Pivmecillinam

Aka: Pivmecillinam, Amdinocillin Pivoxil, Pivmecillinam hydrochloride, Pivamdinocillin, Selexid, Mecillinam, Pivoxil, Pivya

advertisement

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
    3. Has not been studied in complicated UTI

III. Contraindications

  1. Pyelonephritis
  2. Penicillin Allergy, Anaphylaxis or Stevens-Johnson Syndrome
  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. Cost: $940-$2200 for a 3-7 day course in 2026
  2. Dermatologic
    1. Vulvovaginal Candidiasis (2%)
    2. Skin Rash (1%)
    3. Pruritus (2%)
  3. Gastrointestinal
    1. Abdominal Pain (1%)
    2. Diarrhea (2%)
    3. Dyspepsia (1%)
    4. Nausea (4%)
    5. Vomiting (1%)
  4. 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. Drug Interactions

  1. Methotrexate
    1. Pivmecillinam reduces clearance of Methotrexate (raising drug levels)

X. Resources

  1. Pivmecillinam (FDA Drug Monograph)
    1. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/216483s000lbl.pdf

XI. References

  1. LoVecchio (2024) Crit Dec Emerg Med 38(8): 38
  2. Diletti-Swenson (2026) Am Fam Physician 113(55): 504-5 [PubMed]

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Pivmecillinam." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Topics in Pharmacology

advertisement