What is the use of Zosyn (Piperacillin/Tazobactam)?

From the Guidelines

Zosyn, a combination of piperacillin and tazobactam, is recommended for the treatment of moderate to severe bacterial infections, including intra-abdominal infections, skin and skin structure infections, female pelvic infections, and pneumonia, at a dose of 4.5 g administered intravenously every 6 hours, as supported by the most recent guidelines 1.

Key Considerations

• The dosage of Zosyn may need to be adjusted for patients with renal impairment.
• Zosyn works by inhibiting bacterial cell wall synthesis, while the tazobactam component prevents bacterial enzymes from breaking down the piperacillin, enhancing its effectiveness against resistant bacteria.
• Common side effects of Zosyn include diarrhea, headache, constipation, nausea, insomnia, and rash.
• Patients with penicillin allergies should avoid Zosyn due to potential cross-reactivity.

Treatment Duration

• The treatment duration with Zosyn should be individualized based on the infection type and severity, but typically ranges from 7-14 days.
• The use of procalcitonin monitoring may be useful to guide antimicrobial discontinuation, as suggested by recent studies 1.

Special Considerations

• For patients at risk of infection with community-acquired ESBL-producing Enterobacteriaceae, alternative antibiotics such as meropenem, doripenem, or imipenem/cilastatin may be considered 1.
• In cases of carbapenem-resistant Pseudomonas aeruginosa, other treatment options such as ceftazidime, cefepime, or cefpirome may be recommended 1.

From the FDA Drug Label

Piperacillin and tazobactam for injection is indicated in adults and pediatric patients (2 months of age and older) for the treatment of appendicitis (complicated by rupture or abscess) and peritonitis caused by beta-lactamase producing isolates of Escherichia coli or the following members of the Bacteroides fragilis group: B. fragilis, B. ovatus, B. thetaiotaomicron, or B. vulgatus. Piperacillin and tazobactam for injection is indicated in adults and pediatric patients (2 months of age and older) for the treatment of nosocomial pneumonia (moderate to severe) caused by beta-lactamase producing isolates of Staphylococcus aureus and by piperacillin/tazobactam-susceptible Acinetobacter baumannii, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa Piperacillin and tazobactam for injection is a combination of piperacillin, a penicillin-class antibacterial and tazobactam, a beta-lactamase inhibitor, indicated for the treatment of: Intra-abdominal infections in adult and pediatric patients 2 months of age and older

The main indications for Zosyn (piperacillin and tazobactam) are:

• Intra-abdominal infections
• Nosocomial pneumonia
• Skin and skin structure infections
• Female pelvic infections
• Community-acquired pneumonia 2 2

From the Research

Zosyn (Piperacillin/Tazobactam) Overview

• Zosyn, also known as piperacillin/tazobactam, is a beta-lactam/beta-lactamase inhibitor combination with a broad spectrum of antibacterial activity 3.
• It is effective against most Gram-positive and Gram-negative aerobic bacteria and anaerobic bacteria, including many pathogens producing beta-lactamases 3, 4.

Clinical Uses

• Piperacillin/tazobactam is used to treat various infections, including:
  • Lower respiratory tract infections 3, 4
  • Intra-abdominal infections 3, 4, 5
  • Urinary tract infections 3, 4
  • Skin and soft tissue infections 3, 4, 6
  • Febrile neutropenia 3, 4
• It is also used in combination with other antibiotics, such as aminoglycosides, to treat severe nosocomial infections 3.

Efficacy and Safety

• Piperacillin/tazobactam has been shown to be effective and well-tolerated in clinical trials 3, 4, 5.
• It has a higher clinical success rate compared to other antibacterial regimens in the treatment of intra-abdominal infections and febrile neutropenia 4.
• The most common adverse events associated with piperacillin/tazobactam are gastrointestinal symptoms and skin reactions 3.

Pharmacoeconomics

• Piperacillin/tazobactam has been shown to be cost-effective in the treatment of moderate to severe bacterial infections 4.
• It has lower total medical costs compared to other antibacterial regimens in some studies 4.
• However, the cost-effectiveness of piperacillin/tazobactam can vary depending on the specific costs included and the patient population being treated 4.

Resistance and Susceptibility

• Piperacillin/tazobactam is active against many pathogens, including Enterobacterales and Pseudomonas aeruginosa 7.
• However, resistance to piperacillin/tazobactam can occur, particularly in patients with previous exposure to beta-lactam antibiotics 7.
• The susceptibility of piperacillin/tazobactam to various pathogens can vary depending on the region and the specific patient population being treated 7.