From the Guidelines
Yes, Zosyn (piperacillin/tazobactam) can be used to treat beta-lactamase-positive Bacteroides infections. The standard adult dosage is typically 3.375g (3g piperacillin/0.375g tazobactam) administered intravenously every 6 hours for 7-14 days, depending on infection severity and clinical response 1. Zosyn works well against these infections because tazobactam inhibits the beta-lactamase enzymes that would normally destroy the piperacillin component. This combination allows the piperacillin to maintain its antimicrobial activity against organisms that would otherwise be resistant. Bacteroides species, particularly B. fragilis, commonly produce beta-lactamases, making them resistant to many beta-lactam antibiotics when used alone.
Key Considerations
- Dosage adjustments are necessary for patients with renal impairment, with reduced doses or extended intervals required when creatinine clearance falls below 40 mL/min.
- Monitor for potential side effects including diarrhea, rash, and electrolyte abnormalities during treatment.
- The use of piperacillin/tazobactam in patients with ESBLs infections is still controversial, even if in stable patients, it may be still a therapeutic chance 1.
Treatment Approach
- In patients with complicated intra-abdominal infections (cIAIs) undergoing an adequate source-control procedure, a short course of antibiotic therapy (3-5 d) is always recommended 1.
- Patients who have ongoing signs of peritonitis or systemic illness beyond 5 to 7 days of antibiotic treatment normally warrant a diagnostic investigation to determine whether additional surgical intervention is necessary to address an ongoing uncontrolled source of infection or antimicrobial treatment failure.
- The choice of empiric antibiotic regimens in patients with IAI should be based on the clinical condition of the patients, the individual risk for infection by resistant pathogens, and the local resistance epidemiology 1.
From the FDA Drug Label
Piperacillin and tazobactam for injection, USP 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.
Yes, Zosyn (piperacillin/tazobactam) can be used to treat beta-lactamase-positive Bacteroides infections, specifically those caused by B. fragilis, B. ovatus, B. thetaiotaomicron, or B. vulgatus 2.
- Key points:
- Zosyn is effective against beta-lactamase-producing isolates of Bacteroides fragilis group.
- The drug is indicated for the treatment of intra-abdominal infections, including appendicitis and peritonitis, caused by these organisms.
- Important consideration: When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy 2.
From the Research
Bacteroides Infections and Zosyn (Piperacillin/Tazobactam) Treatment
- Zosyn, a combination of piperacillin and tazobactam, is effective against a broad range of bacteria, including beta-lactamase-producing Bacteroides species 3.
- Tazobactam is an irreversible inhibitor of many beta-lactamases, which enhances the activity of piperacillin against beta-lactamase-producing bacteria, including Bacteroides 4, 3.
- Studies have shown that piperacillin/tazobactam has excellent activity against the Bacteroides fragilis group, making it a suitable option for the treatment of mixed anaerobic infections 3, 5.
Mechanism of Action and Spectrum of Activity
- Piperacillin is a broad-spectrum beta-lactam antibiotic that inhibits bacterial cell wall synthesis, while tazobactam inhibits beta-lactamases, which can degrade piperacillin 6, 4.
- The combination of piperacillin and tazobactam has a synergistic effect against many beta-lactamase-producing bacteria, including Bacteroides species 4, 3.
- Piperacillin/tazobactam has a broad spectrum of activity, encompassing most Gram-positive and Gram-negative aerobic and anaerobic bacteria, including many pathogens producing beta-lactamases 5.
Clinical Efficacy and Safety
- Clinical trials have demonstrated the efficacy of piperacillin/tazobactam in the treatment of various infections, including intra-abdominal, urinary tract, and skin/soft tissue infections 5.
- Piperacillin/tazobactam is generally well-tolerated, with gastrointestinal symptoms and skin reactions being the most common adverse events 5.
- However, a recent study found that piperacillin-tazobactam was not noninferior to meropenem in terms of 30-day mortality in patients with E coli or Klebsiella pneumoniae bloodstream infection and ceftriaxone resistance 7.