Piperacillin indications

The answer is b. (Hardman, pp 1077—1086.) Piperacillin is a broad-spectrum, semisynthetic penicillin for parenteral use. Its spectrum of activity includes various Gram-positive and Gram-negative organisms including Pseudomonas. The indications for piperacillin are similar to those for car-benicillin, ticarcillin, and mezlocillin, with the primary use being sus-... 

The indications for penidllin-3-lactamase inhibitor combinations are empirical therapy for infections caused by a wide range of potential pathogens in both immunocompromised and immunocompetent patients and treatment of mixed aerobic and anaerobic infections, such as intra-abdominal infections. Doses are the same as those used for the single agents except that the recommended dosage of piperacillin in the piperacillin-tazobactam combination is 3 g every 6 hours. Adjustments for renal insufficiency are made based on the penicillin component. 

Tazobactam has recently been launched by Lederle in the U.K. as a combination with piperacillin under the trade name of Tazocin. This product is indicated for urinary tract infections, lower respiratory tract infections and intra-abdominal, biliary and cutaneous infections. 

As long as there is no positive bacteriological result from the bile (or blood), antibiotics are administered on empirical and plausible principles. In this case, mezlocillin or piperacillin is initially recommended, 3x2 (-4 or -5) g/day, i.v. (55) These antibiotics are effective against virtually all bacteria in acute cholangitis, since they can reach high biliary concentrations. Once the course of disease has entered a more severe stage, an additional dose of tobramycin, for example, is indicated (e.g. 3 x 80 mg/day, i.v.). A septic clinical picture requires a course of triple therapy with ureidopenicillin + aminoglycoside (see above) + metronidazole (3 x 500 mg/ day, i.v.). 

Results from animal studies indicate that while furosemide enhanced cephaloridine nephrotoxicity no increased renal toxicity was observed by combining of piperacillin with furosemide [142]. Latamoxef and flo-moxef may decrease nephrotoxicity of vancomycin by inhibiting its uptake into the kidney [146,147]. The results of a retrospective study including renal transplant patients indicate that aztreonam can be safely administered with cyclosporine [148]. Combination therapy with ampicillin/aztreonam in neonates showed a lower renal toxicity than in the group with concurrent administration of oxacillin/ amikacin [149]. 

Indications Neuromuscular blockade, endotracheal intubation Category Non-depolarizing neuromuscular blocker Half-life initial 2 minutes terminal 20 minutes Clinically important, potentially hazardous interactions with amikacin, aminoglycosides, anesthetics, antibiotics, gentamicin, halothane, kanamycin, neomycin, piperacillin, streptomycin, tobramycin... 

The fourth-generation cephalosporins are indicated for the empirical treatment of nosocomial infections where antibiotic resistance owing to extended-spectrum /J-lactamases or chromosomaUy induced /1-lactamases is anticipated. For example, cefepime is superior to ceftazidime and piperacillin for nosocomial isolates of Enterobacter, Citrobacter, and Serratia spp. 

Triazoles and tetrazoles do not exist in nature. However, many synthetic medicines do contain triazoles and tetrazoles. For instance, valsartan, an angiotensin receptor blocker (ARB) indicated for heatment of high blood pressure and other cardiovascular disease contains a tetrazole. Anastrozole contains a 1,2,4-triazole and is an aromatase-inhibiting drug approved for treatment of breast cancer. Tazobactam is a 1,2,3-triazole containing compound that inhibits the action of bacterial -lactamases and is used to treat bacterial infection in combination with the beta-lactam antibiotic piperacillin. ... 

Comparing the area under the curve for intramuscular administration and intravenous administration indicated that the bioavailability of the intramuscularly administered piperacillin was 70-80%. Urinary recovery after 24 hr was 60%. Oral administration of probenecid (1 g) 1 hr prior to the intramuscular injection of 1 g of piperacillin resulted in enhanced mean peak serum concentrations, an increased area under the curve, and a lengthened half-life. The volume of distribution, as well as the clearance rate, was also decreased. This is further evidence that a significant component of the urinary excretion is due to tubular secretion. Animal pharmacology has indicated varying degrees of elimination of piperacillin in the bile. 

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