毒理性
静脉注射哌拉西林的患者中，多达12%的患者可能会出现短暂且轻至中度的血清转氨酶升高，但这些升高的临床意义不大，并不比与之相比较的同类注射用抗生素更常见。与哌拉西林相关的广谱脲酶青霉素类药物美洛西林曾报告有更常见的肝损伤，但该药物已经从市场上撤回。在接受哌拉西林治疗的人员中，极为罕见地报告了个别特异质性肝损伤的案例。肝损伤通常是胆汁淤积性的，在开始治疗后的1到6周内发生。这种损伤可能是严重的，但一旦停止使用哌拉西林，通常是自限性的。肝毒性的特征与其他青霉素类药物相似。哌拉西林和其他青霉素类药物引起的胆汁淤积性肝炎可能持续较长时间，导致持续性胆汁淤积（消失胆管综合征）或血清碱性磷酸酶持续升高，提示部分胆管损失。与哌拉西林相关的多数肝损伤案例与其与β-内酰胺酶抑制剂他唑巴坦（Zosyn及其仿制药）的联合使用有关，这种联合用药比单独使用哌拉西林更为常见。
Patients on intravenous piperacillin may have transient and mild-to-moderate serum aminotransferase elevations in up to 12% of patients, but these are of little clinical significance and not more common than with comparative parenteral antibiotics. Hepatic injury was more commonly reported with mezlocillin, a related extended spectrum ureidopenicillin which has been withdrawn from use. Rare instances of idiosyncratic liver injury have been reported in persons receiving piperacillin. The liver injury is typically cholestatic arising within 1 to 6 weeks of starting therapy. The injury can be severe, but is generally self-limited once piperacillin is stopped. The features of the hepatotoxicity resemble those of other penicillins. The cholestatic hepatitis caused by piperacillin and other penicillins can be prolonged and lead to persistent cholestasis (vanishing bile duct syndrome) or persistent elevations in serum alkaline phosphatase suggestive of partial bile duct loss. Most cases of liver injury related to piperacillin are linked to the combination of piperacillin with the beta-lactamase inhibitor tazobactam (Zosyn and generics), which is more commonly used than piperacillin alone.
来源:LiverTox
