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PubMed1986

[Diffusion of piperacillin in the healthy human peritoneum after administration of a prophylactic dose].

The passage of piperacillin into the omentum was evaluated in 23 patients who received one single intravenous injection of 2 grams. Median concentrations were 7.05 micrograms.g-1 at 30 min, 7.2 micrograms.g-1 at 60 min., 4.65 micrograms.g-1 at 90 min. and 3.53 micrograms.g-1 at 120 min. The corresponding maximal values were 36 micrograms.g-1, 59.7 micrograms.g-1, 36 micrograms.g-1 and 32 micrograms.g-1 respectively. Specimens collected beyond 2 hours showed that the concentrations obtained were maintained.

Adult↗
PubMed1986

[Treatment of infectious outbreaks in neutropenic patients with a piperacillin and amikacin combination].

Two hundred and fifty patients (mean age 39 years) were involved in a multicentric pilot trial aimed at evaluating the effectiveness of a piperacillin (P) + amikacin (A) combination in severe neutropenic patients (less than 500 PNN/microliters). In patients who failed to improve under this combination vancomycin (V) was added. Two hundred and thirty-five patients were assessable for response to P + A. The infection was microbiologically undocumented in 148 of them (63%) and documented in 87 (37%). Response rates were 64% and 53% respectively, rising to 73% in both groups after addition of vancomycin. Thirty p. 100 of the patients had bacteremia. The most frequently encountered pathogens were staphylococci, enterobacteria, streptococci and Pseudomonas aeruginosa. Sixty-six p. 100 of gram-negative and staphylococcal infections responded to the P + A combination, while the response rate of staphylococcal infections was 23%. Fifty-seven p. 100 of staphylococci resistant to P + A were controlled by P + A + V. Fifteen (6.4%) patients died of infection, 5 of them of fungal infection. Toxicity was mild, with 3% renal toxicity. The P + A combination is effective as first line therapy in febrile neutropenic patients. These results and epidemiological data suggest that this combination plus vancomycin would be a suitable second line therapy for patients who did not improve.

Agranulocytosis↗
PubMed1986

In vitro activity of piperacillin, ticarcillin, mezlocillin, ticarcillin-clavulanic acid, aztreonam, ceftazidime, azlocillin, cefoperazone, and thienamycin against Pseudomonas aeruginosa.

The in vitro susceptibility of 103 well-characterized strains of Pseudomonas aeruginosa to nine antimicrobial agents was assessed by means of the Kirby-Bauer disk diffusion assay and the microtiter minimal inhibitory concentration assay. The antimicrobials, from the most to the least active against P aeruginosa, were thienamycin greater than ceftazidime greater than piperacillin greater than azlocillin greater than cefoperazone greater than aztreonam greater than ticarcillin greater than ticarcillin-clavulanic acid greater than mezlocillin. The resistance patterns of the antimicrobial agents suggest that P aeruginosa resistant to a penicillin, cephalosporin, or aztreonam may be susceptible to thienamycin.

Anti-Bacterial Agents↗
PubMed1988

[Reevaluation of clinical efficacy of piperacillin against complicated urinary tract infections].

Forty-six inpatients with complicated urinary tract infections (UTI) were treated with 2 g piperacillin (PIPC) twice a day through drip intravenous infusion. After 5 days, evaluation was made using the criteria proposed by the UTI Committee in Japan. The overall clinical efficacy was rated "excellent" in 4 (8.9%), "moderate" in 22 (47.8%), and "poor" in 20 (43.5%) cases with a total efficacy rate of 56.5% (26/46). We previously presented the clinical efficacy of PIPC in 74 cases with complicated UTI. Herein, a total of 120 cases were analyzed and these cases were divided into two groups. The overall clinical efficacy, bacteriological response, type of infection, background of patients and its safety were evaluated. Almost no change was seen for four years. Also this study revealed the usefulness against Enterococcus infections. In conclusion, PIPC is still a useful antimicrobial agent against complicated UTI even after the appearance of many new Cephems.

Adolescent↗
PubMed1988

Piperacillin plus amikacin versus cefotaxime plus amikacin in neutropenic and feverish patients with malignant hemopathies.

Seventy-one neutropenic patients under cytostatic treatment for malignant hemopathies (neutrophil granulocytes less than or equal to/mm3 with feverish episodes in progress (T greater than or equal to 38.5 degrees C) which were probably of an infectious nature were treated according to two antibiotic protocols (piperacillin + amikacin [P + A] or cefotaxime + amikacin [C + A] in a randomized, comparative, prospective study. Of the 71 patients enrolled, 65 could in the end be evaluated for the purposes of this study (36 treated according to the P + A protocol, 29 according to the C + A protocol). In 16 patients the infection was documented bacteriologically. In these cases the percentages of response were, respectively, 77.7% with the P + A and 71.4% with the C + A protocol. The positive clinical results of the two protocols being studied were, considering the entire survey (bacteriologically documented, clinically documented and FUO infections), respectively, 69.4% in the patients treated with P + A and 62.0% in those treated with C + A. The results of the study seem to indicate that the severity of the neutropenia (N.G. less than 500 or greater than 500) does not affect the response to the antibiotic therapy. Modest and transient side effects (hypokalemia and increase of the ClCr) were noted above all in the patients subjected to the therapy with C + A. The results of this study show, therefore, a superimposable effectiveness of the two therapeutic protocols (P + A and C + A) in the empirical treatment of infections in neutropenic patients with malignant hemopathies.

Adolescent↗
PubMed1987

Amikacin plus ceftazidime versus amikacin plus piperacillin versus amikacin plus aztreonam in infections in neoplastic patients with granulocytopenia.

Sixty granulocytopenic patients (granulocytes less than 1000/mm3) affected with solid tumors, previously submitted to antiblastic therapy and with infections, were treated with three antibiotic combinations: amikacin + ceftazidime, amikacin + piperacillin or amikacin + aztreonam. In 68% of the cases the infections were due to gram-negative and in the remaining 32% to gram-positive microorganisms. The results obtained with the three treatments show a slight but significant statistical difference (p less than 0.05), due to the greater efficacy of the amikacin + ceftazidime combination on gram-positive and amikacin + aztreonam on gram-negative bacteria.

Adult↗
PubMed1987

Comparison between sulbenicillin and piperacillin levels in serum and in bronchial secretions--a pharmacokinetic study.

In order to assess pharmacokinetic differences between sulbenicillin (S) and piperacillin (P), two penicillin derivatives, 24 in-patients, 12 males and 12 females mean age 59.4 years, suffering from recurrent bronchial infections were enrolled. Patients were randomly allocated to S (12 patients) and to P (12 patients) and were given 2 g i.m. every 12 h of the awarded antibiotic, for a 7-day period. At the first and 7th day blood samples (0.25, 0.5, 1, 2, 4, 6, 8 and 12 h after dosing) as well as sputum samples (1, 2, 4, 8, 12 h after dosing) and urine samples (3, 6, 9 and 12 h after dosing) were collected, and the levels of S or P were determined by bacillus subtilis test. The pharmacokinetic analysis was performed by a standard program. On day 1 and 7 the mean peak serum concentration occurred at the first hour for S (39.9 +/- 5.2; 40.9 +/- 5.1 mcg/ml, respectively) and for P (32.2 +/- 5.4; 33.1 +/- 5.4 mcg/ml, respectively). Serum AUC0-12 and AUC0-00 (mg/l.h) levels of S were significantly higher (p less than 0.01 or less) than those of P on day 1 and 7. Similarly MRT (8 h) and Cmax (mg/l) where higher but only on day 7. Sputum AUC0-12 (mg/l.h) level of S was significantly higher (p less than 0.05) than that of P on day 1 and 7. In conclusion serum and sputum S appear to have a different pharmacokinetic profile in respect to P. However, when compared to the AUC, both drugs reach antibacterial levels.

Aged↗
PubMed1986

[High performance liquid chromatographic determination of astromicin and piperacillin used in combination in blood samples].

Aminoglycoside and beta-lactam antibiotics are often used in combination, and many synergistic effects have been reported. We describe here a high performance liquid chromatographic determination method for each of astromicin (ASTM) and piperacillin (PIPC) in blood samples of several species. The procedure for ASTM included purification with CM-Sephadex, separation on a reversed phase column (C-18) and derivatization with o-phthalaldehyde (OPA). The procedure for PIPC included deproteinization with acetonitrile, centrifugation and separation on a reversed phase column (C-18). Either of the drugs did not affect the determination of the other. The detection limits were 0.1 microgram/ml for ASTM and 0.5 microgram/ml for PIPC. These sensitivities seem good enough for a clinical application of the method considering usual dosage levels of these drugs.

Aminoglycosides↗
PubMed1987

Piperacillin and gentamicin as non toxic empirical therapy in pediatric patients with fever and neutropenia.

To minimize renal and hematological toxicity during empirical antibiotic therapy for pediatric patients with fever and neutropenia, piperacillin and gentamicin combination therapy was evaluated. Twenty episodes of fever and neutropenia in pediatric patients (less than 20 years old) with malignancies were studied. Elligible patients were defined as having documented fever (temperature greater than 38.5 degrees C) and absolute neutrophil count less than 500/mm3. Antibiotics were continued until neutropenia resolved and clinical response was seen. No bleeding, renal, hematological or other adverse reactions were evident in the cases studied that could be attributed to antibiotic therapy. The organisms recovered were sensitive to one or both antibiotics. There was clinical improvement and bacteriological response in all cases.

Adolescent↗
PubMedDate not supplied

Synergism of azlocillin, mezlocillin, piperacillin in combination with tobramycin against Klebsiella and Pseudomonas.

Fifty-three clinical isolates of Klebsiella and fifty-one clinical isolates of Pseudomonas aeruginosa, twenty-six of which were carbenicillin-(CARB) resistant, were tested for susceptibility to mezlocillin (MEZ), azlocillin (AZL), and piperacillin (PIP), both alone and in combination with tobramycin (TOB) using the microtiter broth diluent method and an inoculum density of 10(6) CFU/ml. The Klebsiella were highly resistant to TOB, MEZ, and PIP (MIC90: 8, greater than 256, greater than 128 micrograms/ml, respectively). Synergy was demonstrated in 53 percent (PIP/TOB) and 51 percent (MEZ/TOB). An indifferent response was observed in 47 percent (PIP/TOB) and 49 percent MEZ/TOB of the Klebsiella. PIP, MEZ, and AZL in combination with TOB showed synergism against CARB-resistant Pseudomonas in less than 10 percent of the strains tested. Synergy could be demonstrated against CARB-susceptible Pseudomonas with the combinations PIP/TOB, AZL/TOB, and MEZ/TOB in 12 percent, 12 percent, and 24 percent, respectively, of the twenty-five strains tested. Indifferent effects were observed in 84 percent, 88 percent, and 76 percent, respectively, of these same CARB-susceptible strains. These data suggest that there is no significant difference in the incidence of synergy with these new penicillins and tobramycin against either Pseudomonas or Klebsiella.

Azlocillin↗
PubMed1987

[Fundamental study of piperacillin sodium in term and premature neonates].

Piperacillin sodium (PIPC) is a semisynthetic penicillin displaying high antibacterial activities against Gram-positive and Gram-negative bacteria including Pseudomonas sp., Proteus sp., etc. It acts bactericidally and is stable against beta-lactamases. The usefulness of PIPC in the treatment of infections in mature and premature neonates was investigated and the following results were obtained. The pharmacokinetics (half-life, distribution volume, total body clearance) of PIPC after 50 mg/kg intravenous drip infusion in 10 cases of neonates were examined. Relationship between T1/2 and hours after birth was clearly determined. Adverse effects and abnormality in laboratory test values were not observed. It is considered from the above results that PIPC may be an useful antibacterial agent for the treatment of infections in neonates.

Acute Disease↗
PubMed1986

Penetration of piperacillin into renal cysts.

Concentrations of piperacillin in the cystic fluid of eight patients with simple renal cysts were assessed after each patient had been given single or multiple doses of the antibiotic. Concentrations ranged from non-detectable to 9 mcg/ml.

Aged↗
PubMed1985

[Empiric therapy with piperacillin plus amikacin for febrile patients with cancer--with emphasis on granulocytopenia].

Between August 1979 and December 1983 one hundred episodes of fever in 70 patients with cancer, most of whom had granulocytopenia, were treated empirically with a combination of piperacillin (4.0g, every 6 hours) and amikacin (200mg, every 6 hours) at Saitama Cancer Center. Profound granulocytopenia (less than 100/mm3 of granulocytes) was present at the beginning of treatment in 40% of episodes. Oral absorbable or nonabsorbable antibiotics were used in 57 febrile episodes. WBC transfusion was not given. The response rate for all documented infections was 58.1%, including 8 of 9 (88.8%) episodes of bacteremia. The majority of infections with identified organisms were caused by aerobic gram-negative pathogens including P. aeruginosa (8 cases), Klebsiella spp. (3 cases), E. coli (4 cases), Proteus mirabilis (2 cases) and serratia spp. (3 cases). The response rate of gram-negative bacillary infections was 55% Pneumonia with a response rate of 21.1% responded less satisfactorily than all other types of infection. The response rate for profound persistent granulocytopenia (less than 100/mm3 granulocytes without a rise during therapy) was 45.5%. The most common adverse effect was hepatotoxicity (16 episodes). Nephrotoxicity occurred in 4 patients and skin rash in 2 patients.

Acute Disease↗
PubMed1982

Sepsis associated with urinary tract infection. Antibiotic treatment with piperacillin.

Urosepsis is mostly induced by nosocomial gram-negative organisms. It is an infection that is difficult to treat and has high mortality, especially when associated with septic shock. For obstructive urosepsis, which occurs mostly after an acute stone occlusion of the upper urinary tract in pyelonephritis, intensive systemic medical therapy and drainage (and sometimes removal) of the septic kidney are necessary. For non-obstructive urosepsis, which is mostly an iatrogenic complication of diagnostic or therapeutic procedures on the genito-urinary tract, the same intensive medical care and urinary drainage are adequate. Systemic therapy in the treatment of urosepsis encompasses several disorders. Specific pathogenic mechanisms of shock, including failure of the microcirculation, hemostatic disorders, and microbiological problems, have to be considered in the systemic treatment of urosepsis. Appropriate antibiotic therapy may triple chances of survival. In this connection, piperacillin was successfully used in 30 patients with urosepsis treated at our institution.

Adult↗
PubMed1982

[Clinical evaluation of piperacillin in the field of obstetrics and gynecology].

Piperacillin (PIPC) was administered to 4 cases with obstetrical and gynecological infections and the following results were obtained. 1. PIPC was administered by intravenous drip infusion with 4 g per day for 7--14 days. The clinical efficacy was excellent in 2 cases with postoperative parametritis and good in 2 other cases, 1 with infectious ovarian cystoma and 1 with intrauterine infection. In the latter 2 cases surgical treatment was combined. 2. In laboratory findings GOT and GPT were slightly elevated in 2 cases. The relation between the drug and the abnormality was unclear because these rises may be considered due to the anesthesia or the operation itself.

Adult↗
PubMed1982

[Evaluation of the clinical effect and tissue distribution of piperacillin in the field of obstetrics and gynecology].

Piperacillin (PIPC) was administered to patients with obstetrical and gynecological infectious diseases and we studied its clinical effect and tissue distribution. 1. Clinical results. PIPC was administered to 26 patients at a dose of 2--4 g per day (twice a day) by dripping infusion over a period of 3--10 days (total 8--30 g). These included 16 cases with intrauterine infection, 1 with adnexitis, 4 with pelvic inflammatory disease and 5 with infections of the external genitalia. The clinical results were excellent in 11 cases, good in 13 cases and poor in 2 cases so that the overall efficacy rate was 92.3%. For bacteriological study 33 strains were isolated from 20 patients. These included Gram positive bacteria (6 strains), Gram negative bacteria (23 strains) and anaerobes (4 strains). After PIPC treatment 32 strains (including S. epidermidis 4 strains, E. coli 12 strains, K. pneumoniae 3 strains, E. aerogenes 2 strains, P. aeruginosa 2 strains and anaerobes 4 strains, etc.) disappeared except for 1 strain of K. pneumoniae which persisted. The disappearance rate was 97.0%. The only side effect observed was a slight case of malaise during the first administration day, however the relationship between the appearance of this symptom and the drug was unclear. No adverse reaction in laboratory findings was observed. 2. Tissue distribution. We determined the tissue concentration from 90 to 240 minutes after dripping infusion for 1 hour at a dose of 2 g. PIPC concentrations in these tissues including the endometrium, myometrium, cervix uteri, portio vaginalis, oviduct and ovary showed the highest level (18.0--11.7 micrograms/g) at 90 minutes after the beginning of administration. These values were 48.6--31.6% in respect to the uterine arterial blood level (37 micrograms/ml at 90 minutes after infusion).

Adult↗
PubMed1982

[Pharmacokinetic study of piperacillin in the field of obstetrics and gynecology].

The following trial was conducted as a fundamental study in the application of piperacillin (PIPC) in the field of obstetrics and gynecology. A dose of 1 g was administered to 10 patients by intravenous injection and the concentrations of PIPC in the serum and the various tissues of the uterus were measured. This data was analyzed by the computer. 1. These concentrations were analyzed based on a two- or three-compartment model. We obtained the pharmacokinetic parameters and described the simulation curves. Correspondence was observed between the calculated and the actually determined concentrations. 2. PIPC was rapidly distributed to the tissues of the uterus and exhibited high concentrations. Transfer to these tissues correlated well with serum concentrations.

Adult↗