Amdinocillin pivoxil

Amdinocillin Pivoxil, also known as Pivmecillinam, is an orally administered prodrug of mecillinam, a beta-lactam antibiotic belonging to the penicillin class. It is primarily used in the treatment of urinary tract infections (UTIs) caused by susceptible strains of bacteria.

Pharmacology

Mechanism of Action

Amdinocillin Pivoxil is a prodrug that is converted in the body to its active form, mecillinam. Mecillinam exerts its antibacterial effects by inhibiting bacterial cell wall synthesis. It specifically targets penicillin-binding protein 2 (PBP2), which is essential for the synthesis of peptidoglycan, a critical component of the bacterial cell wall. This inhibition leads to cell lysis and death in susceptible bacteria.

Spectrum of Activity

Amdinocillin Pivoxil is effective against a range of Gram-negative bacteria, particularly those causing urinary tract infections. It is notably active against Escherichia coli, Klebsiella species, and Proteus mirabilis. However, it has limited activity against Gram-positive bacteria and is not effective against Pseudomonas aeruginosa.

Pharmacokinetics

After oral administration, Amdinocillin Pivoxil is absorbed from the gastrointestinal tract and rapidly hydrolyzed to mecillinam. The bioavailability of mecillinam from Amdinocillin Pivoxil is approximately 60-70%. The drug is widely distributed in body tissues and fluids, with a particular affinity for the urinary tract. Mecillinam is primarily excreted in the urine, with a half-life of approximately 1-2 hours.

Clinical Use

Indications

Amdinocillin Pivoxil is indicated for the treatment of uncomplicated urinary tract infections caused by susceptible strains of bacteria. It is often used as a first-line treatment in regions where resistance to other antibiotics is prevalent.

Dosage and Administration

The typical dosage of Amdinocillin Pivoxil for adults is 200 mg to 400 mg taken orally, two to three times daily. The duration of treatment usually ranges from 3 to 7 days, depending on the severity of the infection and the patient's response to therapy.

Adverse Effects

Common adverse effects of Amdinocillin Pivoxil include gastrointestinal disturbances such as nausea, vomiting, and diarrhea. Allergic reactions, although rare, can occur and may manifest as skin rashes or, in severe cases, anaphylaxis.

Resistance

Resistance to mecillinam can occur through various mechanisms, including the production of beta-lactamases that hydrolyze the antibiotic, alterations in penicillin-binding proteins, and changes in bacterial permeability. However, mecillinam remains effective against many strains of Escherichia coli that are resistant to other beta-lactams.

Conclusion

Amdinocillin Pivoxil is a valuable antibiotic for the treatment of urinary tract infections, particularly in areas with high rates of resistance to other antibiotics. Its unique mechanism of action and favorable safety profile make it an important option in the antimicrobial arsenal.

See Also

• Beta-lactam antibiotic
• Urinary tract infection
• Antibiotic resistance

External Links

• [DrugBank: Amdinocillin Pivoxil](https://www.drugbank.ca/drugs/DB01603)
• [PubChem: Amdinocillin Pivoxil](https://pubchem.ncbi.nlm.nih.gov/compound/5282180)