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Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

PIPERACILLIN

Indication

  • reserved for the treatment of infections which are caused by susceptible Gram-negative bacteria which are ampicillin resistant; in general, piperacillin should NOT be used for the treatment of Gram-positive organisms, since other agents (eg. Penicillin, Ampicillin) are more appropriate

Pharmacology

  • piperacillin is a semisynthetic extended-spectrum penicillin
  • extended-spectrum penicillins, such as piperacillin (and ticarcillin, carbenicillin) are, in general, less active against Gram-positive aerobic bacteria but possess a wider spectrum of activity than penicillin or ampicillin
  • piperacillin is active in vitro against many Gram-positive aerobic cocci (including group B streptococci), Gram-negative aerobic cocci (including Enterobacteriaceae, Pseudomonas) and anaerobic bacteria (including some strains of Bacteroides)
  • the antibacterial activity of piperacillin and aminoglycosides may be additive or synergistic against some strains of Pseudomonas aeruginosa
  • piperacillin is not well absorbed from the GI tract and therefore must be given IV or IM
  • piperacillin is well distributed throughout most body tissues and fluids; piperacillin does not attain high concentrations in the CSF; penetration into the CSF is generally higher when the meninges are inflamed; biliary concentration has been reported to be 30-60 times higher than concurrent levels
  • the volume of distribution is neonates has been reported to vary from 0.38-0.58 L/kg
  • the terminal half life in adults with normal renal function is between 0.6-1.3 h; in neonates the half life varies from 2.1 to 3.6 h and is inversely proportional to post natal age.

Side Effects

  • hypersensitivity reactions (rare in the neonate)
  • hematologic effects (rare)
  • GI effects (vomiting, loose stools, diarrhea)
  • local reactions (vein irritation, pain, erythema, phlebitis)
  • transient increases in serum levels of liver enzymes have been reported
  • when used in anti-Pseudomonal doses piperacillin can interfere with platelet aggregation, which under certain circumstances may promote bleeding; this effect appears to be related to the dose and the duration of therapy

Dose

  • administer IM or slow IV infusion
  • the recommended dose is 50 to 100 mg/kg; the following schedule has been suggested

    Postconceptional Age
    (weeks)
    Postnatal Age
    (days)
    Interval
    (hours)
    < 30 0 - 28
    >28
    12
    8
    30 - 36 0 - 14
    >14
    12
    8
    37 - 44 0 - 7
    >7
    12
    8
    > 44 All 6

    From: Young T E and Mangum OB: Neofax - A Manual of Drugs used in Neonatal Care; Columbus, Ohio, Ross Laboratories, 1992 (used with permission)

Use of Dosage Chart: eg. A 28 week gestation infant, who is 5 weeks old and weighs 1.25 kg, is prescribed pipercillin 100 mq IV q 8h.

Q. Is this correct (according to the dosage chart)?

A. Infant is 33 weeks postconception and greater than 14 days old. He/she should receive 50 to 100 mg/kg every 8 hours (actual dose is 80 mq/kg every 8 hours). Therefore dose is correct.

Supplied

  • 80 mg/mL syringe to be used for IV use prepared by the Department of Pharmacy
  • to prepare an 80 mg/mL solution follow these instructions:
    1. Add 15 mL sterile water to a 3g vial of piperacillin, shake well until solution is clear and drug is dissolved
    2. Withdraw all of the solution into a 60mL syringe, add sterile water for injection to a final volume of 37.5 mL
    3. Therefore, final concentration is

      3 g (3,000 mg) per 37.5 mL
      = 80 mg per mL

  • the reconstituted solution is stable for at least 24 h. Our recommendation is that it be kept in the refrigerator.
  • the sodium content is 1.85 mMol/g

References

  1. McEvoy G K (ed): AHFS Drug Information, American Society of Hospital Pharmacists, 1991.
  2. Young TE and Mangum OB: Neofax - A Manual of Drugs Used in Neonatal Care, Columbus, Ohio: Ross Laboratories, 1992.



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