II. Indications
- Lower Urinary Tract Infection
- FDA Approved in 2024 for simple cystitis in women
- FDA approved for age >6 years old
III. Contraindications
- Pyelonephritis
- Penicillin Allergy or Anaphylaxis
- Specific Inborn Errors of Metabolism associated with carnitine deficiency
- Disorders of mitochondrial Fatty Acid oxidation and carnitine metabolism
- Porphyria
IV. Mechanism
- Oral Extended Spectrum Penicillin
- Aminopenicillanic acid ester
- Prodrug metabolized to active drug Mecillinam
- Interferes with cell wall of Gram Negative Bacteria
- Specifically targets Penicillin binding Protein 2
- Does not cover Pseudomonas aeruginosa
- Activity against Beta-Lactamase resistant organisms (including some ESBL Bacteria)
- Escherichia coli
- Proteus mirabilis
- Staphylococcus saprophyticus
V. Medications
- Pivmecillinam Tablet 185 mg
VI. Dosing
- Lower Urinary Tract Infections
- Adult (or child age >=6 years, weight >40 kg)
- Take 185 mg orally three times daily for 3 to 7 days
VII. Adverse Effects
- Dermatologic
- Vulvovaginal Candidiasis (2%)
- Skin Rash (1%)
- Pruritus (2%)
- Gastrointestinal
- Abdominal Pain (1%)
- Diarrhea (2%)
- Dyspepsia (1%)
- Nausea (4%)
- Vomiting (1%)
- Neurologic
- Headaches (1%)
VIII. Safety
- Unknown safety in Lactation
- Pregnancy
- Penicillins as a class are widely used safely in pregnancy
- However, Mecillinam (active metabolite) does cross placenta, and longterm safety data is not available
IX. Resources
- Pivmecillinam (FDA Drug Monograph)
X. References
- LoVecchio (2024) Crit Dec Emerg Med 38(8): 38