Preliminary report comparing piperacillin and carbenicillin for complicated urinary tract infections

Physicochemical Characteristics of Antimicrobials and Practical Recommendations for Intravenous Administration: A Systematic Review

Most antimicrobial drugs need an intravenous (IV) administration to achieve maximum efficacy against target pathogens. IV administration is related to complications, such as tissue infiltration and thrombo-phlebitis. This systematic review aims to provide practical recommendations about diluent, pH, osmolarity, dosage, infusion rate, vesicant properties, and phlebitis rate of the most commonly used antimicrobial drugs evaluated in randomized controlled studies (RCT) till 31 March 2023. The authors searched for available IV antimicrobial drugs in RCT in PUBMED EMBASE®, EBSCO® CINAHL®, and the Cochrane Controlled Clinical trials. Drugs' chemical features were searched online, in drug data sheets, and in scientific papers, establishing that the drugs with a pH of <5 or >9, osmolarity >600 mOsm/L, high incidence of phlebitis reported in the literature, and vesicant drugs need the adoption of utmost caution during administration. We evaluated 931 papers; 232 studies were included. A total of 82 antimicrobials were identified. Regarding antibiotics, 37 reach the "caution" criterion, as well as seven antivirals, 10 antifungals, and three antiprotozoals. In this subgroup of antimicrobials, the correct vascular access device (VAD) selection is essential to avoid complications due to the administration through a peripheral vein. Knowing the physicochemical characteristics of antimicrobials is crucial to improve the patient's safety significantly, thus avoiding administration errors and local side effects.

Clinical comparison of piperacillin and cefamandole in treatment of complicated urinary tract infections

The efficacy and safety of piperacillin were compared with those of cefamandole in 72 patients (mean age: 63 years) with complicated urinary tract infections. Efficacy was evaluable in 25/34 piperacillin-treated patients (12 Gm/day) and in 23/38 cefamandole-treated patients (6 Gm/day). Clinical cure or improvement was noted in all patients who were given piperacillin and in 96 per cent (22/23) of those who received cefamandole. Seventy-one per cent (41/58) of the organisms cultured pretherapy were gram-negative aerobic bacteria. Escherichia coli was the most frequently isolated organism (15/58, or 26%), followed by Pseudomonas species (8/58, or 14%), and Proteus species (8/58, or 14%). Adverse clinical experiences were few, and none was directly attributed to therapy with either antibiotic. The changes noted in the results of laboratory tests were considered to be unrelated to the antibiotics administered. Thus, both piperacillin and cefamandole were safe and effective in the treatment of patients with complicated urinary tract infections.