What oral antibiotics are prescribed on discharge for a patient with pneumonia treated with Zosyn (piperacillin-tazobactam) in the hospital?

From the Guidelines

For a patient transitioning from intravenous Zosyn (piperacillin-tazobactam) for pneumonia to oral antibiotics at discharge, the most appropriate option is amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily, as it provides broad coverage similar to Zosyn and is recommended by the American Thoracic Society and Infectious Diseases Society of America 1. When selecting an oral antibiotic, it is essential to consider the patient's clinical improvement, pathogen identified (if any), antibiotic susceptibilities, and patient factors like allergies or kidney function.

• Amoxicillin-clavulanate is often preferred for its broad coverage similar to Zosyn,
• doxycycline 100 mg twice daily works well for atypical pathogens,
• and levofloxacin 750 mg once daily provides excellent respiratory coverage but carries more side effect concerns. The oral antibiotic should be started immediately after the last Zosyn dose to ensure continuous coverage.
• Patients should complete the full course even if feeling better,
• take the medication with food if indicated,
• stay hydrated, and
• follow up with their provider within 1-2 weeks to ensure resolution of the pneumonia, as recommended by the guidelines 1. It is crucial to note that the choice of antibiotic should be based on the most recent and highest quality evidence, and in this case, the 2019 guidelines from the American Thoracic Society and Infectious Diseases Society of America provide the strongest recommendation 1.

From the FDA Drug Label

Azithromycin Tablets, USP are indicated for the treatment of patients with mild to moderate infections (pneumonia: see WARNINGS) caused by susceptible strains of the designated microorganisms in the specific conditions listed below Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy NOTE: Azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, elderly or debilitated patients, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia)

The patient is on zosyn for pneumonia in the hospital, which suggests a moderate to severe infection. Azithromycin may not be suitable for this patient upon discharge, as it is indicated for mild to moderate infections and the patient's condition may be more severe. However, if the patient's condition has improved and they are deemed appropriate for oral therapy, azithromycin could be considered as an option for oral antibiotics on discharge, depending on the specific causative organism and its susceptibility to azithromycin 2.

• Key considerations include:
  • The patient's overall health and ability to respond to oral therapy
  • The severity of the pneumonia and the presence of any underlying health problems
  • The results of culture and susceptibility tests to determine the causative organism and its susceptibility to azithromycin It is essential to consult with a healthcare professional to determine the best course of treatment for the patient.

From the Research

Antibiotic Treatment for Pneumonia

When a patient is discharged from the hospital after being treated with Zosyn (piperacillin/tazobactam) for pneumonia, the choice of oral antibiotics depends on various factors, including the severity of the pneumonia, the patient's overall health, and the susceptibility of the causative organism to antibiotics.

Oral Antibiotic Options

Some possible oral antibiotic options for patients who have been treated with Zosyn for pneumonia include:

• Ceftriaxone, which has been shown to be effective in treating aspiration pneumonia, including cases caused by oral streptococcus and anaerobes 3
• Amoxicillin-clavulanate, which is a broad-spectrum antibiotic that can cover a range of bacteria, including those that cause pneumonia
• Fluoroquinolones, such as levofloxacin or moxifloxacin, which are broad-spectrum antibiotics that can be used to treat pneumonia caused by a variety of bacteria

Considerations for Antibiotic Choice

When choosing an oral antibiotic for a patient who has been treated with Zosyn for pneumonia, it is essential to consider the following factors:

• The severity of the pneumonia and the patient's overall health
• The susceptibility of the causative organism to antibiotics
• The potential for antibiotic resistance
• The patient's medical history and any allergies or sensitivities to antibiotics
• The cost and availability of the antibiotic

Studies on Antibiotic Treatment for Pneumonia

Several studies have compared the effectiveness of different antibiotics in treating pneumonia, including:

• A study that compared the clinical benefits of piperacillin/tazobactam versus a combination of ceftriaxone and clindamycin in the treatment of early, non-ventilator, hospital-acquired pneumonia 4
• A study that evaluated the empirical antibiotic treatment for community-acquired pneumonia and the accuracy of treatment for Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumoniae 5
• A study that compared the efficacy, safety, and tolerance of piperacillin/tazobactam with co-amoxiclav plus an aminoglycoside in the treatment of severe pneumonia 6
• A study that compared the clinical efficacy of tazobactam/piperacillin with imipenem/cilastatin in patients with moderate-to-severe aspiration pneumonia 7