Introduction
Pivmecillinam is a mecillinam prodrug, a pivaloyloxymethyl ester of amdinocillin that is well absorbed orally, but broken down to amdinocillin in the intestinal mucosa. It is active against gram-negative organisms and used as for amdinocillin. [PubChem]
Uses
Pivmecillinam is a prodrug of the beta lactam antibiotic mecillinam, indicated for the treatment of uncomplicated urinary tract infections (UTIs).
Used to treat infections due to mecillinam-sensitive organisms such as urinary tract infections, salmonellosis and typhoid fever.
Associated Conditions
Pharmacodynamics
Pivmecillinam is a pivaloyloxymethyl ester of amdinocillin that is well absorbed orally, but broken down to amdinocillin in the intestinal mucosa. It is active against gram-negative organisms and used as for amdinocillin.
Mechanism of Action
Pivmecillinam interferes with the biosynthesis of the bacterial cell wall however its activity is slightly different from that of other penicillins and cephalosporins
Absorption
Well absorbed following oral administration.
Food Interactions
- Take with or without food. The absorption is unaffected by food.
Dosage
- The usual dose: 1-2 tablets 3 times daily according to severity of the infection.
- In acute uncomplicated cystitis: initially 400 mg then 200 mg every 8 hours for 3 days.
- In chronic or recurrent bacteriurea: 400 mg 6-8 hours.
- For the treatment of salmonellosis (including enteric fever): 1.2-2.4 gm daily for 14 days. To eliminate salmonella carriage, therapy may be prolonged for 2-4 weeks. In complicated urinary tract infection the usual treatment time is 1-2 weeks.
- For prophylactic treatment of recurrent urinary tract infections: 1 tablet every evening is recommended.
- 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.
- In shigellosis: 20 mg/kg 4 times a day for 5 days.
- For UTI: 20-40 mg/kg/day in 3-4 divided doses
- For salmonellosis: 30-60 mg/kg/day in 3-4 divided doses
