piperacilina

piperacilina, also known as piperacillin, is a broad‑spectrum penicillin derivative used primarily in combination with beta‑lactamase inhibitors such as tazobactam. The combination, piperacillin‑tazobactam, is marketed as Zosyn among other trade names. It belongs to the fourth‑generation penicillins and exhibits activity against gram‑positive cocci, gram‑negative rods, and anaerobes.

The drug was first synthesized in the late 1970s by the pharmaceutical company Pfizer and received approval for clinical use in the United States in 1987. Since its introduction, piperacillin‑tazobactam has become a common empiric therapy for intra‑abdominal, urinary tract, and hospital‑acquired pneumonia, as well as skin and soft‑tissue infections.

Chemical features of piperacillin include a β‑lactam ring fused to a thiazolidine ring and a side chain that contains a 3‑cyclobutyl‑4‑hydroxy‑2‑imino‑5‑propylpenicillanic acid core. Its isomeric form, piperacillic acid, is named for its pronounced resistance to β‑lactamases. The drug is metabolised primarily by the liver, with a half‑life of about 1 to 1.5 hours in patients with normal renal function.

The antibacterial spectrum encompasses Enterobacteriaceae (escherichia coli, klebsiella pneumoniae), pseudomonas aeruginosa, archaea, staphylococcus aureus, streptococcus species, and clostridia. Clinical trials demonstrate superiority over ampicillin‑sulbactam for complicated intra‑abdominal and urinary tract infections, and it remains a first‑line option for ventilator‑associated pneumonia in intensive care settings.

Typical dosing for adults is 2 to 4 grams of piperacillin given every 6 hours, or 2 grams every 8 hours, depending on infection severity and renal function; infusions may be continuous over 4 hours. Common adverse reactions include gastrointestinal discomfort, hypersensitivity reactions, and transient elevation of liver enzymes. Routine monitoring of renal function and serum creatinine is advised when doses are increased.