Does Tazocin (piperacillin/tazobactam) cover Pseudomonas?

From the Guidelines

Tazocin (piperacillin/tazobactam) is recommended for the treatment of infections due to Pseudomonas aeruginosa, particularly when the antimicrobial susceptibility testing results are interpreted as susceptible, as stated in the 2022 guidelines 1.

Key Points

• The combination of piperacillin and tazobactam provides broad-spectrum activity against Pseudomonas aeruginosa.
• The typical adult dosage is 3.375-4.5 g IV q6h, with adjustments needed for patients with renal impairment.
• Tazocin is effective against Pseudomonas because piperacillin has good activity against this organism, and the addition of tazobactam protects piperacillin from degradation by certain beta-lactamases.
• Resistance can develop, particularly in healthcare settings with high antibiotic use or in patients with previous Pseudomonas infections.
• When treating suspected or confirmed Pseudomonas infections, it's essential to obtain cultures before starting therapy when possible, and to reassess based on culture results and clinical response.
• In severe infections or high-risk patients, combination therapy with an aminoglycoside or fluoroquinolone might be considered to enhance efficacy and reduce the risk of resistance development, as suggested in the 2007 guidelines 1.

Considerations

• The 2022 guidelines 1 provide the most recent and highest quality evidence for the treatment of infections due to multidrug-resistant organisms, including Pseudomonas aeruginosa.
• The 2010 guidelines 1 provide additional information on the diagnosis and management of complicated intra-abdominal infection, but are not as relevant to the treatment of Pseudomonas aeruginosa.
• The 2007 guidelines 1 provide information on the management of community-acquired pneumonia, including the treatment of Pseudomonas aeruginosa, but are not as recent or high-quality as the 2022 guidelines.

From the FDA Drug Label

Piperacillin and tazobactam for injection, USP is indicated in adults and pediatric patients (2 months of age and older) for the treatment of nosocomial pneumonia (moderate to severe) caused by beta-lactamase producing isolates of ... Pseudomonas aeruginosa (Nosocomial pneumonia caused by P. aeruginosa should be treated in combination with an aminoglycoside)

Piperacillin and tazobactam has been shown to be active against most isolates of the following microorganisms, both in vitro and in clinical infections ... Pseudomonas aeruginosa (given in combination with an aminoglycoside to which the isolate is susceptible)

Tazocin (piperacillin/tazobactam) covers Pseudomonas, but only when given in combination with an aminoglycoside to which the isolate is susceptible 2.

From the Research

Coverage of Pseudomonas by Tazocin (Piperacillin/Tazobactam)

• Tazocin (piperacillin/tazobactam) has been studied for its effectiveness against Pseudomonas aeruginosa in various settings 3, 4, 5, 6, 7.
• The studies suggest that piperacillin/tazobactam can be effective against Pseudomonas aeruginosa, but the efficacy depends on the dosage regimen and the susceptibility of the isolate 3, 5, 6.
• A study from 2007 found that extended-infusion piperacillin/tazobactam therapy was associated with improved outcomes in critically ill patients with P. aeruginosa infection 3.
• Another study from 2022 found that the combination of piperacillin/tazobactam and tobramycin was synergistic against P. aeruginosa isolates, but the efficacy depended on the dosage regimen and the pharmacokinetics of the drugs 5.
• A 2023 study found that high-doses and extended infusion of piperacillin/tazobactam were needed to optimize exposure against carbapenem-resistant P. aeruginosa isolates that were susceptible to piperacillin/tazobactam 6.
• However, a 2008 study found that empirical piperacillin/tazobactam therapy was associated with increased mortality in patients with P. aeruginosa bacteremia due to isolates with reduced susceptibility to piperacillin/tazobactam 7.

Key Findings

• Piperacillin/tazobactam can be effective against Pseudomonas aeruginosa, but the efficacy depends on the dosage regimen and the susceptibility of the isolate.
• Extended-infusion piperacillin/tazobactam therapy may be associated with improved outcomes in critically ill patients with P. aeruginosa infection.
• High-doses and extended infusion of piperacillin/tazobactam may be needed to optimize exposure against carbapenem-resistant P. aeruginosa isolates that are susceptible to piperacillin/tazobactam.
• Empirical piperacillin/tazobactam therapy may be associated with increased mortality in patients with P. aeruginosa bacteremia due to isolates with reduced susceptibility to piperacillin/tazobactam.