Usage
Cefpirome + Sulbactam is prescribed for the treatment of various bacterial infections, including lower respiratory tract infections (e.g., pneumonia, bronchitis), complicated upper and lower urinary tract infections, skin and soft tissue infections, intra-abdominal infections, bacteremia/septicemia, and infections in neutropenic and immunocompromised patients. It is also used prophylactically to prevent infections during surgical procedures.
Pharmacological Classification: Antibiotic combination (Cephalosporin + Beta-lactamase inhibitor)
Mechanism of Action: Cefpirome, a fourth-generation cephalosporin, inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs). Sulbactam, a beta-lactamase inhibitor, protects cefpirome from degradation by bacterial beta-lactamases, extending its spectrum of activity.
Alternate Names
Cefpirome/Sulbactam, Sulbactam/Cefpirome. Brand names include Cefitryp S and Piromet-S.
How It Works
Pharmacodynamics: Cefpirome exerts its bactericidal effect by disrupting the synthesis of the bacterial cell wall, ultimately leading to cell death. Sulbactam enhances cefpirome’s activity by inhibiting beta-lactamase, an enzyme produced by some bacteria that can break down certain antibiotics.
Pharmacokinetics: Cefpirome is well-absorbed after intramuscular administration, reaching peak serum concentrations within 1-2 hours. It is widely distributed in body fluids and tissues. Cefpirome is primarily eliminated by the kidneys, with approximately 80-90% of the administered dose excreted unchanged in the urine. Sulbactam is also primarily eliminated via renal excretion.
Mode of Action: Cefpirome binds to PBPs, which are enzymes involved in the final transpeptidation step of peptidoglycan synthesis in the bacterial cell wall. This binding inhibits cell wall biosynthesis, leading to bacterial cell death. Sulbactam inhibits beta-lactamases, thus preventing cefpirome degradation.
Elimination Pathways: Renal excretion is the main pathway for both cefpirome and sulbactam.
Dosage
Standard Dosage
Adults:
1.5 g to 3 g IV every 12 hours. Administer via IV injection over 3-5 minutes or IV infusion over 20-30 minutes. The sulbactam component should not exceed 4 g daily.
Children:
Consult a doctor. Limited data is available for pediatric use; careful consideration of risks and benefits is required. Dosages may be extrapolated from adult data based on body weight, but expert guidance is recommended. One source suggests 50mg/kg body weight every 8-12 hours.
Special Cases:
- Elderly Patients: No specific dose adjustment is required unless renal function is impaired.
- Patients with Renal Impairment: Cefpirome dosage needs to be adjusted based on creatinine clearance (CrCl). Sulbactam dosage also requires adjustment. Consult specific dosing guidelines for these cases.
- Patients with Hepatic Dysfunction: Dose adjustment may be needed, particularly for sulbactam.
- Patients with Comorbid Conditions: Careful consideration is needed for patients with conditions like diabetes or cardiovascular disease.
Clinical Use Cases
Dosage for specific clinical use cases such as Intubation, Surgical Procedures, Mechanical Ventilation, ICU Use, and Emergency Situations should be guided by clinical guidelines and the specific patient context, considering infection severity and patient factors.
Dosage Adjustments
Dose modifications are necessary based on patient-specific factors like renal/hepatic dysfunction, metabolic disorders, or genetic polymorphisms affecting drug metabolism. Consult specific dosing guidelines for these situations.
Side Effects
Common Side Effects:
Nausea, diarrhea, stomach upset, indigestion, headache, pain at the injection site, rash.
Rare but Serious Side Effects:
Allergic reactions (e.g., hives, difficulty breathing, swelling), blood disorders (e.g., leukopenia, thrombocytopenia), pseudomembranous colitis, anaphylaxis, neurotoxicity (including seizures).
Long-Term Effects:
Potential long-term effects of prolonged use include renal and hepatic dysfunction and superinfections (e.g., fungal infections).
Adverse Drug Reactions (ADR):
Clinically significant ADRs include severe allergic reactions (anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis, and Clostridium difficile-associated diarrhea.
Contraindications
Hypersensitivity to cefpirome, sulbactam, or other cephalosporins or beta-lactam antibiotics. Pregnancy and lactation are generally contraindicated, although the drug may be used if benefits outweigh risks.
Drug Interactions
Cefpirome + Sulbactam may interact with typhoid and cholera vaccines, aminoglycosides (e.g., gentamicin, amikacin), diuretics (e.g., furosemide), gout medicine (probenecid), and anticoagulants (e.g., warfarin). Consult a comprehensive drug interaction database for detailed information. Avoid alcohol during treatment.
Pregnancy and Breastfeeding
Consult a doctor. Limited data is available on the effect of Cefpirome + Sulbactam during pregnancy and breastfeeding. Use only if the benefits clearly outweigh the risks.
Drug Profile Summary
- Mechanism of Action: Cefpirome inhibits bacterial cell wall synthesis; sulbactam inhibits beta-lactamase.
- Side Effects: Nausea, diarrhea, rash, allergic reactions, blood disorders, pseudomembranous colitis, anaphylaxis.
- Contraindications: Hypersensitivity to cefpirome, sulbactam, or other cephalosporins/beta-lactams.
- Drug Interactions: Aminoglycosides, diuretics, probenecid, anticoagulants.
- Pregnancy & Breastfeeding: Consult a doctor; use with caution.
- Dosage: Adults: 1.5-3g IV q12h; Children: consult a doctor; adjustments needed for renal/hepatic impairment.
- Monitoring Parameters: Renal function, liver function, complete blood count, coagulation parameters (if applicable).
Popular Combinations
Information on popular combinations was not found in the provided source but may be available elsewhere.
Precautions
- Pre-screening for allergies and organ dysfunction is crucial.
- Monitor renal and hepatic function, especially during long-term therapy.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cefpirome + Sulbactam?
A: Adults: 1.5-3 g IV every 12 hours. Pediatric and special population dosing should be determined in consultation with expert guidance.
Q2: What infections does Cefpirome + Sulbactam treat?
A: It treats a range of bacterial infections, including respiratory, urinary tract, skin and soft tissue, intra-abdominal, and bloodstream infections.
Q3: What is the role of sulbactam in this combination?
A: Sulbactam inhibits bacterial beta-lactamases, which helps prevent resistance to cefpirome.
Q4: Are there any serious side effects to watch out for?
A: Yes, serious side effects include severe allergic reactions (anaphylaxis), blood disorders, pseudomembranous colitis, and Clostridium difficile infection.
Q5: Can Cefpirome + Sulbactam be used during pregnancy?
A: Limited data is available; consult a doctor. Use only if the potential benefits outweigh the risks.
Q6: How should I adjust the dose for patients with renal impairment?
A: Cefpirome and sulbactam dosages need adjustments based on the degree of renal impairment (CrCl). Consult specific dosing guidelines for these cases.
Q7: What are the common drug interactions with Cefpirome + Sulbactam?
A: It can interact with aminoglycosides, probenecid, anticoagulants, and diuretics. Alcohol should be avoided during therapy.
Q8: What are the key monitoring parameters during treatment?
A: Monitor renal function, liver function, and complete blood count. Coagulation parameters may also need monitoring, if applicable.
Q9: What should I do in case of a suspected overdose?
A: Seek immediate medical attention. Supportive care and symptomatic treatment should be initiated.
Q10: Is Cefpirome + Sulbactam effective against all bacteria?
A: No, it is not effective against all bacteria. It has a broad spectrum of activity but is ineffective against some bacterial strains, particularly those not susceptible to cephalosporins. Culture and sensitivity testing are important to guide appropriate therapy.
