Pivmecillinam
Pivmecillinam (INN) or amdinocillin pivoxil (USAN), traded under the names Selexid, Penomax, and Coactabs, is an orally administrable prodrug of mecillinam, an extended-spectrum penicillin antibiotic. Pivmecillinam is classified as the pivaloyloxymethyl ester of mecillinam. Notably, neither of these drugs has approval for use within the United States.
The therapeutic applications of Pivmecillinam are restricted mainly to combat Gram-negative bacteria. Its primary indication is in treating lower urinary tract infections. Since the 1970s, it has been a widely recognized treatment in the Nordic countries. Due to its effectiveness, it has been recommended as the first-line drug in the empirical management of acute cystitis.
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Like its penicillin counterparts, pivmecillinam has a similar adverse effect profile. Common side effects associated with its use include rash and gastrointestinal disturbances, with symptoms such as nausea and vomiting being prevalent.
It's imperative to note that prodrugs yielding pivalic acid upon metabolism in the body, like pivmecillinam, pivampicillin, and cefditoren pivoxil, are known to cause a decrease in the body's carnitine levels.
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