From the Guidelines
For diverticulitis with abscess that has failed treatment with ceftriaxone, metronidazole, and amoxicillin/clavulanate, the recommended dosing for Zosyn (piperacillin/tazobactam) is 3.375 g every 6 hours. This recommendation is based on the guidelines for the diagnosis and management of complicated intra-abdominal infection in adults and children, as outlined in the Clinical Infectious Diseases journal 1.
Key Considerations
- The dosage of 3.375 g every 6 hours is for adults with normal renal and hepatic function.
- For patients with renal impairment, dose adjustments are necessary:
- For creatinine clearance 20-40 mL/min, use 2.25g every 6 hours.
- For clearance <20 mL/min, use 2.25g every 8 hours.
- Hemodialysis patients should receive 2.25g every 8 hours plus an additional 0.75g after each dialysis session.
Rationale
Zosyn is appropriate in this scenario because it provides broader coverage against gram-negative organisms, anaerobes, and some gram-positives that may be resistant to previous antibiotics, as indicated by the treatment failure with ceftriaxone, metronidazole, and amoxicillin/clavulanate. The combination of piperacillin (a penicillin) with tazobactam (a beta-lactamase inhibitor) helps overcome certain resistance mechanisms.
Monitoring and Additional Therapy
Monitor for improvement in clinical symptoms, white blood cell count, and fever. Consider drainage of any abscess >3cm in addition to antibiotic therapy for optimal outcomes, as the treatment of diverticulitis with abscess often requires a multifaceted approach including both medical and surgical interventions.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Recommended Dosing for Zosyn (Piperacillin/Tazobactam)
- The recommended dosing for Zosyn (piperacillin/tazobactam) in the treatment of diverticulitis with abscess is not explicitly stated in the provided studies.
- However, according to the study 2, piperacillin-tazobactam was administered to 14 patients, and it was associated with a lower therapeutic failure rate compared to amoxicillin-clavulanic acid.
- The study 3 mentions that piperacillin and tazobactam are antibiotics that have been successfully used in clinical practice for the treatment of severe and complicated diverticulitis.
Treatment of Diverticulitis with Abscess
- The study 4 suggests that antibiotics alone can be used as initial treatment for selected patients with large diverticular abscess, with a failure rate of 25%.
- The study 2 found that surgical treatment was associated with a lower risk of recurrence in patients with abscess >4 cm, compared to antibiotics.
- The study 5 recommends non-operative management, including bowel rest and intravenous antibiotics, for small abscesses, and percutaneous drainage for larger abscesses of 3-5 cm.
Antibiotic Therapy
- The study 6 found that outpatient treatment with antibiotics is feasible and safe for uncomplicated and mild complicated diverticulitis.
- The study 2 found that amoxicillin-clavulanic acid was associated with a higher therapeutic failure rate than piperacillin-tazobactam/ciprofloxacin + metronidazole.
- The study 5 recommends the use of antibiotics selectively for patients with uncomplicated diverticulitis, and intravenous antibiotics for patients with complicated diverticulitis.