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Piperacillin - Pipracil ® - Renal dosing

Usual Dosing (Adults)

3 grams q4-6h or 4 grams q6h.
Maximum: 24 g/24 hours

DOSAGE AND ADMINISTRATION
PIPRACIL may be administered by the intramuscular route (see NOTE) or intravenously as a three- to five-minute intravenous injection or as a 20- to 30-minute infusion. The usual dosage of PIPRACIL for serious infections is 3 to 4 g given every four to six hours as a 20- to 30-minute infusion. For serious infections, the intravenous route should be used.

PIPRACIL should not be mixed with an aminoglycoside in a syringe or infusion bottle since this can result in inactivation of the aminoglycoside.

The maximum daily dose for adults is usually 24 g/day, although higher doses have been used.

Intramuscular injections (see NOTE) should be limited to 2 g per injection site. This route of administration has been used primarily in the treatment of patients with uncomplicated gonorrhea and urinary tract infections.

DOSAGE RECOMMENDATIONS
Type of Infection Usual Total Daily Dose
†One g of probenecid should be given orally one-half hour prior to injection.
Serious infections such as septicemia, nosocomial pneumonia, intra-abdominal infections, aerobic and anaerobic gynecologic infections, and skin and soft tissue infections
12 – 18 g/d I.V. (200 – 300 mg/kg/d) in divided doses every 4 to 6 h
Complicated urinary tract infections 8 – 16 g/d I.V. (125 – 200 mg/kg/d) in divided doses every 6 to 8 h
Uncomplicated urinary tract infections and most community-acquired pneumonia 6 – 8 g/d I.M. or I.V. (100– 125 mg/kg/d) in divided doses every 6 to 12 h
Uncomplicated gonorrhea infections 2 g I.M.† as a one-time dose

The average duration of PIPRACIL treatment is from seven to ten days, except in the treatment of gynecologic infections, which is from three to ten days; the duration should be guided by the patient's clinical and bacteriological progress. For most acute infections, treatment should be continued for at least 48 to 72 hours after the patient becomes asymptomatic. Antibiotic therapy for S. pyogenes infections should be maintained for at least ten days to reduce the risk of rheumatic fever.

When PIPRACIL is given concurrently with aminoglycosides, both drugs should be used in full therapeutic doses.

Renal Dosing

dialysis [>40 ml/min]: No changes
[20-40]: 3-4 grams q8h.
[<20 ]: 4 grams q12h. 

Alternatively:
[10-50]: Administer q6-8 hours.
[<10]: Administer q8h.


Renal Impairment
Creatinine
Clearance
mL/min
Urinary Tract
Infection
(uncomplicated)
Urinary Tract
Infection
(complicated)
Serious
Systemic
Infection
>40 No dosage adjustment necessary
20-40 No dosage adjustment necessary 9 g/day
3 g every 8 h
12 g/day
4 g every 8 h
<20 6 g/day
3 g every 12 h
6 g/day
3 g every 12 h
8 g/day
4 g every 12 h

For patients on hemodialysis, the maximum daily dose is 6 g/day (2 g every 8 hours). In addition, because hemodialysis removes 30% to 50% of piperacillin in 4 hours, a 1-g additional dose should be administered following each dialysis period.

For patients with renal failure and hepatic insufficiency, measurement of serum levels of piperacillin will provide additional guidance for adjusting dosage.

Hemodialysis

dialysis Hemo:
Manufacturer: 2 grams IV q8h + 1 gram additional dose after each dialysis

Continuous arteriovenous or venovenous hemofiltration: 
Dose as for Clcr 10-50 mL/minute.

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Please review the latest applicable package insert for additional information and possible updates.  A local search option of this data can be found here.

Disclaimer

The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer
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