From the Guidelines
Vancomycin (Vanc) and piperacillin-tazobactam (Zosyn) combination is not the first-line treatment for uncomplicated urinary tract infections (UTIs), but it can be used for complicated UTIs or when multidrug-resistant organisms are suspected. This combination provides broad-spectrum coverage against many bacteria that cause UTIs, including resistant organisms. Zosyn is particularly effective against common UTI pathogens like E. coli, Klebsiella, and Pseudomonas, while vancomycin targets gram-positive bacteria including resistant strains like MRSA. According to the American College of Physicians guidelines 1, for typical community-acquired UTIs, narrower-spectrum antibiotics like nitrofurantoin, trimethoprim-sulfamethoxazole, or fluoroquinolones are preferred to reduce antimicrobial resistance development. Some key points to consider when treating UTIs include:
- The IDSA/European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guideline recommends treatment durations depending on the type of antibiotic, including 5 days of nitrofurantoin, 3 days of TMP–SMX, or a single dose of fosfomycin for uncomplicated cystitis 1.
- For pyelonephritis, the IDSA/ESCMID guideline recommends either an oral fluoroquinolone for 7 days or TMP–SMX for 14 days for treatment of patients with pyelonephritis not requiring hospitalization 1. The vanc/Zosyn combination also carries risks of side effects including kidney injury, especially when used together, and should be used judiciously with appropriate dosing based on kidney function and monitoring of drug levels for vancomycin.
From the Research
Coverage of UTI by Vanc and Zosyn
- Vanc (Vancomycin) is not typically used to treat urinary tract infections (UTIs) as it is more effective against Gram-positive bacteria, whereas UTIs are often caused by Gram-negative bacteria 2, 3.
- Zosyn (Piperacillin-Tazobactam) is a broad-spectrum antibiotic that can be used to treat UTIs, especially those caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae 4, 3, 5.
Spectrum of Activity
- Zosyn has been shown to be effective against a range of Gram-negative bacteria, including Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae 4, 3.
- However, the use of Zosyn as a first-line treatment for UTIs may be limited by the increasing rates of antibiotic resistance, particularly among ESBL-producing organisms 2, 3.
Treatment Options
- For uncomplicated UTIs, first-line treatment options include nitrofurantoin, fosfomycin, and pivmecillinam 2, 3.
- For complicated UTIs or those caused by resistant organisms, treatment options may include Zosyn, carbapenems, and other broad-spectrum antibiotics 4, 3, 5.
Clinical Evidence
- A study published in 2020 found that Zosyn may be an effective alternative to carbapenems for the treatment of non-bacteremic UTIs due to ESBL-producing Enterobacteriaceae 5.
- Another study published in 1994 found that Zosyn was effective in treating complicated UTIs, with a clinical response rate of 86% 4.