From the Guidelines
Zosyn (piperacillin/tazobactam) is not the preferred treatment for colitis, especially for Clostridioides difficile colitis, where oral vancomycin or fidaxomicin are recommended as first-line therapy. The choice of antibiotic for treating colitis should be guided by the specific cause of the condition and culture results when available. For bacterial colitis caused by susceptible organisms, Zosyn may be considered, but its broad spectrum can disrupt normal gut flora and potentially worsen certain types of colitis, particularly C. diff infection 1.
Key Considerations
- The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) recommends oral vancomycin or metronidazole for the treatment of Clostridioides difficile infection (CDI), with vancomycin being superior to metronidazole in cases of severe CDI 1.
- Zosyn's broad-spectrum activity can lead to the disruption of normal gut flora, which may exacerbate certain types of colitis, such as C. diff infection.
- The specific cause of colitis should always be determined before selecting treatment, and the choice of antibiotic should be guided by culture results when available.
Treatment Options
- For Clostridioides difficile colitis, oral vancomycin or fidaxomicin are preferred as first-line therapy 1.
- For bacterial colitis caused by susceptible organisms, Zosyn may be considered, but its use should be guided by culture results and the specific cause of the condition.
- For inflammatory bowel disease-related colitis, such as ulcerative colitis or Crohn's disease, Zosyn has no role, as these conditions require anti-inflammatory or immunomodulatory treatments.
From the Research
Effectiveness of Zosyn for Colitis
- Zosyn, a combination of piperacillin and tazobactam, has a broad spectrum of antibacterial activity, including Gram-positive and Gram-negative aerobic and anaerobic bacteria 2, 3.
- Studies have shown that piperacillin/tazobactam is effective in treating intra-abdominal infections, which can include colitis 2, 4, 3.
- Piperacillin/tazobactam has been shown to be effective against many of the bacteria that can cause colitis, including Enterobacteriaceae, anaerobic bacteria, and enterococci 2, 4, 3.
- However, the effectiveness of Zosyn for colitis may depend on the specific cause of the colitis and the susceptibility of the bacteria to piperacillin/tazobactam 4, 3.
Specific Studies
- A study published in 1993 found that piperacillin/tazobactam treatment decreased the numbers of enterobacteria, enterococci, bifidobacteria, eubacteria, lactobacilli, clostridia, and Gram-positive cocci in the bowel microflora of patients with intra-abdominal infections 5.
- A study published in 1999 found that piperacillin/tazobactam was effective in treating patients with intra-abdominal infections, including those with colitis 2.
- A study published in 2002 found that piperacillin/tazobactam was effective in treating patients with intra-abdominal infections caused by perforation of the large bowel and rectum or dehiscence of the anastomosis after resection of the large bowel and rectum 4.
- A study published in 2007 found that piperacillin/tazobactam was effective in treating patients with intra-abdominal infections, skin and soft tissue infections, lower respiratory tract infections, complicated urinary tract infections, gynecological infections, and febrile neutropenia 3.
Bacterial Coverage
- Piperacillin/tazobactam has been shown to be effective against a wide range of bacteria, including:
- Gram-negative aerobic bacteria, such as Enterobacteriaceae and Pseudomonas 2, 3
- Anaerobic bacteria, such as Bacteroides fragilis and Clostridium difficile 2, 6, 3
- Gram-positive bacteria, such as enterococci and Staphylococcus aureus 2, 3
- However, piperacillin/tazobactam may not be effective against all bacteria, such as those that produce AmpC beta-lactamases or extended-spectrum beta-lactamases 3.