| PIPERACILLIN SODIUM
Classifications: beta-lactam antibiotic; penicillin; Therapeutic: antibiotic
Pregnancy Category: B
2 g, 3 g, 4 g injection
Piperacillin is a beta-lactam antibiotic and is mainly bactericidal. It inhibits the final stage of bacterial cell wall
synthesis by preferentially binding to specific penicillin-binding proteins (PBPs) located inside the bacterial cell wall.
This interferes with bacterial cell wall synthesis promotes loss of membrane integrity and leads to death of the organism.
Extended-spectrum parenteral penicillin with antibiotic activity against most gram-negative and many gram-positive anaerobic
and aerobic organisms.
Susceptible organisms that cause gynecologic, skin and skin structure, gonococcal, and streptococcal infections; lower respiratory
tract, intraabdominal, and bone and joint infections; septicemia, urinary tract infections. Also used prophylactically prior
to and during surgery and as empiric antiinfective therapy in granulocytopenic patients.
Hypersensitivity to penicillins.
Liver and kidney dysfunction; hypersensitivity to cephalosporins or carbapenem; cystic fibrosis; eczema, asthma; GI disease;
pregnancy (category B); children; lactation.
Route & Dosage
|Uncomplicated Urinary Tract Infection
Adult: IV/IM 68 g/d divided q612h
Adult: IV 816 g/d divided q68h
Mild to Moderate Infections
Child: IV 200300 mg/kg/d divided q46h (max: 24 g/d)
Neonate: IV 150200 mg/kg/d divided q68h
Moderate to Severe Infections
Adult: IV/IM 13 g q68h
Life-Threatening Infection, Pseudomonas Infections
Adult: IV 1218 g/d divided q46h)
Uncomplicated Gonococcal Infections
Adult: IM 2 g with 1 g oral probenecid given 30 min before
Clcr 2040 mL/min: use 34 g q8h; <20 mL/min: give q12h
Hemodialysis: 2050% dialyzable
Note: Patients undergoing hemodialysis usually receive a maximum dosage of 2 g piperacillin q8h and an additional 1 g dose after
each dialysis period. Doses and frequency are usually modified if creatinine clearance is <40 mL/min.
- Limit IM injections to 2 g/site. Use the gluteal muscle, preferably. Use deltoid muscle only if well developed.
- Diluents for reconstitution include sterile or bacteriostatic water for injection, bacteriostatic NaCl injection, and sterile
lidocaine HCl injection 0.51.0% without epinephrine for IM. When reconstituted, solution contains 1 g/2.5 mL.
- Note: Verify correct IV concentration and rate of infusion for administration to neonates, infants, or children with physician.
PREPARE: Direct: Reconstitute by diluting each 1 g or fraction thereof with 5 mL sterile water or NS for injection. Shake well until dissolved. Intermittent: Further dilute with 50100 mL NS or D5W.
ADMINISTER: Direct: Give over 35 min. Avoid rapid injection. Intermittent: Give over 30 min.
INCOMPATIBILITIES Solution/additive: aminoglycosides. Y-site: aminoglycosides, amiodarone, amphotericin B cholesteryl complex, cisatracurium, filgrastim, fluconazole, gatifloxacin, gemcitabine, ondansetron, sargramostim, vancomycin, vinorelbine.
Adverse Effects (≥1%)Body as a Whole:
Coughing, sneezing, feeling of uneasiness; systemic anaphylaxis,
fever, widespread increase in capillary permeability and vasodilation with resulting edema (mouth, tongue, pharynx, larynx), laryngospasm,
malaise, serum sickness (fever, malaise, pruritus, urticaria, lymphadenopathy, arthralgia, angioedema of face and extremities,
prostration, eosinophilia), SLE-like syndrome, Injection site reactions (pain, inflammation, abscess, phlebitis),
superinfections (especially with Candida
and gram-negative bacteria), neuromuscular irritability (twitching, lethargy, confusion, stupor, hyperreflexia, multifocal
myoclonus, localized or generalized seizures, coma
Hypotension, circulatory collapse,
cardiac arrhythmias, cardiac arrest. GI:
Vomiting, diarrhea, severe abdominal cramps, nausea, epigastric distress, diarrhea, flatulence, dark discoloration of tongue,
sore mouth or tongue. Urogenital:
Interstitial nephritis, Loeffler's syndrome, vasculitis. Hematologic:
Hemolytic anemia, thrombocytopenia. Metabolic:
Hyperkalemia (penicillin G potassium); hypokalemia, alkalosis, hypernatremia, CHF (penicillin G sodium). Respiratory:
Itchy palms or axilla, pruritus, urticaria,
flushed skin, delayed skin rashes
ranging from urticaria to exfoliative dermatitis, Stevens-Johnson syndrome, fixed-drug eruptions, contact dermatitis.
May increase risk of bleeding with anticoagulants
decreases elimination of piperacillin.
45 min IM; 5 min IV. Distribution:
Widely distributed; highest concentrations in urine and bile; adequate CSF penetration with inflamed meninges; crosses
placenta; distributed into breast milk. Metabolism:
In liver. Elimination:
Primarily in urine, partly in bile. Half-Life:
Assessment & Drug Effects
- Obtain history of hypersensitivity to penicillins, cephalosporins, or other drugs prior to administration.
- Lab tests: C&S prior to first dose of the drug; start drug pending results. Periodic CBC with differential, platelet count,
Hgb and Hct, and serum electrolytes.
- Monitor for hypersensitivity response; discontinue drug and notify physician if allergic response noted.
- Lab tests: Periodic CBC with differential, platelet count, Hgb and Hct, and serum electrolytes.
- Monitor for hemorrhagic manifestations because high doses may induce coagulation abnormalities.
Patient & Family Education
- Report significant, unexplained diarrhea.
- Withhold drug and report to physician if signs of an allergic reaction develop (e.g., itching, rash, hives).