Piperacillin
| Evidence Level: L5 | Predicted Indications: 10 |
Table of Contents
Piperacillin: From Bacterial Infection Treatment to Rheumatoid Arthritis
One-Sentence Summary
Piperacillin is a beta-lactam antibiotic, marketed in Singapore as an injectable, mainly in combination with tazobactam. The TxGNN model predicts it may be effective for rheumatoid arthritis, but no clinical trials are registered and the 15 retrieved publications are mostly case reports that show co-occurrence, not therapeutic benefit. This prediction is best viewed as a computational signal and not as supported evidence.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Not stated in the approved licence data compiled for this report |
| Predicted New Indication | Rheumatoid arthritis |
| TxGNN Prediction Score | 99.94% |
| Evidence Level | L5 |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 5 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Currently, detailed mechanism of action data is not available. Piperacillin is known to be a beta-lactam antibiotic that inhibits bacterial cell wall synthesis. It has no established anti-inflammatory or immunomodulatory action relevant to rheumatoid arthritis.
The original indication (bacterial infection) and the predicted indication (an autoimmune joint disease) do not share a clear pathway. The high TxGNN score is most likely a graph-based artifact. The retrieved literature describes patients with rheumatoid arthritis who were treated for infections, or who had adverse events from other drugs such as methotrexate. This shows co-occurrence, not benefit.
Other predictions (ranks 2–10) were also reviewed, and none has a plausible mechanistic link supported by trials. Sclerosing cholangitis is the only one with a loosely related rationale (antibiotics for bacterial cholangitis complications), but no direct evidence was supplied.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
The 15 retrieved publications are case reports, reviews or retrospective cohorts. None evaluates piperacillin as a treatment for rheumatoid arthritis. The most relevant items are listed below.
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 33987340 | 2021 | Cohort | Annals of Translational Medicine | Prevalence and features of antibiotic-associated drug-induced liver injury; a safety signal, not efficacy |
| 41257433 | 2026 | Cohort/Predictive model | British Journal of Clinical Pharmacology | Risk model for eosinophilia in patients on ampicillin/sulbactam or piperacillin/tazobactam |
| 37599303 | 2023 | Case report | Orthopadie | Prosthetic knee infection in an RA patient; piperacillin/tazobactam used for pneumonia |
| 22605835 | 2012 | Case report | BMJ Case Reports | Purulent pericarditis in an RA patient on etanercept; empirical piperacillin-tazobactam given |
| 41268563 | 2025 | Case report | Frontiers in Immunology | Atypical E. coli erysipelas with septic shock in an immunosuppressed RA patient |
| 38343452 | 2024 | Case report | Proceedings (Baylor Univ. Med. Center) | Low-dose methotrexate toxicity with pancytopenia in RA, rescued with leucovorin |
| 34178513 | 2021 | Case report | Cureus | Pancytopenia from low-dose methotrexate in RA |
| 36945293 | 2023 | Case report | Cureus | Recurrent pleural effusion in an RA patient in remission |
| 40119266 | 2025 | Case report/Review | BMC Infectious Diseases | Septic shock from drug-resistant Edwardsiella tarda |
| 39104733 | 2024 | Case report | Clinical Case Reports | ANCA-negative pauci-immune necrotizing glomerulonephritis |
Singapore Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| SIN13985P | Piperacillin/Tazobactam Sandoz Powder for solution for Injection/Infusion 4.5g vials | Powder, for solution | Not stated in the data compiled |
| SIN13758P | TAZPEN FOR INJECTION 4.5g/VIAL | Injection, powder, for solution | Not stated in the data compiled |
| SIN15299P | SALATAZ POWDER FOR SOLUTION FOR INJECTION/INFUSION 4.5G/VIAL | Injection, powder, for solution | Not stated in the data compiled |
| SIN15482P | PIPTAZ-AFT POWDER FOR SOLUTION FOR INJECTION 4.5G/VIAL | Injection, powder, lyophilized, for solution | Not stated in the data compiled |
| SIN08362P | TAZOCIN FOR INJECTION 4.5 g/vial | Injection, powder, for solution | Not stated in the data compiled |
Safety Considerations
- Drug Interactions: 81 interactions were recorded. Main ones by severity:
- Major: Vancomycin
- Moderate: Doxycycline, Tetracycline, Minocycline, Kanamycin, Streptomycin, Picosulfuric acid
- Minor: Clarithromycin
- Other listed drugs (for example proton pump inhibitors, prednisone, prednisolone, morphine, simvastatin) have an unclassified interaction level.
- Other safety signals in the retrieved literature: antibiotic-associated liver injury and eosinophilia (see the literature table).
For warnings and contraindications, please refer to the package insert.
Conclusion and Next Steps
Decision: Hold
Rationale: The prediction rests only on a model score. There are no clinical trials, no plausible anti-inflammatory mechanism, and the literature reflects infections and drug toxicity in RA patients and not treatment benefit. Evidence is at level L5.
To proceed, the following is needed:
- A mechanistic rationale showing a plausible link between piperacillin and rheumatoid arthritis pathways (current mechanism data are unavailable)
- Preclinical or clinical studies that directly test piperacillin in rheumatoid arthritis
- The Singapore package insert (approved indications, warnings and contraindications), needed before any safety screening
- Review of the lower-ranked predictions only if new supporting evidence appears (for example, sclerosing cholangitis)
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.