PYOCIDIN
Clinical safety rating: caution
Comprehensive clinical and safety monograph for PYOCIDIN (PYOCIDIN).
Pyocidin is a bactericidal antibiotic that inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit, preventing the attachment of aminoacyl-tRNA to the mRNA-ribosome complex.
| Metabolism | Hepatic metabolism via conjugation; minimal cytochrome P450 involvement |
| Excretion | Primarily renal excretion of unchanged drug (60-70%), with 20-30% biliary excretion and minor fecal elimination (<10%). |
| Half-life | Terminal elimination half-life is 2-3 hours in patients with normal renal function; extends to 12-18 hours in severe renal impairment (CrCl <30 mL/min). |
| Protein binding | Approximately 85-90% bound primarily to serum albumin. |
| Volume of Distribution | 0.2-0.3 L/kg, indicating limited distribution into total body water and minimal tissue penetration. |
| Bioavailability | Oral: 50-60% (due to first-pass metabolism); intramuscular: 80-90%; intravenous: 100%. |
| Onset of Action | Intravenous: 15-30 minutes; intramuscular: 30-60 minutes; oral: 1-2 hours. |
| Duration of Action | 4-6 hours for typical dosing intervals; prolonged in renal impairment requiring dose adjustment. |
5 mg/kg intramuscular or subcutaneous every 24 hours. Max dose 300 mg per injection.
| Dosage form | SOLUTION/DROPS |
| Renal impairment | GFR 30-50 mL/min: 3 mg/kg every 24 hours. GFR <30 mL/min: 2.5 mg/kg every 48 hours. Hemodialysis: not recommended. |
| Liver impairment | Child-Pugh A: no adjustment. Child-Pugh B: 3 mg/kg every 24 hours. Child-Pugh C: 2 mg/kg every 48 hours. |
| Pediatric use | Infants and children: 5 mg/kg intramuscular every 24 hours, max 150 mg. Neonates: 4 mg/kg every 36 hours. |
| Geriatric use | Start at 3 mg/kg every 24 hours; titrate based on renal function and tolerability. Max dose 300 mg. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for PYOCIDIN (PYOCIDIN).
| Breastfeeding | It is not known whether PYOCIDIN is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when PYOCIDIN is administered to a nursing woman. M/P ratio: unknown. Decide to discontinue nursing or discontinue drug based on importance to mother. |
| Teratogenic Risk | There is no data on teratogenic risk for PYOCIDIN in humans. In animal studies, no evidence of fetal harm was observed at doses up to 5 times the human dose. However, because animal studies are not always predictive of human response, PYOCIDIN should be used during pregnancy only if clearly needed. First trimester: insufficient data; risk cannot be excluded. Second and third trimesters: no known specific risks; use only if maternal benefit justifies potential fetal risk. |
■ FDA Black Box Warning
None
| Serious Effects |
Hypersensitivity to pyocidin or any component; myasthenia gravis (due to neuromuscular blocking effects)
| Precautions | May cause nephrotoxicity and ototoxicity; caution in patients with renal impairment; monitor renal function and hearing |
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| Fetal Monitoring | Monitor maternal renal function, hepatic function, and complete blood cell count periodically during therapy. Fetal monitoring: standard prenatal care; no specific fetal monitoring required unless maternal condition warrants. In neonates, no specific adverse effects reported; observe for signs of hypersensitivity or gastrointestinal disturbances. |
| Fertility Effects | Animal studies have shown no impairment of fertility with PYOCIDIN. In humans, no data are available regarding effects on fertility. It is not expected to cause significant effects on reproductive function, but individual cases of menstrual irregularities have not been reported. |