amdinocillin pivoxil


Summary: Pivaloyloxymethyl ester of amdinocillin that is well absorbed orally, but broken down to amdinocillin in the intestinal mucosa. It is active against gram-negative organisms and used as for amdinocillin.

Top Publications

  1. Alam A, Islam M, Hossain M, Mahalanabis D, Hye H. Comparison of pivmecillinam and nalidixic acid in the treatment of acute shigellosis in children. Scand J Gastroenterol. 1994;29:313-7 pubmed
    ..The results suggest that pivmecillinam given orally was, in fact, more effective than nalidixic acid in the treatment of acute shigellosis in children, particularly when the resistant strains are taken into account. ..
  2. Prado D, Liu H, Velasquez T, Cleary T. Comparative efficacy of pivmecillinam and cotrimoxazole in acute shigellosis in children. Scand J Infect Dis. 1993;25:713-9 pubmed
    ..No major drug-related side effects were observed in either group. We concluded that pivmecillinam is equivalent to cotrimoxazole in the treatment of shigellosis in children. ..
  3. Salam M, Dhar U, Khan W, Bennish M. Randomised comparison of ciprofloxacin suspension and pivmecillinam for childhood shigellosis. Lancet. 1998;352:522-7 pubmed
    ..Ciprofloxacin had greater bacteriological efficacy and was not associated with the development of arthropathy. We conclude that ciprofloxacin is an effective and safe drug for use in multiply resistant childhood shigellosis. ..
  4. Abrahamsson K, Eriksson B, Holme E, Jodal U, Lindstedt S, Nordin I. Impaired ketogenesis in carnitine depletion caused by short-term administration of pivalic acid prodrug. Biochem Med Metab Biol. 1994;52:18-21 pubmed
    ..We conclude that there is a substantial risk to develop carnitine deficiency and impaired fatty acid oxidation in the liver during short-term treatment with drugs conjugated with pivalic acid. ..
  5. Khan W, Begum M, Salam M, Bardhan P, Islam M, Mahalanabis D. Comparative trial of five antimicrobial compounds in the treatment of cholera in adults. Trans R Soc Trop Med Hyg. 1995;89:103-6 pubmed
    ..3% (P < 0.001 for both comparisons) in the erythromycin and tetracycline groups. Ciprofloxacin in conjunction with appropriate fluid therapy was the most effective treatment for cholera in adults; erythromycin was the next best. ..
  6. Auer S, Wojna A, Hell M. Oral treatment options for ambulatory patients with urinary tract infections caused by extended-spectrum-beta-lactamase-producing Escherichia coli. Antimicrob Agents Chemother. 2010;54:4006-8 pubmed publisher
    ..Susceptibility rates indicate that fosfomycin (97%), nitrofurantoin (94%), and pivmecillinam (85%) could be considered important oral treatment options. ..
  7. Høiby N, Tvede M, Johansen H. [Is new prescription of antibiotics after treatment with sulfonamide or pivmecillinam a validated method for assessment of treatment failure?]. Ugeskr Laeger. 2002;164:920-1 pubmed
  8. Segura Porta F, Moreno A, Serrate G, Claramonte X, Martos Rodríguez A, Mensa J, et al. [Antibiotic treatment of acute gastroenteritis]. Rev Clin Esp. 1997;197:241-4 pubmed ciprofloxacin and mecillinam was 100% and 90%, respectively. Therapy with ciprofloxacin or pivmecillinam showed a similar efficiency. Fecal excretion lasted no longer than five weeks and no chronic carriers were observed. ..
  9. Traa B, Walker C, Munos M, Black R. Antibiotics for the treatment of dysentery in children. Int J Epidemiol. 2010;39 Suppl 1:i70-4 pubmed publisher

More Information


  1. Ljung R, Reimers A, Ericsson O, Burstrom B. Inequality in quality? Regional and educational differences in treatment with fluoroquinolone in urinary tract infection of 236,376 Swedish patients. BMJ Qual Saf. 2011;20:9-14 pubmed publisher
  2. Ejrnæs K, Stegger M, Reisner A, Ferry S, Monsen T, Holm S, et al. Characteristics of Escherichia coli causing persistence or relapse of urinary tract infections: phylogenetic groups, virulence factors and biofilm formation. Virulence. 2011;2:528-37 pubmed publisher
    ..In conclusion, our results show potential targets for prevention and treatment of persistence/relapse of UTI and potential markers for selecting treatment lengths and warrant studies of these and new VFGs...
  3. Bjerrum L, Dessau R, Hallas J. Treatment failures after antibiotic therapy of uncomplicated urinary tract infections. A prescription database study. Scand J Prim Health Care. 2002;20:97-101 pubmed
    ..42, CI 1.14-1.77) than sulfamethizole. This study does not support a change in current Danish practice of sulfamethizole being first-line treatment for uncomplicated UVI. ..
  4. Salam M, Seas C, Khan W, Bennish M. Treatment of shigellosis: IV. Cefixime is ineffective in shigellosis in adults. Ann Intern Med. 1995;123:505-8 pubmed
    ..009). Cefixime is ineffective in treating shigellosis in adults when used in the standard recommended dosage. ..
  5. Titelman E, Iversen A, Kalin M, Giske C. Efficacy of pivmecillinam for treatment of lower urinary tract infection caused by extended-spectrum ?-lactamase-producing Escherichia coli and Klebsiella pneumoniae. Microb Drug Resist. 2012;18:189-92 pubmed publisher
    ..The persistent bacteriuria appears to be of little clinical importance, but larger clinical studies are needed to determine the usefulness of pivmecillinam in infections caused by ESBL-producing bacteria. ..
  6. Nørgaard M, Skriver M, Sørensen H, Schønheyder H, Pedersen L. Risk of miscarriage for pregnant users of pivmecillinam: a population-based case-control study. APMIS. 2008;116:278-83 pubmed publisher
    ..We concluded that use of pivmecillinam was associated with an increased risk of miscarriage, but the risk was not significantly (p=0.64) different from the risk associated with use of sulfamethizole. ..
  7. Sevillano D, Aguilar L, Alou L, Gimenez M, Torrico M, González N, et al. Urine bactericidal activity against Escherichia coli isolates exhibiting different resistance phenotypes/genotypes in an in vitro pharmacodynamic model simulating urine concentrations obtained after oral administration of a 400-milligram single dose . Antimicrob Agents Chemother. 2008;52:1184-6 pubmed
    ..Extension of bactericidal activity depended on the resistance genotype/phenotype tested. ..
  8. Sakata H. [Clinical efficacy of tebipenem pivoxil treatment in children with pneumonia, who had no relief despite having administered oral beta-lactam antibiotics]. Jpn J Antibiot. 2011;64:171-7 pubmed
    ..Thus, TBPM-PI was determined to be effective. Diarrhea or loose stool was observed as an adverse reaction in 4 children (13.3%). ..
  9. Andrews J, Kendall M, Mitchard M. Factors influencing the absorption and disposition of mecillinam and pivmecillinam in man. Br J Clin Pharmacol. 1976;3:627-32 pubmed
  10. Neuzillet Y, Naber K, Schito G, Gualco L, Botto H. French results of the ARESC study: clinical aspects and epidemiology of antimicrobial resistance in female patients with cystitis. Implications for empiric therapy. Med Mal Infect. 2012;42:66-75 pubmed publisher
    ..Uncomplicated cystitis is one of the most frequent community infections. We report the French results of the international ARESC study on the clinical aspects, epidemiology, and antimicrobial susceptibility of uropathogens...
  11. Bornemann L, Castellano S, Lin A, Enthoven D, Patel I. Influence of food on bioavailability of amdinocillin pivoxil. Antimicrob Agents Chemother. 1988;32:592-4 pubmed
    The bioavailability of amdinocillin was not altered when amdinocillin pivoxil was ingested 1 h before a standard breakfast, and it increased by 20% when amdinocillin pivoxil was ingested with or 1 h after a standard breakfast...
  12. Kabir I, Rahman M, Haider R, Mazumder R, Khaled M, Mahalanabis D. Increased height gain of children fed a high-protein diet during convalescence from shigellosis: a six-month follow-Up study. J Nutr. 1998;128:1688-91 pubmed
    ..9 vs. 2.3, P = 0.41). These results demonstrate that feeding an HP diet to the malnourished children during recovery from shigellosis enhanced linear growth with a modest reduction in diarrheal morbidity during the 6-mo follow-up period...
  13. Abrahamsson K, Holme E, Jodal U, Lindstedt S, Nordin I. Effect of short-term treatment with pivalic acid containing antibiotics on serum carnitine concentration--a risk irrespective of age. Biochem Mol Med. 1995;55:77-9 pubmed
    ..Therefore, there is reason for cautious use of this type of drug irrespective of the age of the patients. ..
  14. Holme E, Greter J, Jacobson C, Lindstedt S, Nordin I, Kristiansson B, et al. Carnitine deficiency induced by pivampicillin and pivmecillinam therapy. Lancet. 1989;2:469-73 pubmed
    ..The risk of adverse effects from prodrugs that give rise to pivalic acid should be seriously considered, particularly in patients under metabolic stress. ..
  15. Arakawa S, Tanaka K, Miura T, Shigemura K, Takenaka A, Matsui T, et al. Usefulness and problems of the urinary tract infection criteria for evaluating drug efficacy for complicated urinary tract infections. J Infect Chemother. 2007;13:279-84 pubmed
  16. Bjerrum L, Gahrn Hansen B, Grinsted P. Pivmecillinam versus sulfamethizole for short-term treatment of uncomplicated acute cystitis in general practice: a randomized controlled trial. Scand J Prim Health Care. 2009;27:6-11 pubmed publisher
    ..Five days after initiation of treatment there was no significant difference in clinical and bacteriological cure between the two antibiotic regimes. ..
  17. Pruvost O, Roumagnac P, Gaube C, Chiroleu F, Gagnevin L. New media for the semiselective isolation and enumeration of Xanthomonas campestris pv. mangiferaeindicae, the causal agent of mango bacterial black spot. J Appl Microbiol. 2005;99:803-15 pubmed
    ..This work provides a description of new semiselective media, which should be valuable tools to study the ecology and epidemiology of X. campestris pv. mangiferaeindicae. ..
  18. Sullivan A, Fianu Jonasson A, Landgren B, Nord C. Ecological effects of perorally administered pivmecillinam on the normal vaginal microflora. Antimicrob Agents Chemother. 2005;49:170-5 pubmed
    ..No other major changes in the normal microflora occurred during the study. Administration of pivmecillinam had a minor ecological impact on the normal vaginal microflora. ..
  19. Holme E, Jodal U, Linstedt S, Nordin I. Effects of pivalic acid-containing prodrugs on carnitine homeostasis and on response to fasting in children. Scand J Clin Lab Invest. 1992;52:361-72 pubmed
    ..We believe that prodrugs which contain pivalic acid should be avoided if acceptable alternatives exist. If used, supplementation with at least four-fold molar excess of carnitine is advisable. ..
  20. Sullivan A, Edlund C, Svenungsson B, Emtestam L, Nord C. Effect of perorally administered pivmecillinam on the normal oropharyngeal, intestinal and skin microflora. J Chemother. 2001;13:299-308 pubmed
    ..underneath the wing of the nose. The major effect of pivmecillinam was seen on E. coli and to some extent on Propionibacterium spp. No further ecological disturbances were noticed in the oropharyngeal, intestinal or skin microflora. ..
  21. Lindbäck H, Lindback J, Melhus A. Inadequate adherence to Swedish guidelines for uncomplicated lower urinary tract infections among adults in general practice. APMIS. 2017;125:816-821 pubmed publisher
    ..To reduce the selection of multiresistant bacteria, an improvement of the use of diagnostic criteria/tools and antibiotic drugs in primary care is necessary. ..
  22. Nicolle L. Pivmecillinam in the treatment of urinary tract infections. J Antimicrob Chemother. 2000;46 Suppl 1:35-9; discussion 63-5 pubmed
    ..These recent studies confirm earlier reports and clinical experience that pivmecillinam is effective and well tolerated for the treatment of acute cystitis in women. ..
  23. Menday A. Comparison of pivmecillinam and cephalexin in acute uncomplicated urinary tract infection. Int J Antimicrob Agents. 2000;13:183-7 pubmed
    ..1% for pivmecillinam and 80.6% for cephalexin. Both treatments were well tolerated. This study has confirmed that a 3-day course of pivmecillinam is effective and well tolerated in uncomplicated cystitis. ..
  24. Nicolle L, Madsen K, Debeeck G, Blochlinger E, Borrild N, Bru J, et al. Three days of pivmecillinam or norfloxacin for treatment of acute uncomplicated urinary infection in women. Scand J Infect Dis. 2002;34:487-92 pubmed
    ..In conclusion, short-course therapy with pivmecillinam is an effective empirical treatment for pre-menopausal women. ..
  25. Diep Q, Bøhmer T, Holme J, Torvik A, Storrøsten O, Loennecken C, et al. Slow replenishment of carnitine deficiency after cessation of long-term treatment with pivaloyl-containing antibiotics. Pharm World Sci. 1993;15:225-9 pubmed
    ..All symptoms caused by carnitine depletion disappeared. This was achieved on a normal diet without carnitine supplementation. ..
  26. Ferry S, Holm S, Stenlund H, Lundholm R, Monsen T. Clinical and bacteriological outcome of different doses and duration of pivmecillinam compared with placebo therapy of uncomplicated lower urinary tract infection in women: the LUTIW project. Scand J Prim Health Care. 2007;25:49-57 pubmed
    ..Pivmecillinam therapies are superior to placebo and seven days regimens are more efficient than three days. Pivmecillinam 200 mg x 2 x 7 days is recommended as a first-line therapy for LUTIW. ..
  27. Vinther Skriver M, Nørgaard M, Pedersen L, Carl Schønheyder H, Sørensen H. Pivmecillinam and adverse birth and neonatal outcomes: a population-based cohort study. Scand J Infect Dis. 2004;36:733-7 pubmed
    ..79 (95% CI 0.38-1.68) for exposure within 28 d before delivery. Use of pivmecillinam during pregnancy did not appear to increase the risk of adverse birth and neonatal outcomes; however, statistical precision is still low. ..
  28. Heikkilä A, Pyykkö K, Erkkola R, Iisalo E. The pharmacokinetics of mecillinam and pivmecillinam in pregnant and non-pregnant women. Br J Clin Pharmacol. 1992;33:629-33 pubmed
    ..05) and late pregnancy (t1/2,Z = 107 +/- 41 min, P less than 0.05) as compared with the non-pregnant state (t1/2,Z = 75 +/- 21 min).(ABSTRACT TRUNCATED AT 250 WORDS) ..
  29. Egede F, Kristensen I. A comparative study of ofloxacin and pivmecillinam in acute exacerbations of chronic bronchitis. Scand J Infect Dis Suppl. 1990;68:46-9 pubmed
    ..1% to 97.2%) and clinical cure rate (97.4% to 97.6%). There were, however, signs of fewer adverse reactions and a better patient acceptance in the ofloxacin group. ..
  30. Pitkäjärvi T, Pyykönen M, Kannisto K, Piippo T, Viita P. Pivmecillinam treatment in acute cystitis. Three versus seven days study. Arzneimittelforschung. 1990;40:1156-8 pubmed
    ..S.). Pivmecillinam treatment in acute cystitis in women was equally effective whether given for three or seven days, with the same total frequency of adverse reactions for the two regimens. ..
  31. Schønheyder H, Thrane N, Sørensen H. [Repeat antibiotic prescriptions following treatment with sulfonamide or pivmecillinam. A survey of prescriptions among women aged 15-50 years in the county of Nordjylland]. Ugeskr Laeger. 2001;164:43-6 pubmed
    ..Controlled clinical trials should be performed before revision of current Danish recommendations are considered. ..
  32. Ekwall E, Svenungsson B. Pivampicillin/pivmecillinam in the treatment of shigella carriers. Scand J Infect Dis. 1990;22:623-4 pubmed
    ..It is concluded that pivampicillin/pivmecillinam is effective for patients excreting shigella bacteria. ..
  33. Johansen H, Børch K, Espersen F, Koch C, Høiby N. Randomised trial of pivampicillin plus pivmecillinam vs. pivampicillin in children and young adults with chronic obstructive pulmonary disease and infection with Haemophilus influenzae. Curr Med Res Opin. 1999;15:300-9 pubmed
    ..The efficacy of double beta lactam treatment in lung infections with H. influenzae appears to be equivalent to that of ampicillin on clinical lung symptoms, lung function tests, adverse effects and bacteriology. ..
  34. Høiby N. [Is repeat antibiotic prescription following treatment with sulfonamide or pivmecillinam a valid method for assessment of therapeutic failure in urinary infection?]. Ugeskr Laeger. 2003;165:4316-7 pubmed
  35. Ferry S, Holm S, Stenlund H, Lundholm R, Monsen T. The natural course of uncomplicated lower urinary tract infection in women illustrated by a randomized placebo controlled study. Scand J Infect Dis. 2004;36:296-301 pubmed
    ..We conclude that patient near-laboratory tests are required to establish the diagnosis of lower UTI, and the guidelines for diagnosis of UTI need to be revised. ..
  36. Larsen H, Nielsen G, Møller M, Ebbesen F, Schønheyder H, Sørensen H. Birth outcome and risk of neonatal hypoglycaemia following in utero exposure to pivmecillinam: a population-based cohort study with 414 exposed pregnancies. Scand J Infect Dis. 2001;33:439-44 pubmed
    ..32, 95% CI 0.30-18.16) or hypoglycaemia (OR 0.73, 95% CI 0.18-3.00) that were induced by carnitine depletion. No significantly increased risk in adverse birth outcome was therefore found in women treated with pivmecillinam. ..
  37. Frimodt Møller N. [Sulfamethizole versus pivmecillinam in urinary tract infections]. Ugeskr Laeger. 2003;165:4317; author reply 4317-8 pubmed
  38. Menday A. Symptomatic vaginal candidiasis after pivmecillinam and norfloxacin treatment of acute uncomplicated lower urinary tract infection. Int J Antimicrob Agents. 2002;20:297-300 pubmed
  39. Jernelius H, Zbornik J, Bauer C. One or three weeks' treatment of acute pyelonephritis? A double-blind comparison, using a fixed combination of pivampicillin plus pivmecillinam. Acta Med Scand. 1988;223:469-77 pubmed
    ..Three weeks' treatment is effective in uncomplicated cases, but even longer treatment or low-dose prophylaxis is indicated in certain patients with predisposing factors. ..
  40. Bergman M, Nyberg S, Huovinen P, Paakkari P, Hakanen A. Association between antimicrobial consumption and resistance in Escherichia coli. Antimicrob Agents Chemother. 2009;53:912-7 pubmed publisher
    ..The majority of the associations studied were not significant, including the association between fluoroquinolone use and fluoroquinolone resistance. ..
  41. Jonsson M, Englund G, Norgard K. Norfloxacin vs. pivmecillinam in the treatment of uncomplicated lower urinary tract infections in hospitalized elderly patients. Scand J Infect Dis. 1990;22:339-44 pubmed
    ..5% of the 96 patients in the pivmecillinam group (p less than 0.001). Adverse drug reactions, mostly gastrointestinal disturbances, were noticed in single cases. ..
  42. Ashraf H, Mahalanabis D, Mitra A, Tzipori S, Fuchs G. Hyperimmune bovine colostrum in the treatment of shigellosis in children: a double-blind, randomized, controlled trial. Acta Paediatr. 2001;90:1373-8 pubmed
    ..The results indicate that HBC as an adjuvant is unable to show any beneficial effect in reducing the stool frequency, duration or severity of childhood shigellosis due to S. dysenteriae type I infection. ..
  43. Mortimer O, Wiholm B. Oesophageal injury associated with pivmecillinam tablets. Eur J Clin Pharmacol. 1989;37:605-7 pubmed
    ..Further galenical development of the tablets and better patient information should reduce the number of patients injured. ..
  44. Paerregaard A, Gutschik E. Capnocytophaga bacteremia complicating premature delivery by cesarean section. Eur J Clin Microbiol. 1987;6:580-1 pubmed
    ..The patient, a 30 year old woman without immunological incompetence or other predisposing disease, responded to peroral pivmecillinam. Capnocytophaga spp. should be considered a possible cause of post-partum endometritis...
  45. Abrahamsson K, Eriksson B, Holme E, Jodal U, Jonsson A, Lindstedt S. Pivalic acid-induced carnitine deficiency and physical exercise in humans. Metabolism. 1996;45:1501-7 pubmed
    ..The work at maximal oxygen uptake (VO2max) and the maximal heart rate were reduced. Since VO2max is considered dependent on heart function, carnitine depletion seemed to affect cardiac function. ..
  46. Ejrnaes K, Sandvang D, Lundgren B, Ferry S, Holm S, Monsen T, et al. Pulsed-field gel electrophoresis typing of Escherichia coli strains from samples collected before and after pivmecillinam or placebo treatment of uncomplicated community-acquired urinary tract infection in women. J Clin Microbiol. 2006;44:1776-81 pubmed
    ..coli strains are able to persist in the bladder epithelium despite appropriate antibiotic treatment, constituting a reservoir for recurrent UTI. ..
  47. Bjerrum L, Dessau R, Hallas J. [Prescriptions of a new antibiotic following treatment with sulfamethizole or pivmecillinam]. Ugeskr Laeger. 2003;165:3732-5 pubmed
  48. Graninger W. Pivmecillinam--therapy of choice for lower urinary tract infection. Int J Antimicrob Agents. 2003;22 Suppl 2:73-8 pubmed
    ..With the low resistance, its proven efficacy and favourable safety profile, pivmecillinam is a suitable first-line agent for empirical treatment of acute cystitis. ..
  49. Lokrantz C, Eriksson B, Rosen I, Asztely F. Hyperammonemic encephalopathy induced by a combination of valproate and pivmecillinam. Acta Neurol Scand. 2004;109:297-301 pubmed
    ..Our case shows that caution is required when treatment with VPA is combined with pivmecillinam due to the risk of developing hyperammonemic encephalopathy. ..
  50. Diep Q, Bøhmer T, Storrøsten O, Holme J, Torvik A, Loennecken C, et al. [Slow replenishment of carnitine level after long-term treatment with pivampicillin/pivmecillinam]. Tidsskr Nor Laegeforen. 1994;114:1614-6 pubmed
    ..All symptoms caused by carnitine depletion disappeared after the serum carnitine reached 20 mumol/l. This was achieved on a normal diet without carnitine supplement. ..
  51. Abrahamsson K, Mellander M, Eriksson B, Holme E, Jodal U, Jonsson A, et al. Transient reduction of human left ventricular mass in carnitine depletion induced by antibiotics containing pivalic acid. Br Heart J. 1995;74:656-9 pubmed
    ..Extended treatment with pivalic acid containing antibiotics causes carnitine depletion which may lead to changes in cardiac structure. ..
  52. Nicolle L. Pivmecillinam for the treatment of acute uncomplicated urinary infection. Int J Clin Pract. 1999;53:612-7 pubmed
    ..Further trials to define the comparative efficacy of pivmecillinam with other antimicrobials, and further studies of community resistance in E. coli isolates to this agent are needed. ..
  53. Svenungsson B, Ekwall E, Hansson H. Efficacy of the combination pivampicillin/pivmecillinam compared to placebo in the treatment of convalescent carriers of nontyphi Salmonella. Infection. 1990;18:163-5 pubmed
    ..No abnormalities could be found in those patients who did not respond to therapy except for earlier cholecystectomy in two patients, both in the pivampicillin/pivmecillinam group. ..