From the Guidelines
Zosyn (piperacillin/tazobactam) is not recommended as a first-line treatment for Enterococcus infections. Enterococci have intrinsic resistance to many beta-lactam antibiotics, including piperacillin/tazobactam, making Zosyn generally ineffective against these organisms 1. For Enterococcus infections, ampicillin is typically the preferred treatment for susceptible strains, often at doses of 2g IV every 4-6 hours. For ampicillin-resistant Enterococcus or more serious infections like endocarditis or meningitis, vancomycin (15-20 mg/kg IV every 8-12 hours) is commonly used, sometimes in combination with an aminoglycoside like gentamicin for synergistic effects 1. For vancomycin-resistant Enterococcus (VRE), linezolid or daptomycin are usually employed, with high dose daptomycin 8-12 mg/kg/day being recommended for VRE bacteremia 1.
Some key points to consider when treating Enterococcus infections include:
- The use of ampicillin or vancomycin as first-line treatments, depending on the susceptibility of the strain and the severity of the infection
- The potential need for combination therapy with an aminoglycoside for synergistic effects
- The use of linezolid or daptomycin for VRE infections
- The importance of monitoring for resistance and adjusting treatment accordingly
It's also important to note that the treatment of Enterococcus infections should be guided by the results of susceptibility testing and the clinical response of the patient. In general, the most effective treatment for Enterococcus infections will depend on the specific strain and the severity of the infection, and should be guided by the most recent and highest quality evidence 1.
From the Research
Zosyn Use for Enterococcus
- Zosyn, also known as piperacillin/tazobactam, is used for empirical therapy of severe and complex infections, including those caused by Enterococcus species 2.
- The in vitro activity of piperacillin/tazobactam against Enterococcus faecalis is high, with a reported susceptibility rate of 96% 2.
- However, the effectiveness of piperacillin/tazobactam against Enterococcus faecium is lower, and the use of combination therapy with other antibiotics, such as linezolid, may be necessary to achieve optimal outcomes 3.
- Studies have shown that piperacillin/tazobactam is active against beta-lactamase-producing Enterococcus faecalis, and the addition of tazobactam to piperacillin can reverse the inoculum effect and improve the efficacy of the antibiotic 4.
Clinical Use of Zosyn for Enterococcus Infections
- Piperacillin/tazobactam has been used to treat a variety of infections, including intra-abdominal infections, skin and soft tissue infections, and lower respiratory tract infections, and has been shown to be effective against Enterococcus species in these settings 5, 6.
- The use of piperacillin/tazobactam in combination with other antibiotics, such as aminoglycosides, may be necessary to achieve optimal outcomes in patients with Enterococcus infections 4.
- The safety and tolerability profile of piperacillin/tazobactam is excellent, making it a reliable option for the empiric treatment of moderate-to-severe infections in hospitalized patients 6.