Adult: 2 g as a single dose in combination w/ 1 g oral dose of probenecid given 30 min before the inj.
Intravenous Severe infections
Adult: 200-300 mg/kg daily in divided doses or 3-4 g 4-6 hrly, via inj over 3-5 min or infusion over 20-30 min. For life-threatening conditions esp those caused by Pseudomonas or Klebsiella spp: At least 16 mg daily. Max: 24 g daily. Child: ≥1 mth 300-400 mg/kg daily in 4-6 divided doses.
Parenteral Mild or uncomplicated infections
Adult: 100-125 mg/kg daily. IV: 2 g 6-8 hrly or 4 g 12 hrly. IM: 2 g 8-12 hrly. Child: ≥1 mth 200 mg/kg daily in 3-4 divided doses.
Parenteral Prophylaxis of infection during surgery
Adult: 2 g just before the procedure or when the umbilical cord is clamped in caesarean section, followed by at least 2 doses of 2 g 4-6 hrly w/in 24 hr of procedure.
Renal Impairment
Haemodialysis patients: 2 g 8 hrly, w/ an additional dose of 1 g given after each haemodialysis run.
CrCl
Dosage
<20
4 g 12 hrly.
20-40
4 g 8 hrly.
Reconstitution
Intravenous:
Reconstitute each gram w/ at least 5 mL of a suitable diluent. For infusion, reconstituted soln may be further diluted to the desired vol (e.g. 50 mL or 100 mL) w/ suitable IV soln and admixtures. Intramuscular:
Reconstitute each gram w/ 2 mL of a suitable diluent to achieve a concentration of 1 g/2.5 mL.
Incompatibility
Aminoglycoside, Na bicarbonate, amiodarone, amphotericin B cholesteryl sulfate complex, filgrastim, gemcitabine, sargramostim, tobramycin, vinorelbine.
Contraindications
Hypersensitivity to piperacillin or other penicillins.
Special Precautions
Patient w/ history of β-lactam hypersensitivity. Moderate to severe renal impairment. Pregnancy and lactation.
Observe for signs and symptoms of anaphylaxis during 1st dose. Monitor electrolytes and cardiac status, serum creatinine, BUN, hepatic function and CBC.
Overdosage
Symptoms: Neuromuscular hyperirritability or convulsive seizures. Management: Symptomatic and supportive treatment. May be removed by haemodialysis.
Drug Interactions
May prolong the neuromuscular blocking effect of vecuronium when used perioperatively. May enhance the anticoagulant effect of vit K antagonists (e.g. warfarin). May increase the risk of methotrexate toxicity. Probenecid may increase the peak serum level of piperacillin.
Lab Interference
May result in false-positive reaction for glucose in the urine using a copper-reduction method.
Action
Description: Piperacillin inhibits bacterial cell wall synthesis by binding to 1 or more of the penicillin-binding proteins (PBPs) which in turn inhibit the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested. Pharmacokinetics: Absorption: Well absorbed after IM inj. Time to peak plasma concentration: 30-50 min. Distribution: Widely distributed in body tissues and fluids. Crosses the placenta into the foetal circulation and enters breast milk (small amounts). Plasma protein binding: Approx 20%. Excretion: Via urine (approx 60-80%) as unchanged drug and bile (up to 20%). Plasma half-life: Approx 1 hr.
Chemical Structure
Piperacillin Source: National Center for Biotechnology Information. PubChem Database. Piperacillin, CID=43672, https://pubchem.ncbi.nlm.nih.gov/compound/Piperacillin (accessed on Jan. 22, 2020)
Storage
Dry powd: Store between 20-25°C. Reconstituted soln: Store between 20-25°C (stable for 24 hr) or between 2-8°C (stable for 48 hr).
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