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)
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
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Related Studies
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 |