Piperacillin Sodium

A to Z Drug Facts

 Actions Inhibits bacterial cell wall mucopeptide synthesis.

 Indications Treatment of intra-abdominal, urinary tract, gynecologic, lower respiratory tract infections, septicemia, skin and skin structure infections, bone and joint infections and gonococcal urethritis; surgical prophylaxis; treatment of infection due to susceptible microorganisms including infections caused by Streptococcus and Pseudomonas species.

 Contraindications Hypersensitivity to penicillins or cephalosporins.

 Route/Dosage

ADULTS: IM/IV 3 to 4 g q 4 to 6 hr (max 24 g/day).

CHILDREN: IM/IV 200 to 500 mg/kg/day divided q 4 to 6 hr.

NEWBORNS: IM/IV 100 mg/kg/dose q 12 hr.

 Interactions

Aminoglycosides, parenteral: May inactivate aminoglycosides in vitro; do not mix in same IV solution. May be used in combination for synergy. Anticoagulants: May increase bleeding risks by prolonging bleeding time. Chloramphenicol: Synergism or antagonism may develop. Contraceptives, oral: May reduce efficacy of oral contraceptives. Use additional form of contraception during piperacillin therapy. Erythromycin: Synergism or antagonism may develop. Heparin: May increase bleeding risks of heparin by prolonging bleeding time. Tetracyclines: May impair bactericidal effects of piperacillin.

 Lab Test Interferences May cause false-positive urine glucose test results with Benedict's solution, Fehling's solution, or Clinitest tablets but not with enzyme-based tests (eg, Clinistix0, Tes-tape); false-positive direct Coombs' test result in certain patient groups; positive direct antiglobulin tests (DAT); false-positive protein reactions with sulfosalicylic acid and boiling test, acetic acid test, biuret reaction and nitric acid test but not with the bromphenol blue test (Multi-Stix).

 Adverse Reactions

CNS: Neurotoxicity (eg, lethargy, neuromuscular irritability, hallucinations, convulsions, seizures) especially with large dose or patient with renal failure; dizziness; fatigue; insomnia; reversible hyperactivity; prolonged muscle relaxation. DERMATOLOGIC: Ecchymosis. EENT: Itchy eyes. GI: Nausea; vomiting; abdominal pain or cramping; epigastric distress; diarrhea or bloody diarrhea; rectal bleeding; flatulence; enterocolitis; pseudomembranous colitis; anorexia. GU: Interstitial nephritis (oliguria, proteinuria, hematuria, hyaline casts, pyuria); nephropathy; elevated creatinine or BUN; vaginitis; moniliasis. HEMATOLOGIC: Anemia; hemolytic anemia; thrombocytopenia; thrombocytopenic purpura; eosinophilia; leukopenia; granulocytopenia; neutropenia; bone marrow depression; agranulocytosis; reduced Hgb or Hct; prolongation of bleeding and prothrombin time; decrease in WBC and lymphocyte counts; increase in lymphocytes, monocytes, basophils and platelets. HEPATIC: Elevated AST or AST and bilirubin; transient hepatitis; cholestatic jaundice. METABOLIC: Elevated serum alkaline phosphatase; hypernatremia; hypokalemia, reduced albumin, total proteins and uric acid. OTHER: Hypersensitivity reactions (ie, urticaria, angioneurotic edema, laryngospasm, bronchospasm, hypotension, vascular collapse, death, maculopapular to exfoliative dermatitis, vesicular eruptions, erythema multiforme, serum sickness, laryngeal edema, skin rashes, prostration); vaginitis; hyperthermia; pain at site of injection; deep vein thrombosis; hematomas; vein irritation; phlebitis; hyperthermia; sciatic neuritis.

 Precautions

Pregnancy: Category B. LACTATION: Excreted in breast milk. Bleeding abnormalities: Hemorrhagic manifestations associated with abnormalities of coagulation tests (bleeding time, prothrombin time, platelet aggregation) may occur. Abnormalities should revert to normal once drug is discontinued. Cystic fibrosis patients: May experience higher incidence of side effects when treated with piperacillin. Hypersensitivity: Reactions range from mild to life-threatening. Administer cautiously to cephalosporin-sensitive patients due to possible cross-reactivity. Pseudomembranous colitis: May occur due to overgrowth of clostridia. Renal failure: Dosage adjustment required. Superinfection: May result in bacterial or fungal overgrowth of nonsusceptible organisms.

 Administration/Storage

• Obtain culture and sensitivity before administering first dose.
• IM or IV route.
• For IM use, dilute to 1 g/2.5 mL. Lidocaine (0.5% to 1%) may be used to dilute (for IM use only).
• Do not give > 2 g IM at any one site.
• For IV injection, reconstitute each gram with ³ 5 mL compatible diluent.
• IV infusion is diluted further with 50 to 100 mL of D5W or normal saline and infused over 20 to 30 min.
• Time doses for even distribution throughout 24 hours.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Assess for drug reactions especially in patients with asthma, hay fever, urticaria, or allergy to cephalosporins.
• Assess baseline CBC and liver and renal function study results prior to initiating therapy and monitor throughout therapy.
• Monitor results of diagnostic cultures and sensitivity tests.
• Monitor patient for ³ 20 min after administering penicillin to observe for signs or symptoms of anaphylaxis. Notify health care provider if skin rash, hives, wheezing, nausea, or vomiting occur.

 Patient/Family Education

• Instruct patient to notify health care provider if symptoms of potential superinfection (eg, nausea/vomiting, diarrhea, black tongue, swollen joints, unusual bleeding or bruising) occur.
• Explain signs and symptoms of allergic reaction (eg, hives, wheezing, skin rash, itching) and importance of seeking medical supervision as soon as possible.
• Emphasize need for good hygiene to avoid superinfections.
• If patient develops allergy to piperacillin, advise patient to notify future caregivers of penicillin allergy and patient should wear Medi-Alert identification.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts