II. Indications

  1. Lower Urinary Tract Infection
    1. FDA Approved in 2024 for simple cystitis in women
    2. FDA approved for age >6 years old

III. Contraindications

  1. Pyelonephritis
  2. Penicillin Allergy or Anaphylaxis
  3. Specific Inborn Errors of Metabolism associated with carnitine deficiency
    1. Disorders of mitochondrial Fatty Acid oxidation and carnitine metabolism
    2. Porphyria

IV. Mechanism

  1. Oral Extended Spectrum Penicillin
  2. Aminopenicillanic acid ester
    1. Prodrug metabolized to active drug Mecillinam
  3. Interferes with cell wall of Gram Negative Bacteria
    1. Specifically targets Penicillin binding Protein 2
    2. Does not cover Pseudomonas aeruginosa
  4. Activity against Beta-Lactamase resistant organisms (including some ESBL Bacteria)
    1. Escherichia coli
    2. Proteus Mirabilis
    3. Staphylococcus Saprophyticus

V. Medications

  1. Pivmecillinam Tablet 185 mg

VI. Dosing

  1. Lower Urinary Tract Infections
    1. Adult (or child age >=6 years, weight >40 kg)
    2. Take 185 mg orally three times daily for 3 to 7 days

VII. Adverse Effects

  1. Dermatologic
    1. Vulvovaginal Candidiasis (2%)
    2. Skin Rash (1%)
    3. Pruritus (2%)
  2. Gastrointestinal
    1. Abdominal Pain (1%)
    2. Diarrhea (2%)
    3. Dyspepsia (1%)
    4. Nausea (4%)
    5. Vomiting (1%)
  3. Neurologic
    1. Headaches (1%)

VIII. Safety

  1. Unknown safety in Lactation
  2. Pregnancy
    1. Penicillins as a class are widely used safely in pregnancy
    2. However, Mecillinam (active metabolite) does cross placenta, and longterm safety data is not available

IX. Resources

X. References

  1. LoVecchio (2024) Crit Dec Emerg Med 38(8): 38

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Related Studies

Ontology: Amdinocillin Pivoxil (C0002436)

Definition (NCI) The pivoxil ester form of a semisynthetic, broad spectrum beta-lactam penicillin with antibacterial activity. Amdinocillin specifically binds to and inactivates penicillin-binding protein 2 (PBP 2) located on the inner membrane of the bacterial cell wall. Inactivation of PBPs interferes with the cross-linkage of peptidoglycan chains necessary for bacterial cell wall strength and rigidity. This interrupts bacterial cell wall synthesis and results in the weakening of the bacterial cell wall, eventually causing cell lysis.
Definition (MSH) 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.
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH D000561
SnomedCT 387542008, 96064003
English Amdinocillin Pivoxil, Mecillinam Pivaloyl Ester, Pivaloyl Ester, Mecillinam, Pivamdinocillin, Pivmecillinam, Pivoxil, Amdinocillin, 4-Thia-1-azabicyclo(3.2.0)heptane-2-carboxylic acid, 6-(((hexahydro-1H-azepin-1-yl)methylene)amino)-3,3-dimethyl-7-oxo-, (2,2-dimethyl-1-oxopropoxy)methyl ester, (2S-(2alpha,5alpha,6beta))-, Amdinocillin Pivoxil [Chemical/Ingredient], pivmecillinam, AMDINOCILLIN PIVOXIL, Amdinocillin pivoxil, Amdinocillin pivoxil (product), Amdinocillin pivoxil (substance)
Swedish Amdinocillinpivoxil
Czech amdinocilin pivoxil
Finnish Mesillinaamipivoksiili
Italian Pivmecillina, Amdinocillina pivossile
Russian PIVMETSILLINAM, AMDINOTSILLIN PIVOKSIL, FL 1039, АМДИНОЦИЛЛИН ПИВОКСИЛ, ПИВМЕЦИЛЛИНАМ
Japanese メリシン, ピブメシリナム塩酸塩, 塩酸ピブメシリナム, ピブメシリナム, アムジノシリンピボキシル
French Pivmécillinam, Pivoxil amdinocilline, Pivamdinocilline
Spanish pivmecilinam (producto), pivmecilinam, amdinocilina pivoxilo (producto), amdinocilina pivoxilo (sustancia), amdinocilina pivoxilo, pivamdinocilina, Amdinocilina Pivoxil, Pivmecilinam
Polish Piwmecylinam
German Amdinocillin pivoxil, Pivmecillinam
Portuguese Andinocilina Pivoxil, Pivmecilinam

Ontology: Pivmecillinam hydrochloride (C0350794)

Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH D000561
SnomedCT 323782007
German Pivmecillinam-Hydrochlorid
French Chlorhydrate de pivmécillinam, Chlorhydrate de pivamdinocilline, Amdinocilline pivoxil chlorhydrate
English amdinocillin pivoxil HCl, Pivmecillinam hydrochloride, Pivmecillinam hydrochloride (substance), Hydrochloride, Pivmecillinam, Pivmecillinam Hydrochloride
Spanish clorhidrato de pivmecilina (sustancia), clorhidrato de pivmecilina