Mezlocillin, piperacillin, and ticarcillin are parenteral antibiotics formulated as sodium salts, so prescribers must consider the sodium content of these antibiotics when administering them to patients with congestive heart failure. During their distribution phase, an-tipseudomonal penicillins achieve only low concentrations in the cerebrospinal fluid. Consequently, an-tipseudomonal penicillins are not among the drugs of first choice for meningitis therapy.
The antipseudomonal penicillins undergo renal elimination (Table 45.1). Piperacillin and ticarcillin have minimal hepatic metabolism. In contrast, me-zlocillin has significant hepatic metabolism and requires dose adjustment in patients with hepatic insufficiency.
The antipseudomonal penicillins have comparable spectra of activity against many gram-positive and gram-negative pathogens, including most anaerobes. Mezlocillin, piperacillin, and ticarcillin have similar clinical outcomes in patients with known or suspected P. aeruginosa infections. Antipseudomonal penicillins are used to treat pneumonias associated with cystic fibrosis or mechanical ventilation.
Carbenicillin indanyl sodium is an antipseudomonal penicillin formulated for oral administration. The drug achieves negligible carbenicillin concentrations in the urine of patients with renal failure. Consequently, car-benicillin is not appropriate for patients with renal failure. In patients with normal renal function, however, carbenicillin indanyl sodium is used to treat urinary tract infections caused by P. aeruginosa, Proteus spp., and Escherichia coli.
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