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Piperacillin / Pipracil

- See:
       - Penicillin Family
       - AntiPseudomonal Agents

- Discussion:
    - piperazine penicillin derivative with increased activity against many gm negative bacteria - P.aeruginosa, Enterobacteriacae - S.faecalis; Anaerobes (B.fragilis);
    - for serious infect.: 200-300 mg/kg/24hr IV in 4-6 divided doses;
    - for complicated UTI: 125-200 mg/kg/day given IV in 3-4 div. doses;
    - for uncomplicated UTI and community aquired pneumoniae: 100-125mg/kg IV in 2-4 divided doses;
    - note must decrease dose w/ renal failure: 1.85mEq Na/gm;
    - Dose for70 kg Adult: gm/dosing interval in hrs: CrCl: >80: 3/4; CrCl:50-79::3/4; CrCl:30-49::3/6; CrCl:10-29::2/6-8;
    - 70-90% of drug will be excreted in to urine (w/ nl RF(x))
    - peds: 200-300 mg/kg/day q6hr;
    - note possible convulsions;
    - will interact with aminoglycosides, oral anticoagulants, OC;
    - interaction w/ cefoxitin: antagonism vs pseudomonas;
    - piperacillin is more potent than ticarcillin against  P. aeruginosa and Klebsiella, but has activity similar to that of ticarcillin against most other gram-negative pathogens.
    - zosyn: includes the addition of tazobactam to piperacillin;
             - this addition will help to combat antimicrobial resistance;
             - dose: 3.375 mg IV q 6-8 hours

Piperacillin/tazobactam therapy for diabetic foot infection.