PIPERACILLIN SODIUM

Pipril

 Reviewed by Dorothy Cooper
November 1996
Administration Newborn Drug Protocol Index Newborn Services Home Page

Dose and Administration

  1. 50-100 mg/kg/dose IV infusion by syringe pump over 30 minutes, or IM.
Postmenstrual Age
(weeks) 		Postnatal Age
(days)		 Dosing Interval
(hours)
≤29 0 to 28 12
>28 8
30 to 36 0 to 14 12
>14 8
37 to 44 0 to 7 12
>7 8
45 All 6

Indications

  1. Suspected/proven infections caused by Pseudomonas aeruginosa.
  2. Use should be restricted to clinical situations in which ticarcillin has expected disadvantages (need for lower sodium load, hypocalcaemia or platelet dysfunction).

Contraindications and Precautions

  1. Hypersensitivity to penicillins/cephalosporins.
  2. Should not be used for gram positive infections.
  3. Caution in preterm infants, especially extreme immaturity.
  4. Caution in infants with liver, renal or gastrointestinal disease.

Clinical Pharmacology

Broad spectrum semi-synthetic penicillin antibiotic bactericidal against gram positive and gram negative aerobic and anaerobic organisms. Increased activity against Pseudomonas aeruginosa and many strains of Klebsiella, Serratia, E. coli, Enterobacter, Citrobacter and Proteus. Exerts its bacteriocidal action by inhibiting cell wall synthesis. Piperacillin is inactivated by beta lactamases produced by staphylococci and some gram negative bacteria.

Poor oral absorption. Widely distributed in human tissues and body fluids. Very little passes into the CSF unless the meninges are inflamed. Low binding (16%) to human plasma protein. Excreted, mainly unchanged by the kidney. In the presence of urinary tract infections, piperacillin appears to undergo some bacterial degradation. The half-life in neonates is about 220 minutes. Reduction in serum concentrations may be achieved by dialysis.

Possible Adverse Effects

  1. Venous irritation, soft tissue, injury at IV injection site.
  2. Pain, erythema, soft tissue injury at IM injection site.
  3. Hypersensitivity reactions (fever, rash).
  4. Gastrointestinal disturbance (nausea, vomiting, diarrhoea).
  5. Lethargy, seizures at high doses.
  6. Increase in alkaline phosphatase, AST, creatinine.
  7. Transient leukopenia, neutropenia, eosinophilia.

Special Considerations

  1. May give concurrently with aminoglycoside therapy for synergistic effect. Administer separately as simultaneous administration may cause inactivation.
  2. Adjust dose in suspected renal dysfunction (usually by lengthening the dosing interval).
  3. Sodium content: 1.8mmol/gm