What is the recommended use and dosage of Cefoperazone/Sulbactam with Amikacin?

From the Guidelines

Cefoperazone/Sulbactam with Amikacin is recommended for serious infections, particularly those caused by Pseudomonas aeruginosa, with a dosage of 4g IV q12h for Cefoperazone/Sulbactam and 20mg/kg/day for Amikacin, with treatment duration typically ranging from 7-14 days. The combination of Cefoperazone/Sulbactam with Amikacin is typically used for hospital-acquired pneumonia, complicated intra-abdominal infections, or sepsis caused by susceptible organisms, including Pseudomonas aeruginosa 1.

• The standard adult dosage for Cefoperazone/Sulbactam is 4g IV q12h, as indicated for Pseudomonas aeruginosa infections.
• Amikacin is usually dosed at 20mg/kg/day, with a typical adult dose being 500mg every 12 hours or 350mg every 8 hours.
• Renal function must be monitored closely as both medications require dose adjustment in patients with impaired kidney function.
• Treatment duration typically ranges from 7-14 days depending on infection severity and clinical response.
• Therapeutic drug monitoring is essential for Amikacin to maintain peak levels between 20-30 μg/mL and trough levels below 8 μg/mL to prevent toxicity. This combination provides synergistic activity against many gram-negative bacteria, with Cefoperazone/Sulbactam targeting cell wall synthesis while Amikacin inhibits bacterial protein synthesis, making it effective against resistant strains, including Pseudomonas aeruginosa, as indicated in the guidelines for the treatment of pneumonia in Taiwan 1. However, this powerful combination should be reserved for serious infections to minimize the development of antimicrobial resistance. Key considerations include monitoring renal function, adjusting doses as necessary, and using therapeutic drug monitoring for Amikacin to ensure efficacy and prevent toxicity.

From the Research

Recommended Use and Dosage of Cefoperazone/Sulbactam with Amikacin

The recommended use and dosage of Cefoperazone/Sulbactam with Amikacin can be determined based on the following studies:

• Cefoperazone/Sulbactam is effective in treating hospital-acquired and healthcare-associated pneumonia, with a recommended dosage of 2g every 12 hours 2.
• Amikacin can be given once daily at a dose of 15 mg/kg body weight, combined with other antibiotics, for severe community and hospital-acquired bacterial infections 3.
• The combination of Cefoperazone/Sulbactam with Amikacin may be effective in treating intra-abdominal infections, with a recommended dosage of 2-8 g/day for Cefoperazone/Sulbactam and 15 mg/kg/day for Amikacin 4.

Key Findings

• Cefoperazone/Sulbactam has been shown to be non-inferior to cefepime in the treatment of hospital-acquired and healthcare-associated pneumonia 2.
• Amikacin given once daily has been shown to be practical and probably efficacious and safe in severely infected patients 3.
• The pharmacokinetics of Cefoperazone and Sulbactam in combination have been evaluated in elderly, seriously ill patients, with results showing that both drugs are present in potentially therapeutic concentrations for the entire 12-h dosing interval 5.

Dosage and Administration

• Cefoperazone/Sulbactam: 2g every 12 hours 2.
• Amikacin: 15 mg/kg body weight once daily 3.
• The combination of Cefoperazone/Sulbactam with Amikacin may be effective in treating intra-abdominal infections, with a recommended dosage of 2-8 g/day for Cefoperazone/Sulbactam and 15 mg/kg/day for Amikacin 4.

Important Considerations

• The risk of nephrotoxicity may be decreased with a once-daily dosing regimen of Amikacin 3.
• Hypoprothrombinemia may occur in patients treated with Cefoperazone, especially in those with serum albumin concentrations below 3.5 g/dl 6.
• The incidence of treatment-related adverse events was lower in patients treated with Cefoperazone/Sulbactam compared to those treated with ceftazidime-amikacin-metronidazole 4.