Formulary
Pivmecillinam hydrochloride: Indications, Dosing, Side Effects and Interactions
The penicillins are bactericidal and act by interfering with bacterial cell wall synthesis.
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Pivmecillinam hydrochloride: Indications, Dosing, Side Effects and Interactions
The penicillins are bactericidal and act by interfering with bacterial cell wall synthesis.
Drug action
The penicillins are bactericidal and act by interfering with bacterial cell wall synthesis. They diffuse well into body tissues and fluids, but penetration into the cerebrospinal fluid is poor except when the meninges are inflamed. They are excreted in the urine in therapeutic concentrations.
Indications and dose
**Acute uncomplicated cystitis**
- **Child** (By Mouth): (body-weight 40 kg and above) Initially 400 mg for 1 dose, then 200 mg every 8 hours for 8 tablets (total of 10 tablets per course).
- **Adult** (By Mouth): (body-weight 40 kg and above) Initially 400 mg for 1 dose, then 200 mg every 8 hours for 8 tablets (total of 10 tablets per course).
**Chronic or recurrent bacteriuria**
- **Child** (By Mouth): (body-weight 40 kg and above) 400 mg every 6-8 hours.
- **Adult** (By Mouth): (body-weight 40 kg and above) 400 mg every 6-8 hours.
**Urinary-tract infections**
- **Child** (By Mouth): (body-weight up to 40 kg) 5-10 mg/kg every 6 hours, alternatively 20-40 mg/kg daily in 3 divided doses.
**Acute uncomplicated cystitis for pivmecillinam hydrochloride**
- **Child (body-weight 40 kg and above)** (By mouth): Initially 400 mg for 1 dose, then 200 mg every 8 hours for 8 tablets (total of 10 tablets per course).
**Chronic or recurrent bacteriuria for pivmecillinam hydrochloride**
- **Child (body-weight 40 kg and above)** (By mouth): 400 mg every 6-8 hours.
**Urinary-tract infections for pivmecillinam hydrochloride**
- **Child (body-weight up to 40 kg)** (By mouth): 5-10 mg/kg every 6 hours, alternatively 20-40 mg/kg daily in 3 divided doses.
Cautions
History of allergy Cautions For pivmecillinam hydrochloride Avoid in Acute porphyrias
Contraindications
Carnitine deficiency; gastro-intestinal obstruction; oesophageal strictures
Side effects
Common or very common Diarrhoea; hypersensitivity; nausea; skin reactions; thrombocytopenia; vomiting Uncommon Arthralgia; leucopenia Rare or very rare Agranulocytosis; angioedema; haemolytic anaemia; hepatic disorders; nephritis tubulointerstitial; neutropenia; pseudomembranous enterocolitis; seizure; severe cutaneous adverse reactions (SCARs) Side-effects, further information Diarrhoea frequently occurs during oral penicillin therapy. It is most common with broad-spectrum penicillins, which can cause antibiotic-associated colitis. Side-effects For pivmecillinam hydrochloride Common or very common Vulvovaginal fungal infection Uncommon Clostridioides difficile colitis; dizziness; fatigue; gastrointestinal discomfort; gastrointestinal disorders; headache; oral ulceration; vertigo Side-effects, further information Carnitine deficiency can occur with long-term or frequently-repeated treatment. Symptoms of carnitine deficiency include muscle aches, fatigue, and confusion.
Interactions
**Other interactions (1):**
- Simultaneous administration of probenecid reduces the excretion of penicillins and hence increases the blood level of the antibiotic.
Pregnancy
Not known to be harmful, but manufacturer advises avoid.
Breast feeding
Trace amount in milk, but appropriate to use.
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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