피페라실린 나트륨

항생제 - 광범위 페니실린

피페라실린은 주로 중증 또는 내성 세균 감염에 사용되는 **광범위 아실아미노페니실린**계 항생제입니다. * **광범위 스펙트럼**: 다양한 호기성 및 혐기성 그람 양성 및 음성균에 대해 확장된 항균 범위를 제공하며, 특히 **녹농균(Pseudomonas aeruginosa)** 및 장내세균과의 많은 균주를 포함합니다. * **임상적 사용**: 수의학적 사용 경험은 다소 제한적이나, 배양 및 감수성 결과가 나오기 전 중증 환자의 경험적 치료나 혼합 감염 및 그람 음성균 오염이 우려되는 수술적 예방에 매우 유용합니다. * **베타락타마제 감수성**: 다른 아미노페니실린과 마찬가지로 피페라실린 단독으로는 베타락타마제 효소에 의해 파괴되기 쉽습니다. 따라서 내성을 극복하기 위해 종종 베타락타마제 억제제(예: 타조박탐)와 병용됩니다. * **투여 방법**: 경구로는 거의 흡수되지 않으므로 반드시 비경구(정맥, 근육 또는 피하)로 투여해야 합니다.

작용 기전: Piperacillin is a **bactericidal** time-dependent antibiotic. * It binds to specific **Penicillin-Binding Proteins (PBPs)** (especially PBP-3) located inside the bacterial cell wall. * Binding to PBPs → inhibition of the third and final stage of bacterial cell wall synthesis (cross-linking of **peptidoglycan** strands). * This weakens the cell wall → activation of bacterial autolysins → **cell lysis and death**. * *Note*: Its efficacy is highly dependent on the amount of time the drug concentration remains above the Minimum Inhibitory Concentration (MIC) of the target pathogen.

동물 종별 용량

Cats

For bacteremia with or without endocarditis · 30 mg/kg IV q6h for 7-14 days · IV · q6h · 7-14 days
For respiratory infections · 25-50 mg/kg IV q8h · IV · q8h

Horses

For susceptible infections · 15-50 mg/kg IV or IM q6-12h · IV/IM · q6-12h

Birds

For Bordetella avium infections · 150 mg/kg IM q8-12h · IM · q8-12h · minimum treatment period is two weeks
For susceptible infections · 100 mg/kg IM two to three times daily · IM · BID-TID
For empirical treatment in Psittacines of gram-negative bacterial infections · 100 mg/kg IM 3-4 times a day if immunocompetent; 4 times a day if immunocompromised · IM · TID-QID

Dogs

For bacteremia with or without endocarditis · 30 mg/kg IV q6h for 7-14 days · IV · q6h · 7-14 days
For respiratory infections · 25-50 mg/kg IV q8h · IV · q8h
For systemic treatment of otitis media or proliferative otitis externa complicated by gram-negative (especially Pseudomonas) bacteria · 20 mg/kg SC three times daily · SC · TID

투여 경로

IVIMSC

금기

Patients with documented hypersensitivity to beta-lactam antibiotics (penicillins, cephalosporins)

이상반응

Hypersensitivity reactions (allergic reactions)
Local tissue irritation, pain at IM injection site
Thrombophlebitis (with IV administration)
Antibiotic-associated diarrhea (due to alterations in gut flora)
Coagulation abnormalities (rare, mostly in renal failure)
Neurotoxicity/seizures (at very high doses or in renal impairment)
Clostridium difficile superinfections (rare)

약물 상호작용

Aminoglycosides (amikacin, gentamicin, tobramycin) · Synergistic against certain bacteria in vitro, but penicillins can chemically inactivate aminoglycosides in vivo (especially in renal failure or at massive doses). Do not mix in the same syringe/bag.
Anticoagulants (heparin, warfarin) · Piperacillin may rarely affect platelets; increased monitoring of coagulation parameters is suggested.
Methotrexate · Piperacillin may increase methotrexate serum levels.
Probenecid · Reduces renal tubular secretion of piperacillin, maintaining higher systemic levels for longer periods.
Vecuronium · Piperacillin may prolong neuromuscular blockade.

모니터링

Clinical efficacy (resolution of clinical signs, fever)
White blood cell count (WBC)
Renal function (if prolonged use or pre-existing impairment)
Coagulation parameters (if on concurrent anticoagulants or high doses)

과용량

Single overdoses are unlikely to pose much risk. * **Massive Overdoses**: May cause vomiting, diarrhea, or neurotoxicity (seizures). * **Chronic High Doses**: Dogs receiving up to 800 mg/kg/day of piperacillin/tazobactam for 6 months demonstrated no serious toxic effects. Doses ≥400 mg/kg/day caused transient liver effects (glycogen granules in cytoplasm, increased smooth endoplasmic reticulum) that mostly reversed after one month. * **Treatment**: Supportive care. Monitor renal and neurological status.

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