Pivampicillin

Pivampicillin belongs to the pharmacological class of Beta-Lactam Antibiotics.

Pivampicillin has been approved to relieve symptoms and treat and maintain gonococcal urethritis and bacterial infection.

Pivampicillin is readily absorbed from the gastrointestinal tract. Pivampicillin is hydrolyzed to ampicillin, pivalic acid, and formaldehyde. About 70% of a dose of Pivampicillin is excreted in the urine as ampicillin within 6 hours.

The common side effects involving the use of Pivampicillin are fever, joint pain, rashes, angioedema, hypersensitivity reactions, neutropenia, thrombocytopenia, etc.

Pivampicillin is available in the form of Tablets.

Pivampicillin is only available in Denmark.

Pivampicillin belongs to the pharmacological class of Beta-Lactam Antibiotics.

Pivampicillin, after being metabolized, forms ampicillin (the active metabolite of pivampicillin) which has a bactericidal action resulting from the inhibition of cell wall mucopeptide biosynthesis.

Pivampicillin has been approved to relieve symptoms and also for the treatment and maintenance of gonococcal urethritis and bacterial infection.

Pivampicillin is available in the form of tablets.

Pivampicillin can be used in the following treatment:

• Gonococcal Urethritis
• Bacterial Infection

Pivampicillin can help to relieve symptoms and also for the treatment and maintenance of gonococcal urethritis and bacterial infection.

Pivampicillin is approved for use in the following clinical indications:

• Gonococcal Urethritis
• Bacterial Infection

Tablet: To be taken as a whole with water

500mg

Tablets

• Dosage Adjustments in Pediatric Patients

Bacterial infections: 3 mth-1 yr: 40-60 mg/kg daily in 2 divided doses. >1 yr: 12.5-17.5 mg/kg two times a day, up to 500 mg two times a day. >10 yr: 500 mg two times a day.

Avoid high-acid foods like citrus fruits and juices like orange and grapefruit, soda, and chocolates.

Alcohol intake might lead to nausea, vomiting, and headache.

Multivitamins and antacids contain minerals, primarily magnesium, calcium, aluminum, iron, or zinc, which bind to the antibiotic and refrain it from working. Spacing them at least for 2 hours after Pivampicillin administration is recommended.

Pivampicillinmay is contraindicated under the following conditions:

• Patients with known hypersensitivity to cephalosporin.

The physician should closely monitor the patients and keep pharmacovigilance as follows:

• Endocrine and Metabolism

Long-term treatment or frequently repeated treatment courses should be used with caution as Pivampicillin (Pivampicillin hydrochloride) has been associated with increased excretion of carnitine in urine and a reduction of serum carnitine. During absorption, Pivampicillin is hydrolyzed to pivalic acid and mecillinam. Pivalic acid is excreted partly as a conjugate with carnitine. Treatment with pivalic acid liberating antibiotics for a duration of 22 and 30 months in children resulted in total muscle carnitine depletion to 10% of reference values. However, no adverse clinical effects were reported, which could be associated with primary or secondary carnitine deficiency. Following 7 to 10 days of treatment at the highest recommended doses of Pivampicillin, there was a significant reduction in serum carnitine which returned to the normal range within two weeks of stopping therapy. Despite these reductions in serum carnitine, total body stores of carnitine were reduced by approximately 10%. The increased excretion of carnitine associated with the use of Pivampicillin is considered to be without clinical significance in short-term treatment.

• Gastrointestinal

Pseudomembranous colitis caused by Clostridium difficile might occur. In the case of diarrhea, the possibility of pseudomembranous colitis should be considered, as well as appropriate actions should be taken. It is advise dthat Pivampicillin tablets must be taken with half a glass of fluid due to risk of esophageal ulceration.

• Hematologic

Pivampicillin should not be used by patients suffering from porphyria, as Pivampicillin has been connected to acute attacks of porphyria.

• Renal

Even though Pivampicillin has exhibited characteristic low toxicity of the penicillins, periodic assessment of renal hepatic as well as hematopoietic functions should be made during prolonged therapy. Pivampicillin is excreted mostly by the kidneys. In patients with renal Impairment, the dosage administered should be reduced in proportion to the degree of loss of renal function. In severe renal function impairment, it is suggested that the plasma level of the drug be monitored to avoid excessive concentrations. The passage of any penicillin from the blood into the brain is facilitated by inflamed meninges and during cardiopulmonary bypass. In the presence of these conditions and particularly when accompanied by renal failure, sufficiently high penicillin serum concentrations can be obtained to produce central nervous system adverse effects. These include myoclonia, convulsive seizure, and depressed consciousness. Although these reactions have not yet been reported for Pivampicillin, physicians should be aware of the possibility of their occurrence.

• Sensitivity

Serious and occasionally fatal hypersensitivity (anaphylactoid) reactions had been reported in patients receiving penicillin. The reactions are more likely to occur in persons with a history of sensitivity to multiple allergens. Before therapy with Pivampicillin, careful inquiry should be made concerning previous hypersensitivity reactions to penicillins, cephalosporins, or other allergens. If any allergic reaction occurs, the administration of Pivampicillin should be discontinued and appropriate therapy instituted. The possibility of superinfections with mycotic or bacterial pathogens is to be kept in mind during therapy. If superinfections, usually involving Pseudomonas or Candida, or hypersensitivity reactions occur, the pivampicillin should be discontinued and appropriate therapy instituted.

• Susceptibility/Resistance Development of Drug-Resistant Bacteria

Prescribing Pivampicillin in the absence of a proven or strongly suspected bacterial infection is unlikely to provide any benefit to the patient and risks the development of drug-resistant bacteria.

Usage of alcohol should be avoided while on Pivampicillin medication, as alcohol can worsen the effects of any underlying disease condition, including conditions such as dizziness, blurred vision, etc.

No sufficient scientific evidence is traceable regarding the use and safety of Pivampicillin in concurrent use with any particular food.

The adverse reactions related to Pivampicillin can be categorized as follows:

• Hypersensitivity reactions, including urticaria
• Fever
• Joint pains
• Rashes
• Angioedema
• Serum sickness-like reactions
• Hemolytic anemia
• Interstitial nephritis
• Neutropenia
• Thrombocytopenia
• CNS toxicity, including convulsions
• Antibiotic-associated colitis
• Gastrointestinal effects
• Pseudomembranous colitis
• Erythematous maculopapular eruptions.
• Anaphylaxis.

The clinically relevant drug interactions of Pivampicillin are briefly summarized here:

• Simultaneous administration of probenecid is said to reduce the excretion of penicillins and hence increases the blood level of the antibiotic.
• Reduce the effect of oral contraceptives.
• The prolonged bleeding time when used with anticoagulants
• Concurrent treatment with valproate, valproic acid, or other medication liberating pivalic acid is to be avoided due to the increased risk of carnitine depletion.

The following are the side effects involving Pivampicillin :

• Hypersensitivity reactions, including urticaria
• Fever
• Joint pains
• Rashes
• Angioedema
• Serum sickness-like reactions
• Hemolytic anemia
• Interstitial nephritis
• Neutropenia
• Thrombocytopenia
• CNS toxicity, including convulsions
• Antibiotic-associated colitis
• Gastrointestinal effects
• Pseudomembranous colitis
• Erythematous maculopapular eruptions.
• Anaphylaxis.

Physicians should be knowledgeable and vigilant about the treatment and identification of over dosage of Pivampicillin.

There is no experience of over dosage with Pivampicillin (Pivampicillin hydrochloride) tablets.

However, excessive doses of Pivampicillin are likely to induce nausea, vomiting, abdominal pain, and diarrhea. Treatment should be restricted to symptomatic as well as supportive measures.

Pharmacodynamics

Pivampicillin is the pivaloyloxymethyl ester of (the semi-synthetic penicillin) ampicillin. It is an inactive pro-drug, which is converted during its absorption from the gastrointestinal tract to the microbiologically active ampicillin, together with formaldehyde and pivalic acid, by non-specific esterases present in most body tissues. Amounts in excess of 99% of the pivampicillin absorbed are converted to ampicillin within 15 minutes of absorption.

Pharmacokinetics

• Absorption:

Pivampicillin is found to be readily absorbed.

• Metabolism:

Pivampicillin is found to be hydrolyzed to ampicillin, pivalic acid, and formaldehyde.

• Excretion:

About 70% of a dose of Pivampicillin is found to be excreted in the urine as ampicillin within 6 hours.

• https://www.mims.com/malaysia/drug/info/pivampicillin?mtype=generic
• https://vial.com/drugs/pivampicillin/
• https://drugs.ncats.io/substance/M3MYK6R22U
• https://go.drugbank.com/drugs/DB01604
• https://pubchem.ncbi.nlm.nih.gov/compound/Pivampicillin
• https://profilbaru.com/article/Pivampicillin
• https://www.sciencedirect.com/topics/chemistry/pivampicillin
• https://www.tabletwise.net/medicine/pivampicillin