Pivmecillinam

What is Pivmecillinam?

Pivmecillinam is an antibiotic that can kill the bacteria that cause urinary tract infections (UTIs). UTIs can affect your bladder, urethra or kidneys. Pivmecillinam is often used to treat cystitis, a bladder infection that’s especially common in women.

Symptoms of cystitis can include a burning or stinging sensation when you pee, the urge to pee more often, dark-coloured or foul-smelling urine and pain in your lower belly.^[1]

How does Pivmecillinam work?

Pivmecillinam is an antibiotic that you take by mouth. It’s a pro-drug, meaning that your body converts it into its active form, mecillinam, which is a beta-lactam antibiotic (like amoxicillin or amipicillin) that works against Gram-negative bacteria.

Mecillinam binds to a protein called penicillin-binding protein 2 (PBP-2), which is found in the cell walls of Gram-negative bacteria. By doing this, it inhibits the formation of bacterial cell walls, which weakens them and causes them to eventually die.
Pivmecillinam has a low impact on the normal bacteria that live on your skin, in your mouth, intestines and vagina. This means that it’s less likely to cause side effects like diarrhoea or yeast infections.^[2]

What form does Pivmecillinam come in?

Pivmecillinam comes in one strength: Pivmecillinam 200mg tablets. Each tablet contains 200mg of pivmecillinam hydrochloride.

Remember to always make sure to take pivmecillinam the exact way your doctor prescribed, but here’s how much you’ll typically be advised to take depending on the type of infection you have:

• For lower UTI in non-pregnant women: The standard treatment lasts 3 days (10 tablets in total). You will take a starting dose of two 200mg tablets (400mg), followed by one 200mg tablet every 8 hours for the rest of the 3-day course.
• For catheter associated UTI: Take 400mg once, then 200mg three times a day for 7 days.
• For chronic or recurrent UTIs in people weighing at least 40 kg: Take 400mg every 6–8 hours. (Note for long-term use: If prescribed for chronic or recurrent UTIs, your clinician will monitor you closely. Repeated or prolonged courses can lower levels of an amino acid called carnitine in your body.)

As a general rule, you don’t need to adjust the dose if you’re older than 65 or have kidney or liver problems.

How to take Pivmecillinam

Make sure to take Pivmecillinam exactly as your clinician has told you, but some general guidelines on how to take it are:

• Take it at evenly spaced times throughout the day.
• If you need to take it three times a day, take it at breakfast, lunch and dinner.
• Always take your tablet while sitting or standing upright, along with a meal and at least half a glass of water.
• Never take Pivmecillinam immediately before lying down or going to bed, as this prevents the tablet from getting stuck and causing throat or oesophageal irritation.
• To take the tablet, tear off one pocket along the dotted lines, peel off the lidding foil, and remove the tablet with dry hands.

How long does Pivmecillinam take to work?

Pivmecillinam hydrochloride is a pro-drug, so it’s converted into its active form, mecillinam, in your body. Mecillinam reaches peak concentrations in the blood within 1-1.5 hours after taking pivmecillinam hydrochloride. So, pivmecillinam hydrochloride starts to work pretty quickly, but you might not feel better for 2-3 days.^[1]

It’s important though to keep taking the full course of medication as prescribed by your clinician even after you start feeling better. Stopping the medication early can make your infection worse and can even make it harder to treat in the future.

Can you drink alcohol while taking Pivmecillinam?

Yes, you can drink alcohol in moderation while taking Pivmecillinam. But alcohol can make some of the side effects of antibiotics worse, like stomach upset, dizziness and drowsiness. Combining the two can also increase the risk of these side effects.

What happens if I make a mistake using Pivmecillinam?

If you accidentally take too much Pivmecillinam hydrochloride, let your doctor know right away. They may need to stop your treatment. You might also feel sick, have an upset stomach or throw up.

If you forgot to take your medicine, take it as soon as you remember. Be sure to drink it with at least half a glass of water or other liquid. Then take your next dose at your usual time.

It’s important to take the full course of medication that your clinician has prescribed, even if you start to feel better. If you stop taking the antibiotics too soon, your infection could come back.