Pivmecillinam

Oral
Acute uncomplicated cystitis

Oral
Chronic or recurrent bacteriuria

Oral
Urinary tract infection

Hypersensitivity to penicillins and/or cephalosporins. Impaired transit through the oesophagus, genetic metabolism anomalies causing severe carnitine deficiency (e.g. propionic acidaemia, carnitine transporter defect, methylmalonic aciduria).

Patient with porphyria. Renal impairment. Children. Pregnancy and lactation. Concomitant use with valproate products.

Significant: Fungal or bacterial superinfection (prolonged use); carnitine deficiency (prolonged or recurrent use); acute porphyria.
Blood and lymphatic system disorders: Thrombocytopenia.
Ear and labyrinth disorders: Vertigo.
Gastrointestinal disorders: Nausea, diarrhoea, vomiting, abdominal pain, oesophageal ulcer, dyspepsia, oesophagitis, mouth ulceration.
General disorders and admin site conditions: Fatigue.
Infections and infestations: Vulvovaginal mycotic infection.
Metabolism and nutrition disorders: Porphyria.
Nervous system disorders: Headache, dizziness.
Skin and subcutaneous tissue disorders: Rash, pruritus, urticaria.
Potentially Fatal: Hypersensitivity reactions (e.g. anaphylaxis); Clostridium difficile infection, pseudomembranous colitis.

Perform culture and susceptibility tests prior to treatment initiation; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Monitor renal function, LFTs, and plasma levels.

Symptoms: Nausea, vomiting, diarrhoea, abdominal pain. Management: Supportive and symptomatic treatment.

Increased risk of adverse toxic effect particularly carnitine deficiency with valproate products. May increase the serum concentration of methotrexate. Increased serum concentration with probenecid. Diminished therapeutic efficacy with erythromycin and tetracyclines.

May cause false-positive urinary glucose with tests using reducing substances.

Description: Pivmecillinam is the pivaloyloxymethyl ester of mecillinam. It interferes with the bacterial cell wall with its high specificity against the penicillin-binding protein 2 (PBP-2) making it different from other penicillins.
Synonym: amdinocillin pivoxil.
Pharmacokinetics:
Absorption: Well absorbed from the gastrointestinal tract. Bioavailability: 60-70%. Time to peak plasma concentration: 1-1.5 hours (mecillinam).
Distribution: Crosses the placenta and enters breast milk. Plasma protein binding: 5-10%.
Metabolism: Rapidly hydrolysed via non-specific esterases in the blood to its active form, mecillinam.
Excretion: Mainly via urine (approx. 60-70% as mecillinam); via bile. Elimination half-life: Approx 1 hour.

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 115163, Pivmecillinam. https://pubchem.ncbi.nlm.nih.gov/compound/Pivmecillinam. Accessed July 27, 2021.

Store between 15-30°C. Protect from moisture.

Penicillins

J01CA08 - pivmecillinam ; Belongs to the class of penicillins with extended spectrum. Used in the systemic treatment of infections.

Anon. Pivmecillinam (Amdinocillin Pivoxil). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 15/07/2021.

Buckingham R (ed). Pivmecillinam. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 15/07/2021.

Joint Formulary Committee. Pivmecillinam Hydrochloride. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 15/07/2021.

Pivmecillinam Hydrochloride 200 mg Film-Coated Tablets (Milpharm Limited). MHRA. https://products.mhra.gov.uk. Accessed 15/07/2021.

Selexid 200 mg Film-Coated Tablets (Karo Pharma AB). MHRA. https://products.mhra.gov.uk. Accessed 15/07/2021.