Does vancomycin or piperacillin-tazobactam (Zosyn) provide coverage for pneumonia?

From the Guidelines

Vancomycin and Zosyn (piperacillin-tazobactam) can be used to treat pneumonia, but they cover different pathogens and are used in different clinical scenarios, with the most recent guidelines from 2019 recommending vancomycin for MRSA coverage and Zosyn for gram-negative coverage 1.

Key Points

• Zosyn is effective against many common pneumonia-causing bacteria, including Streptococcus pneumoniae, Haemophilus influenzae, anaerobes, and many gram-negative organisms, including Pseudomonas aeruginosa.
• Vancomycin primarily covers gram-positive organisms, particularly methicillin-resistant Staphylococcus aureus (MRSA), which can cause pneumonia in certain settings.
• The typical adult dose of Zosyn is 4.5g IV every 6-8 hours, adjusted for renal function, while vancomycin is dosed at 15-20 mg/kg IV every 8-12 hours, with therapeutic drug monitoring recommended.
• For comprehensive coverage in severe pneumonia, especially in hospital settings where drug-resistant organisms are a concern, these antibiotics are often used together, with vancomycin providing MRSA coverage and Zosyn covering gram-negatives and anaerobes.

Clinical Scenarios

• In patients with suspected hospital-acquired pneumonia or ventilator-associated pneumonia, empiric coverage for S. aureus, Pseudomonas aeruginosa, and other gram-negative bacilli is recommended, with vancomycin or linezolid added for MRSA coverage if indicated 1.
• The choice of antibiotic regimen should be based on local epidemiology and susceptibility patterns, as well as patient-specific risk factors for antimicrobial resistance.
• Treatment duration typically ranges from 7-14 days, depending on the severity and clinical response, with adjustments made based on microbiologic data and clinical response to therapy 1.

From the FDA Drug Label

1.2 Nosocomial Pneumonia Piperacillin and tazobactam for injection, USP 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 and tazobactam-susceptible Acinetobacter baumannii, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa 1.5 Community-acquired Pneumonia Piperacillin and tazobactam for injection, USP is indicated in adults for the treatment of community-acquired pneumonia (moderate severity only) caused by beta-lactamase producing isolates of Haemophilus influenzae.

The drug label for Zosyn (piperacillin/tazobactam) indicates that it is used to treat:

• Nosocomial pneumonia caused by certain bacteria, including Staphylococcus aureus and Pseudomonas aeruginosa
• Community-acquired pneumonia caused by Haemophilus influenzae However, there is no information about vancomycin in this drug label. Therefore, based on this label, Zosyn (piperacillin/tazobactam) covers certain types of pneumonia, but vancomycin is not mentioned 2.

From the Research

Antibiotic Coverage for Pneumonia

• Vancomycin is typically used to treat Gram-positive bacterial infections, including methicillin-resistant Staphylococcus aureus (MRSA) 3.
• Zosyn (piperacillin/tazobactam) is a broad-spectrum antibiotic that covers a wide range of Gram-positive and Gram-negative bacteria, including Pseudomonas aeruginosa 4, 5, 6, 7.
• Piperacillin/tazobactam has been shown to be effective in treating community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) 4, 5, 6.
• The use of piperacillin/tazobactam as empirical therapy for HAP has been associated with improved outcomes, particularly when used in combination with an aminoglycoside 3.
• Ceftazidime, carbapenems, and piperacillin/tazobactam have been compared as single definitive therapy for Pseudomonas aeruginosa bloodstream infection, with no significant difference in mortality or clinical outcomes between the three antibiotics 7.

Specific Bacterial Coverage

• Vancomycin does not cover Pseudomonas aeruginosa or other Gram-negative bacteria 3.
• Zosyn (piperacillin/tazobactam) covers Pseudomonas aeruginosa, but its effectiveness may vary depending on the specific strain and resistance pattern 4, 5, 6, 7.
• Piperacillin/tazobactam has been shown to be effective against a wide range of bacterial pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 4, 5, 6.