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Pivmecillinam

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

  • See Also
  1. Extended Spectrum Penicillin
  • 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
  • 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
  • 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
  • Medications
  1. Pivmecillinam Tablet 185 mg
  • 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
  • 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%)
  • 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
  • Drug Interactions
  1. Methotrexate
    1. Pivmecillinam reduces clearance of Methotrexate (raising drug levels)
  • Resources
  1. Pivmecillinam (FDA Drug Monograph)
    1. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/216483s000lbl.pdf
  • References
  1. LoVecchio (2024) Crit Dec Emerg Med 38(8): 38
  2. Diletti-Swenson (2026) Am Fam Physician 113(55): 504-5 [PubMed]