Adult Dosing
Bacterial infection
- 3-4 g IM/IV q4-6 hrs [Max: 24 g/day]
Serious infection
- 12-18 g/day IV (200-300 mg/kg/day) divided q4-6 hrs
Complicated urinary tract infections
- 8-16 g/day IV (125-200 mg/kg/day) divided q6-8 hrs
Uncomplicated urinary tract infections and most community-acquired pneumonia
- 6-8 g/day IM/IV (100-125 mg/kg/day) divided q6-12 hrs
Uncomplicated gonorrhea infections
Note:
- May be given IM or IV as a 3-5 min injection or as a 20-30 min infusion
- IM should be limited to 2 g per injection site
- The duration of treatment is 7-10 days for all infections except gynecologic infections which is 3-10 days
Prophylaxis
Intra abdominal surgery
- 1st dose: 2 g IV as a 20-30-minute infusion, just prior to surgery
- 2nd dose: 2 g during surgery
- 3rd dose: 2 g q6 hrs post op for no more than 24 hrs
Vaginal Hysterectomy
- 1st dose: 2 g IV as a 20-30 minute infusion, just prior to surgery
- 2nd dose: 2 g 6 hr after 1st dose
- 3rd dose: 2 g 12 hrs after 1st dose
Cesarean Section
- 1st dose: 2 g IV after cord is clamped
- 2nd dose: 2 g 4 hrs after the 1st dose
- 3rd dose: 2 g 8 hrs after the 1st dose
Abdominal Hysterectomy
- 1st dose: 2 g IV just prior to surgery
- 2nd dose: 2 g IV on return to recovery room
- 3rd dose: 2 g IV after 6 hrs
Pediatric Dosing
- Safety and efficacy <12 yrs of age have not been established
Serious infection (
12 yrs)
- 12-18 g/day IV (200- 300 mg/kg/day) divided q4-6 hrs
Complicated urinary tract infections (12 yrs)
- 8-16 g/day IV (125-200 mg/kg/day) divided q6-8 hrs
Uncomplicated urinary tract infections and most community-acquired pneumonia (12 yrs)
- 6- 8 g/day IM/IV (100-125 mg/kg/day) divided q6-12 hrs
Note:
- May be given IM or IV as a 3-5 min injection or as a 20-30 min infusion
- IM should be limited to 2 g per injection site
- The duration of treatment is 7-10 days for all infections except gynecologic infections which is 3-10 days
Prophylaxis (12 yrs)
Intra abdominal surgery
- 1st dose: 2 g IV as a 20-30-minute infusion, just prior to surgery
- 2nd dose: 2 g during surgery
- 3rd dose: 2 g q6 hrs post op for no more than 24 hrs
Vaginal Hysterectomy
- 1st dose: 2 g IV as a 20-30-minute infusion, just prior to surgery
- 2nd dose: 2 g 6 hr after 1st dose
- 3rd dose: 2 g 12 hrs after 1st dose
Cesarean Section
- 1st dose: 2 g IV after cord is clamped
- 2nd dose: 2 g 4 hrs after the 1st dose
- 3rd dose: 2 g 8 hrs after the 1st dose
Abdominal Hysterectomy
- 1st dose: 2 g IV just prior to surgery
- 2nd dose: 2 g IV on return to recovery room
- 3rd dose: 2 g IV after 6 hrs
[Outline]
Renal Dose Adjustment (based on CrCl )
- Renal impairment
- >40 (mL/min): No dosage adjustments
- 20-40 (mL/min)
- Complicated urinary tract infections: No dosage adjustments
- Uncomplicated urinary tract infections: 3 g IM/IV q8 hrs
- Serious bacterial infections: 4 g IM/IV q8 hrs
- <20 (mL/min)
- Complicated urinary tract infections: 3 g IM/IV q12 hrs
- Uncomplicated urinary tract infections: 3 g IM/IV q12 hrs
- Serious bacterial infections: 4 g IM/IV q12 hrs
- Hemodialysis: 2 g IM/IV q8 hrs (Max); supplement 1 g after each dialysis period
Hepatic Dose Adjustment
- Hepatic impairment: No adjustments defined
- Serious hypersensitivity (anaphylactic) reactions have been reported in patients on penicillin therapy, and are more likely to occur in individuals with a history of penicillin hypersensitivity and/or a history of sensitivity to multiple allergens
- Before starting piperacillin, carefully inquire about previous hypersensitivity reactions to penicillin, cephalosporins, or other allergens
- If allergic reaction occurs, discontinue the drug and provide immediate emergency treatment with epinephrine, oxygen, intravenous steroids, and airway management including intubation
- Clostridium difficile associated diarrhea (CDAD) ranging from mild diarrhea to fatal colitis may occur with piperacillin therapy, as antibacterial agents alter the normal flora of the colon leading to overgrowth of C. difficile
- C. difficile produces toxins A and B which contribute to CDAD. Hypertoxin producing strains cause increased morbidity and mortality since these infections can be refractory to antibiotic therapy and may require colectomy. Careful medical examination is necessary since CDAD may occur > 2 months after administration of drug
- If CDAD is suspected/confirmed, discontinue the treatment and provide fluid, electrolyte, and protein supplementation along with antibiotics for C. difficile. Evaluate for surgical intervention as clinically needed
- Bleeding manifestations have occurred in some patients. If bleeding manifestations occur, the drug should be discontinued and appropriate therapy instituted
- Superinfections due to emergence of resistant organisms can occur particularly during prolonged treatment. Use appropriate measures if superinfection occurs
- As piperacillin contains monosodium salt, use cautiously in patients requiring restricted salt intake and evaluate electrolyte level periodically in patients with low potassium reserves
- Leukopenia and neutropenia may occur during prolonged therapy
- Prescribing antibiotics in the absence of proven or strongly suspected bacterial infection increases the risk of development of drug-resistant bacteria
- Increases the incidence of fever and rash in cystic fibrosis patients
Cautions: Use cautiously in
- Renal impairment
- Penicillin-sensitive patients
- Hypokalemia
- Salt restriction
- Cystic fibrosis
- Coagulation disorder
Pregnancy Category:B
Breastfeeding: Usually compatible with breastfeeding; maternal doses of piperacillin up to 12 g daily produce low levels in milk that are not expected to cause adverse effects in breastfed infants. Sometimes disruption of the infant's gastrointestinal flora, resulting in diarrhea or thrush has been reported but not adequately evaluated. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT) last accessed 19 Jan 2011. However manufacturer advises caution.
