Pivmecillinam (INN) sold under the brand name Selexid and Pivya among others, is an orally active prodrug of mecillinam, an extended-spectrum penicillin antibiotic.

Indicated for the treatment of female adults with uncomplicated urinary tract infections caused by susceptible isolates of Escherichia coli, Proteus mirabilis, and Staphylococcus saprophyticus.

Pivmecillinam is primarily active against Gram-negative bacteria, and is used primarily in the treatment of lower urinary tract infections. In the Nordic countries, it has been widely used in that indication since the 1970s.

Pivmecillinam is the pivaloyloxymethyl ester of mecillinam.

Routes of administration-By mouth

Low bioavailability

Protein binding 5 to 10% (as mecillinam)

Metabolism Pivmecillinam is hydrolyzed to mecillinam

Elimination half-life 1 to 3 hours

Excretion Kidney and biliary, mostly as mecillinam

The most common side effects include nausea and diarrhea.

The adverse effect profile of pivmecillinam is similar to that of other penicillins.

The most common side effects of mecillinam use are rash and gastrointestinal upset, including nausea and vomiting.

Short-term use of these drugs can cause a marked decrease in blood levels of carnitine, it is unlikely to be of clinical significance; long-term use, however, appears problematic and is not recommended.

Pivmecillinam has been proposed as the first-line drug of choice for empirical treatment of acute cystitis.

It has also been used to treat paratyphoid fever and shigellosis.

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