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.

Therapeutic Effect

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.

Cautious Use

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 6–8 g/d divided q6–12h

Complicated UTIs
Adult: IV 8–16 g/d divided q6–8h

Mild to Moderate Infections
Child: IV 200–300 mg/kg/d divided q4–6h (max: 24 g/d)
Neonate: IV 150–200 mg/kg/d divided q6–8h

Moderate to Severe Infections
Adult: IV/IM 1–3 g q6–8h

Life-Threatening Infection, Pseudomonas Infections
Adult: IV 12–18 g/d divided q4–6h)

Uncomplicated Gonococcal Infections
Adult: IM 2 g with 1 g oral probenecid given 30 min before

Renal Impairment
Clcr 20–40 mL/min: use 3–4 g q8h; <20 mL/min: give q12h
Hemodialysis: 20–50% 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 0.5–1.0% 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 50–100 mL NS or D5W.  

ADMINISTER: Direct: Give over 3–5 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, neuritis 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). CV: 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: Bronchospasm, asthma. Skin: 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.


Drug: May increase risk of bleeding with anticoagulants; probenecid decreases elimination of piperacillin.


Peak: 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: 0.6–1.35 h.

Nursing Implications

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).

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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