From the Guidelines
Cefepime and Tazocin (piperacillin-tazobactam) have distinct differences in their antimicrobial coverage spectrum, with Tazocin offering broader coverage, including anaerobes and many ESBL-producing organisms, making it a preferred choice for intra-abdominal, polymicrobial, and anaerobic infections. The choice between cefepime and Tazocin depends on several factors, including the suspected pathogens, infection site, local resistance patterns, and patient factors such as allergies and renal function.
- Cefepime is a fourth-generation cephalosporin that covers many gram-positive and gram-negative bacteria, including Pseudomonas aeruginosa, but lacks activity against anaerobes, MRSA, and many ESBL-producing organisms 1.
- Tazocin combines piperacillin (a penicillin) with tazobactam (a beta-lactamase inhibitor), providing broader coverage that includes gram-positives, gram-negatives, Pseudomonas, and importantly, anaerobes and many ESBL producers 2.
- The key practical difference is that Tazocin offers superior coverage for intra-abdominal, polymicrobial, and anaerobic infections, as recommended by recent guidelines for the treatment of infections due to multidrug-resistant organisms 2.
- Cefepime is typically dosed at 1-2g IV every 8-12 hours, while Tazocin is usually given as 4.5g IV every 6-8 hours, with both requiring dose adjustments in renal impairment 3.
- When choosing between them, consider the suspected pathogens, infection site, local resistance patterns, and patient factors such as allergies and renal function, as well as the latest recommendations from the World Health Organization's essential medicines and aware: recommendations on first- and second-choice antibiotics for empiric treatment of clinical infections 3.
From the Research
Antibiotic Coverage Comparison
The difference between cefepime and Tazocin (piperacillin/tazobactam) coverage can be understood by examining their effectiveness against various bacterial infections.
- Cefepime has been shown to possess in vitro potencies against methicillin-sensitive Staphylococcus aureus (MSSA) and current clinical strains of Gram-negative bacilli, many of which harbor resistance to other antimicrobial agents 4.
- Piperacillin/tazobactam, on the other hand, has a broad spectrum of antibacterial activity encompassing most Gram-positive and Gram-negative aerobic bacteria and anaerobic bacteria, including many pathogens producing beta-lactamases 5.
Spectrum of Activity
- Cefepime was more active against Enterobacteriaceae than ceftazidime, with 93% of isolates susceptible to cefepime compared to 72% susceptible to ceftazidime 4.
- Piperacillin/tazobactam has been shown to be effective against a wide range of bacterial infections, including lower respiratory tract, intra-abdominal, urinary tract, gynaecological, and skin/soft tissue infections 5.
Clinical Outcomes
- A study comparing cefepime with piperacillin/tazobactam treatment in patients with hospital-acquired pneumonia found that treatment outcomes, including rates of in-hospital mortality, pneumonia-related readmission, and all-cause mortality within 6 months after discharge, were comparable between the two groups 6.
- Another study found that cefepime/enmetazobactam was noninferior to piperacillin/tazobactam for the primary outcome of treatment efficacy in patients with complicated urinary tract infections or acute pyelonephritis, and even demonstrated superiority 7.
Resistance Patterns
- Cefepime has been shown to be effective against bacteria that produce extended-spectrum beta-lactamases (ESBL), with 96% of Gram-negative bacilli tested being susceptible to cefepime 4.
- Piperacillin/tazobactam has also been shown to be effective against bacteria that produce beta-lactamases, although the incidence of resistance may vary depending on the specific bacterial isolate 5.