From the Guidelines
The recommended dose of Zosyn (piperacillin-tazobactam) for pneumonia is 4.5 grams administered intravenously every 6 hours for adults with normal renal function, as supported by the most recent and highest quality study 1.
Key Considerations
- This regimen should be continued for 7-10 days, depending on the severity of infection and clinical response, with adjustments made based on renal function and the specific pathogen involved 1.
- For patients with impaired kidney function, dose adjustment is necessary: for creatinine clearance 20-40 mL/min, reduce to 2.25 grams every 6 hours; for clearance less than 20 mL/min, reduce to 2.25 grams every 8 hours.
- Zosyn provides broad-spectrum coverage against many respiratory pathogens, including Pseudomonas aeruginosa, making it appropriate for hospital-acquired pneumonia or cases where resistant organisms are suspected 1.
Administration and Monitoring
- Infusion should be administered over 30 minutes, and patients should be monitored for allergic reactions, especially those with penicillin allergies.
- Complete the full course of therapy even if symptoms improve before completion, as recommended by guidelines for managing pneumonia 1.
Pathogen-Specific Considerations
- For Pseudomonas aeruginosa, stable hemodynamic status can be managed with piperacillin/tazobactam 4.5 g IV q6h, among other options 1.
- For carbapenem-resistant pathogens, colistin may be considered, with dosing adjusted based on creatinine clearance and hemodynamic status 1.
From the FDA Drug Label
1 Dosage in Adult Patients with Indications Other Than Nosocomial Pneumonia The usual total daily dosage of piperacillin and tazobactam for injection for adult patients with indications other than nosocomial pneumonia is 3.375 g every six hours [totaling 13.5 g (12 g piperacillin and 1. 5 g tazobactam)], to be administered by intravenous infusion over 30 minutes.
5 Community-acquired Pneumonia Piperacillin and tazobactam for injection, USP is indicated in adults for the treatment of community-acquired pneumonia (moderate severity only) caused by beta-lactamase producing isolates of Haemophilus influenzae.
The recommended dose and frequency of Zosyn (Piperacillin/Tazobactam) for community-acquired pneumonia is 3.375 g every six hours, administered by intravenous infusion over 30 minutes 2.
- Dose: 3.375 g
- Frequency: every six hours
- Administration: intravenous infusion over 30 minutes
- Indication: community-acquired pneumonia (moderate severity only) caused by beta-lactamase producing isolates of Haemophilus influenzae.
For nosocomial pneumonia, the recommended dose is 4.5 g every six hours, plus an aminoglycoside, administered by intravenous infusion over 30 minutes 2.
- Dose: 4.5 g
- Frequency: every six hours
- Administration: intravenous infusion over 30 minutes
- Indication: nosocomial pneumonia (moderate to severe) caused by beta-lactamase producing isolates of Staphylococcus aureus and by piperacillin and tazobactam-susceptible Acinetobacter baumannii, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa.
From the Research
Recommended Dose and Frequency of Zosyn (Piperacillin/Tazobactam) for Pneumonia
- The recommended dose and frequency of Zosyn (Piperacillin/Tazobactam) for pneumonia can vary depending on the severity of the infection and the patient's renal function 3.
- For patients with impaired renal function, a dose of 2.25 g three times daily or 4.5 g twice daily is commonly used 3.
- However, if pneumonia is severe or intractable, the dose frequency may be increased to 2.25 g four times daily and 4.5 g three times daily 3.
- Other studies have used different dosing regimens, such as 4.5 g every 6 hours 4 or 5 g every 12 hours 5.
- The efficacy and safety of piperacillin/tazobactam have been compared to other antibiotics, such as biapenem 6 and imipenem/cilastatin 5, in the treatment of pneumonia.
Factors Affecting Dose and Frequency
- Renal function is an important factor in determining the dose and frequency of piperacillin/tazobactam, as the drug can worsen renal function in patients with existing renal impairment 3.
- The severity of the infection and the presence of risk factors, such as aspiration, can also affect the choice of dose and frequency 5.
- Patient age and comorbidities, such as those found in late elderly patients, can also impact the tolerability and efficacy of piperacillin/tazobactam 6.
Clinical Efficacy and Safety
- Piperacillin/tazobactam has been shown to be effective in the treatment of pneumonia, including community-acquired and nosocomial pneumonia 7, 4.
- The drug has a broad spectrum of antibacterial activity and is effective against many Gram-positive and Gram-negative bacteria, including those producing beta-lactamases 7.
- However, piperacillin/tazobactam can cause adverse events, such as gastrointestinal symptoms and skin reactions, and can worsen renal function in patients with existing renal impairment 3, 6.