For treatment of infections caused by mecillinam-sensitive organisms e.g. acute cystitis, complicated urinary tract infections, salmonellosis, shigellosis, enteropathic E. coli diarrhoea, Gram-negative septicaemia, billiary infections.
Beta-lactam; Antibacterial
Pivmecillinam belongs to a new class of penicillin-the amdinopenicillin. Pivmecillinam is a prodrug formulation of mecillinam which allows the drug to be administered by mouth. The prodrug form lacks antibacterial activity, but the active drug is liberated by enzymatic hydrolysis during absorption in the gastrointestinal tract.
Pivmecillinam is bactericidal. It acts by interfering with bacterial cell wall synthesis, but the site of action differs from that of other penicilins. Pivmecillinam is very active against Enterobacteriaceae. It is active against E. coli, Klebsiella, Proteus, Enterobacter, Salmonella, Shigella and Yersinia. Pivmecillinam has poor activity against Gram- positive organisms. It has poor activity against Pseudomonas aeruginosa and has practically no activity against Enterococcus faecalis.
Adults: The usual dose is 1-2 tablets 3 times daily according to severity of the infection. Children: weighing less than 20 kg should be given 20-60 mg/kg divided into 3-4 daily doses. Those weighing more than 20 kg should receive normal adult dose. The tablet should be taken with at least 50-100 ml fluid.
There is no experience with over dosage of pivmecillinam. However, excessive doses are likely to cause nausea, vomiting and gastritis. Treatment should be restricted to symptomatic and supportive measures. If necessary haemodialysis will reduce the blood level.
There have been no reports on allergy to Pivmecillinam among patients with a known history of hypersensitivity to penicillins & cephalosporins.
Generally well tolerated, gastrointestinal disturbances such as nausea, vomiting & diarrhoea or indigestion may occur when a dose has been given on an empty stomach. Skin rashes have been reported in some cases.
Pivmecillinam in pregnancy should be prescribed when the expected benefits are considered to be greater than the potential risk. Mecillinam is not excreted into the milk of lactating mother.
Store at a cool and dry place, protect from light and moisture.
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