Piv

Indications

Pivmecillinam is a penicillin-type antibiotic used mainly to treat urinary tract infections (UTIs), especially uncomplicated cystitis (bladder infection) in adults. A doctor may also use it for other infections caused by sensitive bacteria. It does not work against viral infections such as colds or flu.

How It Works

Pivmecillinam is a "prodrug": after it is absorbed, the body converts it into mecillinam, the active antibiotic. Mecillinam stops many gut-type bacteria, such as E. coli, from building their cell walls, so they burst and die. It concentrates well in the urine.

Dosage and Administration

• Uncomplicated cystitis in adults: commonly 400 mg for the first dose, then 200 mg three times a day, for a total of 3 days. Some doctors prescribe 400 mg two or three times a day for 3 to 5 days. Follow your prescription.
• Other infections and children: as prescribed by the doctor.

Swallow the tablet whole with a full glass of water, during or just after a meal, while sitting or standing upright. Do not take it just before lying down, as it can irritate the food pipe. Finish the full course even if you feel better.

Interactions

• Valproate (Sodium Valproate or Valproic Acid): both lower carnitine in the body; avoid using them together.
• Methotrexate: pivmecillinam may raise its levels and side effects.
• Probenecid: raises pivmecillinam levels.
• Tell your doctor about all other medicines you take.

Contraindications

• Allergy to pivmecillinam, mecillinam, other penicillins or a severe allergy to cephalosporins.
• Inherited carnitine deficiency or conditions affecting carnitine.
• Narrowing or blockage of the food pipe (oesophagus) or problems swallowing.

Side Effects

Common: nausea, diarrhoea, indigestion, and thrush (yeast infection) of the vagina. Less often: vomiting, tummy pain, dizziness, headache and rash.

Get urgent medical help if you have:

• Signs of a serious allergic reaction: swelling of the face, lips or throat, difficulty breathing, widespread rash or blistering.
• Severe or bloody diarrhoea, during or up to several weeks after treatment.
• Chest pain or pain on swallowing.
• Fever, back or side pain, or vomiting, which may mean the infection has spread to the kidneys.

Pregnancy and Lactation

Pivmecillinam has been widely used in pregnancy and is not known to harm the baby, but use it only if your doctor prescribes it. Small amounts pass into breast milk; it is generally considered compatible with breastfeeding, but watch the baby for diarrhoea or thrush and tell your doctor.

Precautions and Warnings

• Repeated or long courses can lower carnitine levels, which may cause muscle weakness or low blood sugar; avoid long-term use unless the doctor advises.
• See a doctor if symptoms do not improve within 2 to 3 days, or come back soon after finishing.
• Tell your doctor about kidney or liver problems.
• Men, children, pregnant women and people with recurrent UTIs should see a doctor rather than self-treating.

Overdose

Too much may cause nausea, vomiting, diarrhoea and stomach discomfort. Seek medical advice.

Therapeutic Class

Penicillin antibiotic (amidinopenicillin).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.