- 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
- 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.
- 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
- administer IM or slow IV infusion
- the recommended dose is 50 to 100 mg/kg; the following schedule has been suggested
< 30 0 - 28
30 - 36 0 - 14
37 - 44 0 - 7
> 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.
- 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:
- Add 15 mL sterile water to a 3g vial of piperacillin, shake well until solution is clear and drug is dissolved
- Withdraw all of the solution into a 60mL syringe, add sterile water for injection to a final volume of 37.5 mL
- 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
- McEvoy G K (ed): AHFS Drug Information, American Society of Hospital Pharmacists, 1991.
- Young TE and Mangum OB: Neofax - A Manual of Drugs Used in Neonatal Care, Columbus, Ohio: Ross Laboratories, 1992.