Piperacillin

General

• Type: Beta Lactam
• Dosage Forms: IV
• Common Trade Names:

Adult Dosing

• 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

Pediatric Dosing

• Neonates: 100 mg/kg IV/IM q12h
• Infants and Children: 200-300 mg/kg/day IV/IM divided q4-6hr

Special Populations

• Pregnancy Rating: B
• Lactation:
• Renal Dosing
  • Adult:
  • CrCl 20-40 mL/min: 3-4 g q8hr
  • CrCl <20 mL/min: 3-4 g q12hr
  • Pediatric
• Hepatic Dosing
  • Adult
  • Pediatric

Contraindications

• Allergy to class/drug
• Caution
  • Non-anaphylactic hypersensitivity to beta-lactams
  • Asthma, cystic fibrosis
  • Recent antibiotic-associated colitis
  • Seizure disorder
  • Renal impairement
  • Sodium restriction
  • Hypokalemia
  • Bleeding risk

Adverse Reactions

Serious

• Anaphylaxis
• Serum sickness-like reaction
• DRESS syndrome
• Acute generalized exanthematous pustulosis
• Erythema multiforme, SJS, TEN
• Interstitial nephritis
• Superinfection
• C. difficile associated diarrhea
• Hemolytic anemia, leukopenia, neutropenia, pancytopenia, agranulocytosis, thrombocytopenia
• Bleeding
• Hypokalemia
• Seizure

Common

• Diarrhea, constipation, nausea/vomiting, dyspepsia
• Headache
• Insomnia
• Rash, pruritus
• Fever
• Agitation
• Electrolyte abnormality
• LFT elevation

Pharmacology

• Half-life: 30-80min
• Metabolism: Hepatic
• Excretion: urinary
• Mechanism of Action: Inhibits biosynthesis of cell wall mucopeptides and stage of active multiplication; has antipseudomonal activity

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	I
	Strep. anginosus gp	S
	Enterococcus faecalis	S
	Enterococcus faecium	I
	MSSA	R
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	R
	C. jeikeium	R
	L. monocytogenes	S
Gram Negatives	N. gonorrhoeae	X2
	N. meningitidis	S
	Moraxella catarrhalis	I
	H. influenzae	I
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	S
	Enterobacter sp, AmpC pos	S
	Serratia sp	S
	Serratia marcescens	X1
	Salmonella sp	S
	Shigella sp	S
	Proteus mirabilis	S
	Proteus vulgaris	S
	Providencia sp.	S
	Morganella sp.	S
	Citrobacter freundii	S
	Citrobacter diversus	S
	Citrobacter sp.	S
	Aeromonas sp	S
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	S
	Burkholderia cepacia	X1
	Stenotrophomonas maltophilia	I
	Yersinia enterocolitica	S
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
	Pasteurella multocida	S
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	R
	Mycoplasm pneumoniae	R
	Rickettsia sp	X1
	Mycobacterium avium	X1
Anaerobes	Actinomyces	S
	Bacteroides fragilis	R
	Prevotella melaninogenica	S
	Clostridium difficile	X2
	Clostridium (not difficile)	S
	Fusobacterium necrophorum	X1
	Peptostreptococcus sp.	S

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia