You are here: Urology Textbook > Drugs in Urology > Pivmecillinam

Pivmecillinam: Mechanism of Action, Side Effects and Dosage

Pivmecillinam is a broad-spectrum penicillin for oral antibiotic therapy with a relatively narrow antibiotic spectrum against gram-negative pathogens.

Mechanism of Action:

Pivmecillinam is hydrolyzed into the active mecillinam, which inhibits the peptidoglycan synthesis of the bacterial wall: it binds to so-called penicillin-binding proteins (peptidoglycan synthetases). It thereby inhibits the peptidoglycan polymerization and covalent cross-linking of the bacterial wall.

Antibiotic Spectrum of Pivmecillinam:

Enterobacteriaceae such as E. coli, Klebsiella, or Proteus. No efficacy against pseudomonads or enterococci. Resistance is low worldwide, even with E. coli with ESBL, there is still good clinical efficacy of 50–80%. Due to the narrow spectrum of activity, the effect on the natural mucosal flora of the mouth, intestine and vagina is low.

Urological Indications for Pivmecillinam:

For treating acute uncomplicated urinary tract infections in adults, children from 6 years of age, and pregnant women.

Pharmacokinetics of Pivmecillinam:

Pivmecillinam is a prodrug hydrolyzed in the body by esterases into the active mecillinam. After oral intake, the bioavailability is 60–70%. The half-life is one hour, excretion mainly via the kidneys.

Side Effects of Pivmecillinam:

• Frequently diarrhea and nausea, vaginal fungal infection.
• Occasionally, Clostridium difficile colitis, allergic reactions, and liver dysfunction occur. Sporadic risk of oesophageal ulcers (in case of passage disorders) or severe skin reactions.

Drug Interactions:

Probenicid inhibits renal tubular excretion and increases serum concentrations. The simultaneous intake of valproic acid leads to a carnitine deficiency.

Contraindications:

Penicillin allergy. Genetic diseases with carnitine deficiency. Known porphyria.

Dosage of Pivmecillinam:

200–400 mg pivmecillinam 1-1-1 p.o. for three days. The daily dose for children >6 years is 20–40 mg/kgKG divided into three single doses, up to a maximum of 1200 mg.

References

L. E. Nicolle, “Pivmecillinam in the treatment of urinary tract infections,” J Antimicrob Chemother, vol. 46 Suppl 1, p. 35–9; discussion 63–5, 2000.

Simon und Stille 1997 SIMON, C. ; STILLE, W.: Antibiotika-Therapie in Klinik und Praxis.
9. Auflage.
Stuttgart New York : Schattauer, 1997

  Deutsche Version: Pharmakologie und Nebenwirkungen von Pivmecillinam

Urology-Textbook.com – Choose the Ad-Free, Professional Resource

This website is designed for physicians and medical professionals. It presents diseases of the genital organs through detailed text and images. Some content may not be suitable for children or sensitive readers. Many illustrations are available exclusively to Steady members. Are you a physician and interested in supporting this project? Join Steady to unlock full access to all images and enjoy an ad-free experience. Try it free for 7 days—no obligation.