p-pr-sln)

n.

A semisynthetic broad-spectrum antibiotic related to penicillin and active against a variety of gram-positive and gram-negative bacteria.

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piperacillin sodium (pīper´sil´in sō´dēm),

n a semisynthetic extended spectrum penicillin active against a wide variety of gram-positive and gram-negative bacteria.

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piperacillin sodium

Pharmacologic class: Penicillin (extended-spectrum)

Therapeutic class: Anti-infective

Pregnancy risk category B

Action

Inhibits bacterial cell-wall synthesis during active multiplication stage, resulting in cell death

Availability

Injection: 2 g, 3 g, 4 g, 40 g

⊘Indications and dosages

➣ To prevent infection during abdominal and vaginal surgery

Adults: For intra-abdominal surgery, 2 g I.V. just before surgery, followed by 2 g during surgery, then 2 g q 6 hours postoperatively for no more than 24 hours. For vaginal hysterectomy, 2 g I.V. just before surgery, followed by 2 g at 6 hours and 2 g at 12 hours after the initial dose. In cesarean delivery, 2 g I.V. after umbilical cord is clamped, followed by 2 g at 4 hours and 2 g at 8 hours after the initial dose. In abdominal hysterectomy, 2 g I.V. just before surgery, followed by 2 g on return to recovery room and 2 g 6 hours later.

➣ Serious infections

Adults: 12 to 18 g/day I.V. in divided doses q 4 to 6 hours

➣ Complicated urinary tract infection (UTI)

Adults: 8 to 16 g/day I.V. in divided doses q 6 to 8 hours

➣ Uncomplicated UTI or community-acquired pneumonia

Adults: 6 to 8 g/day I.M. or I.V. in divided doses q 6 to 12 hours

➣ Uncomplicated gonorrhea

Adults: 2 g I.M. as a single dose, with 1 g probenecid P.O. given 30 minutes before piperacillin injection

Dosage adjustment

• Renal impairment
• Elderly patients
• Children

Contraindications

• Hypersensitivity to penicillin or cephalosporins

Precautions

Use cautiously in:
• uremia, hypokalemia, cystic fibrosis, bleeding tendencies, drug allergies, sodium restriction
• pregnant or breastfeeding patients
• children younger than age 12.

Administration

• Ask patient about allergy to penicillin and cephalosporins before administering.
☞ Keep epinephrine and emergency equipment available.
• For I.M. use, dilute in sterile water for injection or normal saline solution, to yield a final concentration of 400 mg/ml. Limit dosage to 2 g. Preferably, inject into upper outer buttock area.
• For intermittent I.V. infusion, dilute reconstituted solution in 50 ml of dextrose 5% in water, normal saline solution, dextrose 5% in normal saline solution, or lactated Ringer's solution. Infuse over 20 to 30 minutes.
• When giving I.V. bolus, inject reconstituted solution over 3 to 5 minutes.
• Don't mix with aminoglycosides in syringe or infusion container; doing so inactivates aminoglycoside.

Route	Onset	Peak	Duration
I.V.	Immediate	Immediate	Dose dependent
I.M.	Unknown	30-50 min	Dose dependent

Adverse reactions

CNS: headache, dizziness, fatigue, seizures

CV: thrombophlebitis, deep-vein thrombosis

GI: nausea, vomiting, constipation, diarrhea, bloody diarrhea, pseudomembranous colitis

Hematologic: hematoma, eosinophilia, neutropenia, leukopenia, thrombocytopenia

Hepatic: cholestatic hepatitis

Metabolic: hypokalemia, hypernatremia, sodium overload

Skin: rash, erythema, induration, bruising, erythema multiforme, Stevens-Johnson syndrome

Other: pain, superinfection, anaphylaxis

Interactions

Drug-drug. Aminoglycosides: aminoglycoside inactivation

Aspirin, probenecid: increased piperacillin blood level

Hormonal contraceptives: decreased contraceptive efficacy

Methotrexate: increased risk of methotrexate toxicity

Tetracyclines: decreased piperacillin efficacy

Vecuronium: prolonged neuromuscular blockade

Drug-diagnostic tests. Bilirubin, blood urea nitrogen, creatinine, eosinophils, hepatic enzymes: increased values

Coombs' test (with I.V. piperacillin): false-positive result

Granulocytes, hemoglobin, platelets, white blood cells: decreased levels

Patient monitoring

☞ Monitor for signs and symptoms of anaphylaxis or superinfection.
☞ Be aware that high doses may cause seizures.
☞ Watch for signs and symptoms of thrombophlebitis and deep-vein thrombosis.
• Assess drug efficacy. Obtain repeat cultures after therapy ends.
☞ Monitor potassium level and CBC with white cell differential. Check for blood dyscrasias and hypokalemia.
☞ Assess for signs and symptoms of erythema multiforme (sore throat, rash, cough, iris lesions, mouth sores, cough, fever). Report early signs before condition can progress to Stevens-Johnson syndrome.

Patient teaching

• Stress importance of completing entire course of therapy.
☞ Instruct patient to immediately report allergic reactions, rash, or severe diarrhea.
• Instruct patient to contact prescriber if signs and symptoms of infection worsen or if new symptoms develop.
• Advise female patient taking hormonal contraceptives to use alternate birth-control method.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.