Clinical evaluation of piperacillin with observations on penetrability into cerebrospinal fluid
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Published on: May 6, 2016
Abstract:
Piperacillin, a new semisynthetic penicillin, was evaluated for efficacy and safety in 26 patients, most of whom had pneumonia. Included were four patients with gram-negative meningitis in whom the penetration of piperacillin into cerebrospinal fluid was determined. Cure was achieved in 11 of 17 patients with pneumonia; another 4 were improved. One relapse and one failure occurred among nine patients with gram-negative pneumonia. Cure or improvement occurred in seven of nine patients with gram-negative infection in various extrapulmonary sites. Piperacillin given by continuous infusion in a dosage ranging from 324 to 436 mg/kg of body weight per day to four patients with meningitis resulted in a mean cerebrospinal fluid level of 23 micrograms/ml at 24 h; the mean penetration of piperacillin into the cerebrospinal fluid was 32% at this interval. Levels of piperacillin in cerebrospinal fluid collected later during the course of therapy were also adequate. Adverse effects were noted in six patients, but only one episode of granulocytopenia was serious. Emergence of resistance to piperacillin did not occur, and only one superinfection was noted. Piperacillin appeared to be efficacious in the treatment of pneumonia. It penetrated well into the cerebrospinal fluid of patients with meningitis and may be useful for treatment of selected gram-negative infections in extrapulmonary sites.
Insights
Piperacillin demonstrated efficacy in treating pneumonia and penetrating cerebrospinal fluid for meningitis. This new penicillin showed a good safety profile with minimal adverse effects and no resistance development.
Area of Science:
- Pharmacology
- Infectious Diseases
- Clinical Medicine
Background:
- Piperacillin is a novel semisynthetic penicillin antibiotic.
- Its efficacy and safety profile require thorough evaluation, particularly in challenging infections.
Purpose of the Study:
- To assess the efficacy and safety of piperacillin in patients with pneumonia.
- To determine piperacillin's penetration into cerebrospinal fluid (CSF) in patients with gram-negative meningitis.
- To evaluate piperacillin's effectiveness in treating extrapulmonary gram-negative infections.
Main Methods:
- A clinical study involving 26 patients, primarily with pneumonia.
- Piperacillin administration via continuous infusion for meningitis patients.
- Measurement of piperacillin levels in CSF and assessment of clinical outcomes.
Main Results:
- Piperacillin achieved cure or improvement in 15 of 17 pneumonia patients.
- Seven of nine patients with extrapulmonary gram-negative infections showed cure or improvement.
- Adequate piperacillin CSF levels (mean 23 µg/ml at 24h, 32% penetration) were observed in meningitis patients.
- Six patients experienced adverse effects, with one serious case of granulocytopenia.
- No piperacillin resistance or significant superinfections were noted.
Conclusions:
- Piperacillin is effective for treating pneumonia.
- It exhibits good penetration into the CSF, suggesting potential utility for gram-negative meningitis.
- Piperacillin shows promise for treating selected gram-negative infections at extrapulmonary sites.
