Piperacillin
An extended-spectrum penicillin given intravenously with tazobactam for serious hospital infections, including Pseudomonas.
Drug card
- Class
- Penicillin
- How it works
- Blocking the enzymes that cross-link the bacterial cell wall, so bacteria burst
- Used for
- Hospital-acquired and ventilator-associated pneumonia
- Complicated intra-abdominal infections
- Complicated urinary tract infections
- Complicated skin infections, such as diabetic foot
- Known for
- Acute kidney injury, more so with vancomycin
- Its name
- -cillin means a penicillin
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does piperacillin work?
Piperacillin is a ureidopenicillin derived from ampicillin. It binds PBPs and blocks septum formation and cell wall synthesis, and its spectrum reaches Pseudomonas aeruginosa and many anaerobes as well as Gram-positive bacteria. Beta-lactamases destroy it, so it is given in a fixed combination with the beta-lactamase inhibitor tazobactam.
Like other penicillins: Penicillins carry a beta-lactam ring that binds and inactivates penicillin-binding proteins (PBPs), the enzymes that cross-link peptidoglycan in the bacterial cell wall. The weakened wall gives way and dividing bacteria burst, so penicillins are bactericidal. Bacteria resist them by making beta-lactamases (penicillinases) or by changing their PBPs.
Uses
What is piperacillin used for?
- Hospital-acquired and ventilator-associated pneumonia
- Complicated intra-abdominal infections
- Complicated urinary tract infections
- Complicated skin infections, such as diabetic foot
- Fever in neutropenia (suspected infection)
- Bloodstream infection (bacteremia)
Side effects
Side effects of piperacillin
- Acute kidney injury, more so with vancomycinKnown forSerious
- Diarrhea
- Constipation
- Nausea
- Headache
- Insomnia
- Allergic reactions, including anaphylaxisSerious
- C. difficile colitisSerious
- Bleeding from impaired platelet functionSerious
- Low white cells on long coursesSerious
- Seizures and muscle twitching at high dosesSerious
- Low potassium
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Critically ill patients: it raises the risk of kidney failure, and more so with vancomycin, so kidney function is monitored.
- Mixed with an aminoglycoside it inactivates it, so the two are given separately; it can prolong vecuronium's block.
- It carries sodium and can lower potassium: check electrolytes in salt-restricted patients and those on diuretics.
- Kidney impairment or epilepsy: high doses can cause seizures, so doses are reduced and patients watched.
Good to know: Tazobactam shields it from many beta-lactamases, so the combination also covers beta-lactamase-producing staphylococci, E. coli, Klebsiella and Bacteroides.
Remember it
A way to remember it
Penicillins jam the wall builders: only growing bacteria, busy laying new wall, are killed.
The penicillin-binding proteins are the enzymes that link peptidoglycan strands into a firm wall. Penicillins block them, so bacteria die while they multiply; a drug that halts growth, such as a tetracycline, can blunt this effect.
Written for biofideX
Its name
-cillin means penicillin
Marks penicillins (6-aminopenicillanic acid derivatives), including benzylpenicillin. Beta-lactamase inhibitors given with them keep their own names: clavulanic acid, tazobactam.
- Every drug name stem
Its class
Penicillins
Other penicillins with a card:
Easily mixed up with cephalosporins, carbapenems and glycopeptides.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
- Piperacillin and tazobactam for injection: label (DailyMed)
- Piperacillin/tazobactam 4 g/0.5 g powder for solution for infusion: SmPC (emc)
- Piperacillin (NCI Thesaurus)
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Antibiotics: the cell wall
Piperacillin is one of 12 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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