pivampicillin

Action and Spectrum

Actions and Spectrum: 

pivampicillin is an antibiotic medication used to treat various bacterial infections. It falls into the category of penicillin antibiotics and is a prodrug of ampicillin.  

Action: 

• Prodrug Conversion: pivampicillin is a prodrug, which means it is an inactive compound that the body converts into its active form, ampicillin. After ingestion, pivampicillin is hydrolyzed (broken down) in the body, primarily in the liver, to release ampicillin. 
• Inhibition of Bacterial Cell Wall Synthesis: Ampicillin, the active metabolite of pivampicillin, exerts its antibacterial action by interfering with bacterial cell wall synthesis. It does this by inhibiting the enzymes responsible for cross-linking the peptidoglycan layer in the bacterial cell wall. This weakens the cell wall and making it susceptible to osmotic pressure, leading to bacterial cell lysis and death. 

Spectrum: The spectrum of activity of pivampicillin and its active form, ampicillin, is primarily against Gram-positive and some Gram-negative bacteria.  

• Gram-Positive Bacteria: Ampicillin and pivampicillin are effective against various Gram-positive bacteria, including Streptococcus pneumoniae, Streptococcus pyogenes (Group A Streptococcus), Enterococcus faecalis, and some strains of Staphylococcus aureus that are not resistant to penicillinase. 
• Gram-Negative Bacteria: While ampicillin has some activity against certain Gram-negative bacteria, its effectiveness is generally limited. It is often used in combination with other antibiotics to treat certain Gram-negative infections. 
• Anaerobic Bacteria: Ampicillin and pivampicillin are effective against some anaerobic bacteria, particularly in treating mixed infections involving both aerobes and anaerobes. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Hypersensitivity reactions  

Urticaria 

Rashes 

Fever 

Joint pains 

Serum sickness-like reactions 

Interstitial nephritis 

Angioedema 

Neutropaenia 

Hemolytic anemia 

Thrombocytopaenia 

Gastrointestinal effects 

Black Box Warning

Black Box Warning: 

None 

Contraindication / Caution

Contraindication/Caution: 

Contraindication 

• Hypersensitivity or Allergy to Penicillins: pivampicillin is a penicillin antibiotic, and individuals who have a known hypersensitivity or allergic reaction to penicillins should not use this medication. Allergic reactions to penicillin can range from mild rashes to severe anaphylactic reactions. 
• History of Severe Allergic Reactions to Beta-Lactam Antibiotics: Individuals who have experienced severe allergic reactions (anaphylaxis) to any beta-lactam antibiotics, such as penicillins, cephalosporins, or carbapenems, should avoid pivampicillin. 
• Infectious Mononucleosis (Mono): pivampicillin should not be used in patients with infectious mononucleosis (commonly caused by the Epstein-Barr virus) because it may lead to a rash called “ampicillin rash,” which is not related to an allergy but is more common in individuals with mono. 
• Hepatic Impairment: pivampicillin is primarily metabolized in the liver, and its use should be cautious or avoided in individuals with severe liver impairment or hepatitis. 
• Renal Impairment: In individuals with severe renal impairment or kidney disease, dose adjustments may be necessary, as pivampicillin and its active metabolite, ampicillin, are excreted through the kidneys. Your healthcare provider will determine the dosage in such cases. 
• Clostridium difficile-associated Diarrhea: pivampicillin can disrupt the balance of the gut microbiota and may lead to the overgrowth of Clostridium difficile bacteria, which can cause a severe form of diarrhea known as Clostridium difficile-associated diarrhea (CDAD). It is a contraindication if CDAD is suspected. 
• Pregnancy and Breastfeeding: A healthcare provider should carefully evaluate pivampicillin during pregnancy or breastfeeding, considering the potential benefits and risks. Pregnancy is generally considered safe when the benefits outweigh the risks, but caution is advised. 
• Concomitant Use with Allopurinol: pivampicillin can increase the risk of skin rash when used concurrently with allopurinol (a medication used to treat gout). This combination should be avoided or closely monitored. 
• Concomitant Use with Methotrexate: pivampicillin may increase the blood levels of methotrexate (a medication used for various conditions, including cancer and autoimmune diseases), potentially leading to methotrexate toxicity. Close monitoring is necessary when these drugs are used together. 

Caution 

• Hypersensitivity and Allergy History: While a contraindication for pivampicillin is a known hypersensitivity or allergy to penicillins, individuals with a history of mild or non-life-threatening allergic reactions should still exercise caution.  
• Renal Impairment: pivampicillin is excreted primarily through the kidneys. In individuals with mild-moderate renal impairment, dose adjustments may be necessary to prevent the medication accumulation. 
• Gastrointestinal Issues: pivampicillin may cause gastrointestinal side effects, such as diarrhea, nausea, or abdominal discomfort. If these side effects are severe or persistent, consult your healthcare provider. 
• Use with Allopurinol: Caution is advised when using pivampicillin concurrently with allopurinol, a medication used to treat gout, as it can increase the risk of skin rash. Close monitoring for skin reactions is recommended in this case. 
• Methotrexate Interaction: pivampicillin may raise the blood levels of methotrexate, which is used for various conditions, including cancer and autoimmune diseases. If you take both medications, your healthcare provider should monitor your methotrexate levels closely to prevent toxicity. 
• Use in Elderly Patients: Elderly patients may be more susceptible to specific side effects of antibiotics, including gastrointestinal disturbances and hypersensitivity reactions. Careful monitoring is advised in this population. 
• Use in Infants and Children: pivampicillin can be prescribed for pediatric patients but should be dosed appropriately based on weight and age. Pediatric patients should be closely monitored for adverse effects. 
• Pregnancy and Breastfeeding: pivampicillin is generally considered safe during pregnancy condition when the benefits outweigh the risks. However, caution should be exercised, and the decision to use it should be made after consultation with a healthcare provider. pivampicillin can be excreted in breast milk. 
• Clostridium difficile Infection: Antibiotic use, including pivampicillin, can lead to Clostridium difficile-associated diarrhea (CDAD), which can be severe. If diarrhea develops during or after treatment, especially if it is persistent or severe, inform your healthcare provider. 
• Superinfection: pivampicillin can lead to the development of superinfections (new infections that occur while on antibiotic treatment) or the growth of non-susceptible microorganisms. If you notice new symptoms or worsening of your condition during treatment, contact your healthcare provider. 

Pregnancy / Lactation

Pregnancy consideration:  

US FDA pregnancy category: Not assigned. 

Lactation:   

Excreted into human milk: Not known. 

Pregnancy category: 

• Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 
• Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    
• Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence, these categories of drugs need to be avoided by pregnant women.    
• Category N: There is no data available for the drug under this category. 

Pharmacology

Pharmacology: 

pivampicillin is a prodrug of ampicillin, a broad-spectrum penicillin antibiotic. Following oral administration, pivampicillin is rapidly hydrolyzed by esterases in the body, primarily in the liver, to release ampicillin, its active metabolite. Ampicillin exerts its antibacterial effects by inhibiting bacterial cell wall synthesis.

It does this by binding to and inhibiting enzymes known as penicillin-binding proteins (PBPs), which are crucial for the cross-linking of peptidoglycan in the bacterial cell wall. This disruption weakens the cell wall, making it susceptible to osmotic pressure, ultimately leading to bacterial cell lysis and death. Ampicillin is effective against many Gram-positive and some Gram-negative bacteria, making pivampicillin a valuable antibiotic for treating various bacterial infections. 

Pharmacodynamics: 

Mechanism of action: pivampicillin is a prodrug that undergoes conversion to its active metabolite, ampicillin, in the body. The mechanism of action of pivampicillin, therefore, primarily relies on ampicillin. Ampicillin belongs to the class of antibiotics known as penicillins. Its bactericidal action results from the inhibition of bacterial cell wall mucopeptide biosynthesis. This essential process is crucial for maintaining the structural integrity of bacterial cell walls.

Ampicillin interferes with the synthesis of peptidoglycan, leading to weakening and eventually rupturing of the cell wall. This disruption causes the bacteria to lose their structural support and ultimately leads to cell death. Ampicillin is effective against many bacteria, making it valuable in treating various bacterial infections. pivampicillin, as a prodrug, is designed to enhance the oral bioavailability of ampicillin, making it suitable for oral administration, thereby facilitating its use in treating infections. 

Pharmacokinetics: 

Absorption 

It is primarily absorbed in the small intestine. pivampicillin is absorbed relatively well after oral administration, and it is rapidly hydrolyzed in the body by esterases to its active form, ampicillin and pivalic acid. 

Distribution 

Ampicillin, the active metabolite of pivampicillin, has limited binding to plasma proteins, which allows it to distribute effectively into various body tissues and fluids. 

Metabolism 

pivampicillin is a prodrug administered in an inactive form (pivampicillin) and converted into its active form (ampicillin) through enzymatic hydrolysis in the liver. The pivalic acid released during pivampicillin hydrolysis undergoes metabolism in the liver and is eventually excreted as urinary metabolites. 

Elimination and Excretion 

pivampicillin is primarily excreted through the kidneys via glomerular filtration and tubular secretion. This results in high drug concentrations in the urine, making it effective against urinary tract infections. 

Adminstartion

Administration: 

pivampicillin is typically administered orally as a tablet or suspension (liquid form).  

• Dosage: The dosage of pivampicillin can vary based on the type and severity of the infection, the patient’s age and weight, and other factors. Always take the prescribed dose precisely as directed by your healthcare provider. Do not change the dose or stop taking the medication without consulting your healthcare provider. 
• Frequency: pivampicillin is usually taken twice to four times daily, spaced evenly throughout the day. This helps maintain a consistent level of the medication in your bloodstream to treat the infection effectively. 
• Timing: Take pivampicillin on an empty stomach, preferably one hour before or 2 hours after meals, unless otherwise instructed by your healthcare provider. This can help improve the absorption of the medication. If you experience stomach upset when taking it on an empty stomach, you can take it with a small amount of food. 
• Shake Well (if in liquid form): If prescribed a liquid suspension of pivampicillin, shake the bottle well prior each use to ensure the medication is evenly mixed. 
• Use a Measuring Device (if liquid form): If you use a liquid suspension, use a specialized measuring device (e.g., an oral syringe or dosing cup) to measure the correct dose. Please do not use a regular household spoon, as it may not provide accurate measurements. 
• Complete the Course: It’s essential to complete the entire prescribed course of pivampicillin, even if you start feeling better before you finish all the medication. Stopping antibiotics prematurely can lead to the survival of bacteria, potentially causing a relapse or antibiotic resistance. 
• Avoid Alcohol: While taking pivampicillin, it’s advisable to avoid consuming alcohol, as it can interact with the medication and leads to unwanted side effects. 
• Storage: Store pivampicillin at the recommended temperature and away from moisture and direct sunlight.  
• Follow-up: Attend any follow-up appointments as scheduled by your healthcare provider. They may want to monitor your progress and, if necessary, adjust your treatment plan. 
• Adherence: It’s crucial to adhere to the prescribed dosage and schedule consistently. Missing doses or not taking the medication as directed can reduce its effectiveness in treating the infection. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: pivampicillin 

Why do we use pivampicillin? 

pivampicillin is an antibiotic medication that is used to treat a variety of bacterial infections. It belongs to the penicillin class of antibiotics and is converted into its active form, ampicillin, in the body.  

Respiratory Tract Infections: pivampicillin can be prescribed to treat respiratory tract infections, including Sinusitis and tonsillitis. 

Ear, Nose, and Throat Infections: It is effective against infections in the ear, nose, and also throat, such as: 

• Otitis media (middle ear infection) 
• Otitis externa (ear canal infection) 
• Tonsillitis and adenoid infections 

Urinary Tract Infections (UTIs): pivampicillin can treat uncomplicated urinary tract infections caused by susceptible bacteria. 

Skin and Soft Tissue Infections: It is generally prescribed for skin and also soft tissue infections, including cellulitis, impetigo, and erysipelas. 

Gastrointestinal Infections: pivampicillin may be used to treat gastrointestinal tract bacterial infections, such as gastroenteritis, caused by susceptible organisms. 

Genitourinary Infections: It can treat certain genitourinary infections, such as acute uncomplicated gonorrhea. 

Dental Infections: pivampicillin may be prescribed for dental infections, including dental abscesses and infections of the oral cavity. 

Prophylaxis: In some cases, pivampicillin may be used prophylactically (preventatively) in specific medical procedures to reduce the risk of infection, such as before dental surgery for individuals at risk of endocarditis. 

Mixed Infections: pivampicillin may be used to treat infections involving aerobic (oxygen-requiring) and anaerobic (non-oxygen-requiring) bacteria.