Generic
Pivmecillinam
8 brands available in the market
At a glance
Pivmecillinam is an antibiotic used for treatment of infections caused by mecillinam-sensitive organisms, including acute cystitis, complicated urinary tract infections, salmonellosis, shigellosis, enteropathic E. coli diarrhea, gram-negative septicemia, and biliary infections.
Description
Pivmecillinam belongs to the amdinopenicillin class of penicillins. It is a prodrug formulation of mecillinam that allows oral administration. The prodrug lacks antibacterial activity, but the active drug is liberated by enzymatic hydrolysis during absorption in the GI tract. It interferes with bacterial cell wall synthesis, but the site of action differs from other penicillins.
Indications
- Acute cystitis
- Complicated urinary tract infections
- Salmonellosis (including enteric fever)
- Shigellosis
- Enteropathic E. coli diarrhea
- Gram-negative septicemia
- Biliary infections
Therapeutic class
Narrow spectrum penicillin
Pharmacological class
Amdinopenicillin (Penicillin)
Pharmacology
Pivmecillinam is a prodrug of mecillinam which is hydrolyzed in vivo to active mecillinam. Mecillinam interferes with bacterial cell wall synthesis, but the site of action differs from other penicillins. It is active against many gram-negative bacteria including Enterobacteriaceae (E. coli, Klebsiella, Proteus, Enterobacter, Salmonella, Shigella, Yersinia). It has poor activity against gram-positive organisms.
Mechanism of action
Kills bacteria by interfering with bacterial cell wall synthesis.
Dosage
Adult Dose (Oral):
- Usual dose: 1-2 tablets 3 times daily according to severity
- Acute uncomplicated cystitis: Initially 400 mg, then 200 mg every 8 hours for 3 days
- Chronic or recurrent bacteriuria: 400 mg every 6-8 hours
- Salmonellosis (including enteric fever): 1.2-2.4 g daily for 14 days; carriage elimination: 2-4 weeks
- Complicated UTI: 1-2 weeks
- Prophylaxis of recurrent UTI: 1 tablet every evening
Pediatric Dose (Oral):
- <20 kg: 20-60 mg/kg in 3-4 divided doses
- >20 kg: Adult dose
- Shigellosis: 20 mg/kg 4 times daily for 5 days
- UTI: 20-40 mg/kg/day in 3-4 divided doses
- Salmonellosis: 30-60 mg/kg/day in 3-4 divided doses
Administration
- Take with at least 50-100 ml fluid
- Best taken with or immediately after a meal (bioavailability unaffected)
Missed dose
If you miss a dose, take it as soon as you remember; skip if it's almost time for next dose; do not double the dose.
Side effects
Common Side Effects:
- Nausea
- Vomiting
- Diarrhea
- Indigestion
- Skin rashes
- Hypersensitivity reactions (urticaria, fever, joint pains, angioedema, serum sickness-like reactions)
- Hemolytic anemia
- Interstitial nephritis
- Neutropenia, thrombocytopenia
- CNS toxicity (including convulsions)
- Antibiotic-associated colitis
- Induction of carnitine deficiency
- Potentially fatal: Anaphylaxis
Precautions & warnings
- Very high doses in poor renal function (risk of neurotoxicity) or heart failure
- Avoid contact (skin sensitization may occur)
- Monitor serum K concentration, renal and hematological status
- Spirochete infections (especially syphilis); suprainfection with penicillin-resistant organisms with prolonged use
- Avoid intrathecal route
- May cause esophageal injury
Contraindications
- Hypersensitivity to pivmecillinam or penicillins/cephalosporins
- Porphyria
Drug interactions
- Probenecid: Prolongs T½ of pivmecillinam
- Anticoagulants: May cause prolonged bleeding
- Oral contraceptives: May decrease efficacy
- Valproate: Increased risk of carnitine deficiency
Food interactions
Food does not affect absorption; it is not known whether it is safe to consume alcohol.
Use in pregnancy
Use in Pregnancy: Avoid during pregnancy; approximately 1/3 of serum levels found in umbilical cord and low but detectable amounts in amniotic fluid.
Pregnancy Category: B — always consult a doctor before taking during pregnancy.
Use in lactation
Use in Lactation: Mecillinam is not excreted into breast milk.
Pediatric use
Avoid use in infants under 3 months of age.
Geriatric use
Elderly patients require dose adjustment based on renal function.
Renal / hepatic impairment
Renal Impairment: CrCl ≥30 mL/min: Full dosage; CrCl 10-30 mL/min: 50% dosage; CrCl <10 mL/min: 25% dosage; consult your doctor.
Hepatic Impairment: Caution in liver disease; consult your doctor.
Overdose effects
No overdose experience; excessive doses likely to cause nausea, vomiting, and gastritis; treatment: symptomatic and supportive; hemodialysis may reduce blood levels.
Storage conditions
Store in a cool and dry place, protected from light and moisture.
Chemical structure
Pivmecillinam