What is Pivmecillinam?
Pivmecillinam is an antibiotic from the penicillin group that was developed specifically for the treatment of urinary tract infections. It is a prodrug that is converted to mecillinam in the body.
The particular advantage: pivmecillinam can also be used during pregnancy if medically necessary and has very low resistance rates. It acts specifically against gram-negative bacteria such as E. coli – the most common pathogen causing bladder infections.
A well-known brand name is Selexid® (formerly X-Systo®).
Active Ingredients & Mechanism of Action
Active ingredient: Pivmecillinam
Pivmecillinam is activated to mecillinam in the body:
Mechanism of action:
- Prodrug: in the intestine, pivmecillinam is converted to mecillinam
- Mecillinam binds to PBP2 (penicillin-binding protein 2)
- Inhibits bacterial cell wall synthesis
- Leads to the death of the bacteria
Special feature: Mecillinam binds specifically to PBP2, not to PBP1 and PBP3 as other penicillins do. As a result, it has a different spectrum of activity and fewer cross-resistances.
Spectrum of activity:
- E. coli (main pathogen)
- Klebsiella
- Proteus mirabilis
- Citrobacter
- Enterobacter
Who is it suitable for?
Pivmecillinam is suitable for:
- Acute uncomplicated urinary tract infections
- Bladder infection during pregnancy
- Recurrent urinary tract infections
Advantages:
- Can be used during pregnancy if medically necessary
- Low resistance rates
- Hardly any effect on the intestinal flora
- Good tolerability
Not suitable in cases of:
- Kidney infection (pyelonephritis)
- Penicillin allergy
- Severe renal insufficiency
Available Dosages
Acute bladder infection:
- 400 mg 3x daily for 3 days
Available strengths:
- Tablets 200 mg, 400 mg
During pregnancy: Same dosage, duration of treatment as instructed by the doctor.
Dosage form and pack sizes
The medicines catalogue lists one pack variant: one strength in one pack size.
- Dosage form
- Filmtablette
- Strengths
- 400 mg
- Pack sizes
- 9 units
| Strength | Pack | PZN | Duration |
|---|---|---|---|
| 400 mg | 9 units | 13699993 | 0 days |
Packs listed in the German medicines catalogue. Which of them are currently available and what they cost is shown in the price overview.
The Pharmazentralnummer (PZN) is the nationwide unique identifier of a pack in Germany.
Duration is the catalogue value for the usual dosage. How long a pack actually lasts depends on the dose your doctor prescribes.
How to Take
How to take:
- During or after a meal (can help prevent gastrointestinal complaints)
- With a glass of water
- Swallow the tablets whole, do not chew them
Duration of treatment:
- 3 days are recommended
- During pregnancy as instructed by the doctor
- Complete the entire course of treatment
Notes:
- Drink plenty of fluids (at least 2 liters per day)
- Make sure you produce enough urine
- See a doctor if you have fever or flank pain
Contraindications
Pivmecillinam must not be taken in cases of:
- Penicillin allergy
- Severe renal insufficiency
- Carnitine deficiency or disorders of carnitine metabolism
- Esophageal stricture
Caution in cases of:
- Mild to moderate renal insufficiency
- Porphyria
- With long-term use: monitor carnitine levels
Pregnancy: Can be used if medically necessary. Extensive experience (more than 1000 pregnancies) does not indicate a risk of malformations or harmful effects on the unborn or newborn child. Taking it shortly before birth can lead to a false positive result for isovaleric acidemia in newborn screening.
Breastfeeding: Passes into breast milk only in small amounts. Use is possible.
Possible Side Effects
Common (1-10%):
- Nausea
- Diarrhea
- Abdominal pain
- Vomiting
Uncommon:
- Headache
- Dizziness
- Skin rash
- Vaginal yeast infection
Rare:
- Allergic reactions
- Changes in blood count
- Carnitine deficiency (with long-term therapy)
Interactions
Interactions:
- Probenecid – increased mecillinam levels
- Valproic acid – carnitine deficiency intensified
No relevant interactions with:
- Hormonal contraception
- Most other medicines
Special feature: With long-term use, pivmecillinam can increase carnitine excretion. With prophylaxis lasting months: have carnitine levels checked.
Frequently Asked Questions
No, pivmecillinam is a penicillin antibiotic. If you have a penicillin allergy, there is a risk of cross-allergy. Alternatives are fosfomycin or nitrofurantoin.
For pivmecillinam, experience from more than 1000 pregnancies is available. It does not indicate a risk of malformations or harmful effects on the unborn or newborn child. If medically necessary, pivmecillinam can be used during pregnancy. It is one of the drugs of choice for bladder infections during pregnancy.
Taking it with a meal can help prevent gastrointestinal complaints. The absorption of pivmecillinam from the intestine is not significantly affected by food.
Pivmecillinam can increase carnitine excretion. Carnitine is important for energy metabolism. With short-term use (a few days) this is not a problem; with longer prophylaxis, the doctor should check the levels.
Similar Medications
Is Pivmecillinam right for you?
A licensed doctor will review your information and issue a prescription if suitable. Discreet and secure.
Important Notice
This information does not replace medical advice. If you have questions about your health or the suitability of this medication, please consult a doctor or pharmacist.
Important Safety Information
This service operates under German pharmaceutical law (HWG). For risks and side effects, read the package leaflet and consult your doctor or pharmacist. All medications are dispensed from a licensed pharmacy in Germany.