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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="All Drug Records" href="/books/n/livertox/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-livertox-lrg.png" alt="Cover of LiverTox" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK548463_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK548463_dtls__"><div>Bethesda (MD): <a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>; 2012-.</div></div><div class="half_rhythm"><ul class="inline_list"><li style="margin-right:1em"><a class="bk_cntns" href="/books/n/livertox/">Drug Records</a></li></ul></div><div class="bk_noprnt"><form method="get" action="/books/n/livertox/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div><div class="icnblk_cntnt two_col"><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/livertox/Pioglitazone/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/livertox/PiperacillinTazob/" title="Next page in this title">Next ></a></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK548463_"><span class="title" itemprop="name">Piperacillin</span></h1><p class="small">Last Update: <span itemprop="dateModified">October 20, 2020</span>.</p></div><div class="body-content whole_rhythm" itemprop="text"><div id="Piperacillin.OVERVIEW"><h2 id="_Piperacillin_OVERVIEW_">OVERVIEW</h2><div id="Piperacillin.Introduction"><h3>Introduction</h3><p>Piperacillin is an extended spectrum ureidopenicillin and is used to treat moderate-to-severe infections due to susceptible organisms. Piperacillin has been linked with idiosyncratic liver injury, but only rarely and in isolated case reports.</p></div><div id="Piperacillin.Background"><h3>Background</h3><p>Piperacillin (pi" per a sil' in) is a fourth generation, extended spectrum penicillin which is used for moderate-to-severe infections caused by susceptible agents, such as (but not limited to) Escherichia coli, Hemophilus influenzae, Listeria monocytogenesis, Neisseria gonorrhoeae, Proteus mirabilis, Salmonella, Shigella, Staphylococcus aureus (non-penicillinase producing), Staphylococcus epidermidis, and Streptococcus pneumoniae. Piperacillin was approved for use in the United States in 1981 and is generally reserved for severe infections requiring parenteral therapy. Piperacillin is available in parenteral form (intramuscular and intravenous) generically and under the trade name Pipracil. Piperacillin is often combined with a beta lactamase inhibitor (tazobactam) to prevent bacterial resistance. The recommended regimen is 2 to 4 grams daily in divided doses given every 4 to 6 hours usually for 5 to 7 days. Common side effects include headache, dizziness, nausea, diarrhea, constipation, skin rash and hypersensitivity reactions. Rare but potentially severe adverse events include anaphylactic and hypersensitivity reactions, Stevens Johnson syndrome and toxic epidermal necrolysis.</p></div><div id="Piperacillin.Hepatotoxicity"><h3>Hepatotoxicity</h3><p>Patients on intravenous piperacillin may have transient and mild-to-moderate serum aminotransferase elevations in up to 12% of patients, but these are of little clinical significance and not more common than with comparative parenteral antibiotics. Hepatic injury was more commonly reported with mezlocillin, a related extended spectrum ureidopenicillin which has been withdrawn from use. Rare instances of idiosyncratic liver injury have been reported in persons receiving piperacillin. The liver injury is typically cholestatic arising within 1 to 6 weeks of starting therapy. The injury can be severe, but is generally self-limited once piperacillin is stopped. The features of the hepatotoxicity resemble those of other penicillins. The cholestatic hepatitis caused by piperacillin and other penicillins can be prolonged and lead to persistent cholestasis (vanishing bile duct syndrome) or persistent elevations in serum alkaline phosphatase suggestive of partial bile duct loss. Most cases of liver injury related to piperacillin are linked to the combination of piperacillin with the beta-lactamase inhibitor tazobactam (Zosyn and generics), which is more commonly used than piperacillin alone.</p><p><a class="def" href="/books/n/livertox/glossary/def-item/glossary.likelihood-score/">Likelihood score</a>: B (known rare cause of clinically apparent liver injury).</p></div><div id="Piperacillin.Mechanism_of_Injury"><h3>Mechanism of Injury</h3><p>The cause of the liver injury associated with piperacillin use is probably hypersensitivity or allergy. Instances of cross reactivity with other penicillins and worsening of cholestasis with reintroduction of the agent have been reported.</p></div><div id="Piperacillin.Outcome_and_Management"><h3>Outcome and Management</h3><p>In the few cases that have been described, patients have recovered within 1 to 3 months once the drug is stopped. Patients with piperacillin induced hepatitis should avoid reexposure to other penicillins and should take cephalosporins with caution.</p><p>References to the safety and potential hepatotoxicity of piperacillin are provided in the drug record on Piperacillin-Tazobactam.</p><p>Drug Class: Antiinfective Agents, <a href="/books/n/livertox/PenicillinFourthGen/">Penicillins (Fourth Generation)</a></p><p>Other Drugs in the Class: <a href="/books/n/livertox/PiperacillinTazob/">Piperacillin-Tazobactam</a>, <a href="/books/n/livertox/Ticarcillin/">Ticarcillin</a>, <a href="/books/n/livertox/TicarcillinClavulana/">Ticarcillin-Clavulanate</a></p></div></div><div id="Piperacillin.CASE_REPORT"><h2 id="_Piperacillin_CASE_REPORT_">CASE REPORT</h2><div id="Piperacillin.Case_1_Cholangiopathy_with"><h3>Case 1. Cholangiopathy with possible causation by piperacillin.(<a class="bk_pop" href="#Piperacillin.REF.1">1</a>)</h3><p>A 20 year old man underwent surgery for abdominal trauma, receiving a single dose of piperacillin and 3 days of imipenem-cilastatin postoperatively and subsequently developed fever, fatigue, and pruritus starting 15 days after surgery. He had moderate elevations in serum aminotransferase and alkaline phosphatase levels and serum bilirubin subsequently rose and peaked at 4.8 mg/dL (Table). He had no history of liver disease or risk factors for viral hepatitis. He had not used alcohol and took no other medications after surgery. He was admitted for evaluation. Ultrasound and CT scan of the abdomen were negative. Tests for viral hepatitis and autoimmune liver disease were negative. A liver biopsy showed intrahepatic cholestasis with portal inflammation. <a class="def" href="/books/n/livertox/glossary/def-item/glossary.lymphocyte/">Lymphocyte</a> transformation tests were reported to be positive with both piperacillin and imipenem-cilastatin. He recovered rapidly and all tests had returned to normal when seen two months later.</p><div id="Piperacillin.Key_Points"><h4>Key Points</h4><div id="Piperacillin.Tc" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548463/table/Piperacillin.Tc/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Piperacillin.Tc_lrgtbl__"><table><tbody><tr><th id="hd_b_Piperacillin.Tc_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medication:</th><td headers="hd_b_Piperacillin.Tc_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Piperacillin, 1 gram IV bolus</td></tr><tr><th id="hd_b_Piperacillin.Tc_1_1_2_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pattern:</th><td headers="hd_b_Piperacillin.Tc_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mixed (R=4.9)</td></tr><tr><th id="hd_b_Piperacillin.Tc_1_1_3_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Severity:</th><td headers="hd_b_Piperacillin.Tc_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3+ (jaundiced and hospitalization)</td></tr><tr><th id="hd_b_Piperacillin.Tc_1_1_4_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a class="def" href="/books/n/livertox/glossary/def-item/glossary.latency/">Latency</a>:</th><td headers="hd_b_Piperacillin.Tc_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 days to symptoms, 22 days to jaundice</td></tr><tr><th id="hd_b_Piperacillin.Tc_1_1_5_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Recovery:</th><td headers="hd_b_Piperacillin.Tc_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">~2 months</td></tr><tr><th id="hd_b_Piperacillin.Tc_1_1_6_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other medications:</th><td headers="hd_b_Piperacillin.Tc_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Imipenem-cilastatin (4 g daily IV for 3 days) and acetaminophen (4 g daily orally for 3 days) in the postoperative period.</td></tr></tbody></table></div></div></div><div id="Piperacillin.Laboratory_Values"><h4>Laboratory Values</h4><div id="Piperacillin.Td" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548463/table/Piperacillin.Td/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Piperacillin.Td_lrgtbl__"><table><thead><tr><th id="hd_h_Piperacillin.Td_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Time After<br />Starting</th><th id="hd_h_Piperacillin.Td_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Time After<br />Stopping</th><th id="hd_h_Piperacillin.Td_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;"><a class="def" href="/books/n/livertox/glossary/def-item/glossary.alanine-aminotransferase-alt-/">ALT</a><br />(U/L)</th><th id="hd_h_Piperacillin.Td_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Alk P<br />(U/L)</th><th id="hd_h_Piperacillin.Td_1_1_1_5" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;"><a class="def" href="/books/n/livertox/glossary/def-item/glossary.bilirubin/">Bilirubin</a><br />(mg/dL)</th><th id="hd_h_Piperacillin.Td_1_1_1_6" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Other</th></tr></thead><tbody><tr><td headers="hd_h_Piperacillin.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pre</td><td headers="hd_h_Piperacillin.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Piperacillin.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">210</td><td headers="hd_h_Piperacillin.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">90</td><td headers="hd_h_Piperacillin.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Piperacillin.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Surgery</td></tr><tr><td headers="hd_h_Piperacillin.Td_1_1_1_1 hd_h_Piperacillin.Td_1_1_1_2 hd_h_Piperacillin.Td_1_1_1_3 hd_h_Piperacillin.Td_1_1_1_4 hd_h_Piperacillin.Td_1_1_1_5 hd_h_Piperacillin.Td_1_1_1_6" colspan="6" scope="col" rowspan="1" style="text-align:center;vertical-align:top;">Emergency surgery small bowel perforation: one dose of piperacillin given IV</td></tr><tr><td headers="hd_h_Piperacillin.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 days</td><td headers="hd_h_Piperacillin.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 days</td><td headers="hd_h_Piperacillin.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">83</td><td headers="hd_h_Piperacillin.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">39</td><td headers="hd_h_Piperacillin.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_Piperacillin.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Discharged</td></tr><tr><td headers="hd_h_Piperacillin.Td_1_1_1_1 hd_h_Piperacillin.Td_1_1_1_2 hd_h_Piperacillin.Td_1_1_1_3 hd_h_Piperacillin.Td_1_1_1_4 hd_h_Piperacillin.Td_1_1_1_5 hd_h_Piperacillin.Td_1_1_1_6" colspan="6" scope="col" rowspan="1" style="text-align:center;vertical-align:top;">Developed fatigue followed by pruritus ~day 15 after surgery</td></tr><tr><td headers="hd_h_Piperacillin.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21 days</td><td headers="hd_h_Piperacillin.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20 days</td><td headers="hd_h_Piperacillin.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">345</td><td headers="hd_h_Piperacillin.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">201</td><td headers="hd_h_Piperacillin.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.9</td><td headers="hd_h_Piperacillin.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Piperacillin.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22 days</td><td headers="hd_h_Piperacillin.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21 days</td><td headers="hd_h_Piperacillin.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">654</td><td headers="hd_h_Piperacillin.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">416</td><td headers="hd_h_Piperacillin.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">2.9</td><td headers="hd_h_Piperacillin.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Piperacillin.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25 days</td><td headers="hd_h_Piperacillin.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24 days</td><td headers="hd_h_Piperacillin.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">669</td><td headers="hd_h_Piperacillin.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">559</td><td headers="hd_h_Piperacillin.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">4.7</td><td headers="hd_h_Piperacillin.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Liver biopsy</td></tr><tr><td headers="hd_h_Piperacillin.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35 days</td><td headers="hd_h_Piperacillin.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34 days</td><td headers="hd_h_Piperacillin.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">210</td><td headers="hd_h_Piperacillin.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">531</td><td headers="hd_h_Piperacillin.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">1.2</td><td headers="hd_h_Piperacillin.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Piperacillin.Td_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3months</td><td headers="hd_h_Piperacillin.Td_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 months</td><td headers="hd_h_Piperacillin.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">13</td><td headers="hd_h_Piperacillin.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">79</td><td headers="hd_h_Piperacillin.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0.8</td><td headers="hd_h_Piperacillin.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_Piperacillin.Td_1_1_1_1 hd_h_Piperacillin.Td_1_1_1_2" colspan="2" scope="row" rowspan="1" style="text-align:center;vertical-align:top;">
|
||
<b>Normal Values</b>
|
||
</td><td headers="hd_h_Piperacillin.Td_1_1_1_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<b><37</b>
|
||
</td><td headers="hd_h_Piperacillin.Td_1_1_1_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<b><108</b>
|
||
</td><td headers="hd_h_Piperacillin.Td_1_1_1_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<b><1.2</b>
|
||
</td><td headers="hd_h_Piperacillin.Td_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div></div></div><div id="Piperacillin.Comment"><h4>Comment</h4><p>The young man clearly had drug induced liver disease with a mixed pattern of serum enzyme elevations and mild cholestasis that resolved completely in follow up. The difficulty is knowing which agent or agents was responsible. He received only one dose of piperacillin and less than 3 days of imipenem/cilastatin. Neither of these agents are common causes of drug induced liver disease. One might also question whether a halogenated anesthetic was used that might have caused liver injury and whether acetaminophen may have contributed. <a class="def" href="/books/n/livertox/glossary/def-item/glossary.hepatotoxicity/">Hepatotoxicity</a> from these agents, however, is usually more rapid in onset and hepatocellular in character. The pattern of injury was most compatible with a penicillin induced hepatic reaction. <a class="def" href="/books/n/livertox/glossary/def-item/glossary.lymphocyte/">Lymphocyte</a> transformation tests may be helpful, but their reliability in discriminating the cause of hepatic injury remains unproven; in this instance reactivity was found with both agents. This patient should probably be advised not to receive penicillin in the future.</p></div></div></div><div id="Piperacillin.PRODUCT_INFORMATION"><h2 id="_Piperacillin_PRODUCT_INFORMATION_">PRODUCT INFORMATION</h2><p>
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||
<b>REPRESENTATIVE TRADE NAMES</b>
|
||
</p><p>Piperacillin – Generic, Pipracil®</p><p>
|
||
<b>DRUG CLASS</b>
|
||
</p><p>Antiinfective Agents</p><p>
|
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<a href="https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=piperacillin" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">COMPLETE LABELING</a>
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</p><p>Product labeling at DailyMed, National Library of Medicine, NIH</p></div><div id="Piperacillin.CHEMICAL_FORMULAS_AND_STRUC"><h2 id="_Piperacillin_CHEMICAL_FORMULAS_AND_STRUC_">CHEMICAL FORMULAS AND STRUCTURES</h2><div id="Piperacillin.Te" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548463/table/Piperacillin.Te/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Piperacillin.Te_lrgtbl__"><table><thead><tr><th id="hd_h_Piperacillin.Te_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">DRUG</th><th id="hd_h_Piperacillin.Te_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CAS REGISTRY NO</th><th id="hd_h_Piperacillin.Te_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">MOLECULAR FORMULA</th><th id="hd_h_Piperacillin.Te_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">STRUCTURE</th></tr></thead><tbody><tr><td headers="hd_h_Piperacillin.Te_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Piperacillin</td><td headers="hd_h_Piperacillin.Te_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/135006689" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem">59703-84-3</a>
|
||
</td><td headers="hd_h_Piperacillin.Te_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">H26-N5-Na-O7-S</td><td headers="hd_h_Piperacillin.Te_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<a href="https://pubchem.ncbi.nlm.nih.gov/substance/135006689" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=135006689" alt="image 135006689 in the ncbi pubchem database" /></a>
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</td></tr></tbody></table></div></div></div><div id="Piperacillin.CITED_REFERENCE"><h2 id="_Piperacillin_CITED_REFERENCE_">CITED REFERENCE</h2><dl class="temp-labeled-list"><dt>1.</dt><dd><div class="bk_ref" id="Piperacillin.REF.1">Quattropani C, Schneider M, Helbling A, Zimmermann A, Krähenbühl S. Cholangiopathy after short-term administration of piperacillin and imipenem/cilastatin. <span><span class="ref-journal">Liver. </span>2001;<span class="ref-vol">21</span>:213–6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/11422785" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11422785</span></a>]</div></dd></dl></div><div id="bk_toc_contnr"></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK548463/?report=reader">PubReader</a></li><li><a href="/books/NBK548463/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK548463" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK548463" style="display:none" title="Cite this Page"><div class="bk_tt">LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Piperacillin. 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<a href="https://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed&pubmedfilters=true&term=Piperacillin+AND+Human%5BMH%5D+AND+(drug+induced+liver+injury+OR+jaundice/CI+OR+bile+duct+diseases/CI+OR+liver/DE+OR+liver+diseases/CI)+AND+(%221900/1/1%22%5BEDat%5D:%222999/12/31%22%5BEDat%5D)" ref="pagearea=document-links&targetsite=external&targetcat=link&targettype=uri">Recent References on Piperacillin: from PubMed.gov</a>
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A review of its antibacterial activity, pharmacokinetic properties and therapeutic potential.</a><span class="source">[Drugs. 1994]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Piperacillin/tazobactam. A review of its antibacterial activity, pharmacokinetic properties and therapeutic potential.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Bryson HM, Brogden RN. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Drugs. 1994 Mar; 47(3):506-35. </em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26867273" ref="ordinalpos=1&linkpos=4&log$=relatedarticles&logdbfrom=pubmed">In vitro susceptibility of multi-drug resistant Pseudomonas aeruginosa and extended-spectrum β-lactamase-producing Klebsiella pneumoniae isolated from clinical specimens at Bugando Medical Centre, Tanzania to Piperacillin-Tazobactam.</a><span class="source">[Tanzan J Health Res. 2014]</span><div class="brieflinkpop offscreen_noflow">In vitro susceptibility of multi-drug resistant Pseudomonas aeruginosa and extended-spectrum β-lactamase-producing Klebsiella pneumoniae isolated from clinical specimens at Bugando Medical Centre, Tanzania to Piperacillin-Tazobactam.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Petro D, Mushi MF, Moremi N, Iddi S, Mirambo M, Seni J, Mshana SE. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Tanzan J Health Res. 2014 Jan; 16(1):54-7. </em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/12052629" ref="ordinalpos=1&linkpos=5&log$=relatedarticles&logdbfrom=pubmed">Potency and antimicrobial spectrum update for piperacillin/tazobactam (2000): emphasis on its activity against resistant organism populations and generally untested species causing community-acquired respiratory tract infections.</a><span class="source">[Diagn Microbiol Infect Dis. 2002]</span><div class="brieflinkpop offscreen_noflow">Potency and antimicrobial spectrum update for piperacillin/tazobactam (2000): emphasis on its activity against resistant organism populations and generally untested species causing community-acquired respiratory tract infections.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Johnson DM, Biedenbach DJ, Jones RN. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">Diagn Microbiol Infect Dis. 2002 May; 43(1):49-60. </em></div></div></li></ul><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed_reviews&uid=31643782" ref="ordinalpos=1&log$=relatedreviews_seeall&logdbfrom=pubmed">See reviews...</a><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=31643782" ref="ordinalpos=1&log$=relatedarticles_seeall&logdbfrom=pubmed">See all...</a></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Recent Activity</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="recent_activity" id="Shutter"></a></div><div class="portlet_content"><div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" id="HTDisplay" class=""><div class="action"><a href="javascript:historyDisplayState('ClearHT')">Clear</a><a href="javascript:historyDisplayState('HTOff')" class="HTOn">Turn Off</a><a href="javascript:historyDisplayState('HTOn')" class="HTOff">Turn On</a></div><ul id="activity"><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=1" href="/portal/utils/pageresolver.fcgi?recordid=67c8e10cb15b832ebc11f02e">Piperacillin - LiverTox</a><div class="ralinkpop offscreen_noflow">Piperacillin - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=2" href="/portal/utils/pageresolver.fcgi?recordid=67c8e10bf4a390645e33ad78">Pioglitazone - LiverTox</a><div class="ralinkpop offscreen_noflow">Pioglitazone - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=3" href="/portal/utils/pageresolver.fcgi?recordid=67c8e10aa68b6b5afc7675d3">Pindolol - LiverTox</a><div class="ralinkpop offscreen_noflow">Pindolol - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=4" href="/portal/utils/pageresolver.fcgi?recordid=67c8e109ab82281a803e8b95">Pimozide - LiverTox</a><div class="ralinkpop offscreen_noflow">Pimozide - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=5" href="/portal/utils/pageresolver.fcgi?recordid=67c8e108f4a390645e33a265">Pimavanserin - LiverTox</a><div class="ralinkpop offscreen_noflow">Pimavanserin - LiverTox<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li></ul><p class="HTOn">Your browsing activity is empty.</p><p class="HTOff">Activity recording is turned off.</p><p id="turnOn" class="HTOff"><a href="javascript:historyDisplayState('HTOn')">Turn recording back on</a></p><a class="seemore" href="/sites/myncbi/recentactivity">See more...</a></div></div></div>
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