What about Piperacillin/Tazobactam (Zosyn)?

From the Guidelines

Piperacillin/Tazobactam (Zosyn) is a recommended antibiotic for severe intra-abdominal infections, particularly in critically ill patients, due to its broad-spectrum activity against gram-positive, gram-negative, and anaerobic organisms, including Pseudomonas aeruginosa 1.

Key Points

• Piperacillin/Tazobactam has good tissue penetration into the pancreas and is effective against gram-negative microorganisms, making it a suitable option for infected necrosis 1.
• It is listed as a first-choice option for severe intra-abdominal infections, particularly in critically ill patients, and is considered more appropriate than other antibiotics such as ceftazidime and aminoglycosides 1.
• The use of Piperacillin/Tazobactam in patients with ESBL-producing infections is still controversial, but it may be a therapeutic option in stable patients 1.
• Continuous infusion of Piperacillin/Tazobactam has been shown to improve clinical cure rates and reduce mortality in critically ill patients, particularly those with severe sepsis or high-risk mortality 1.

Dosage and Administration

• The recommended dosage of Piperacillin/Tazobactam is typically 4.5 g every 6-8 hours, but may vary depending on the patient's renal function and the severity of the infection 1.
• Continuous infusion of Piperacillin/Tazobactam over 4 hours has been shown to be effective in critically ill patients, but the optimal duration of infusion is still debated 1.

Resistance and Limitations

• The use of Piperacillin/Tazobactam should be limited to preserve its activity, particularly in areas with high rates of carbapenem-resistant Enterobacteriaceae 1.
• Piperacillin/Tazobactam is not effective against MRSA or vancomycin-resistant enterococci, and alternative antibiotics should be used in patients with suspected or proven infections caused by these organisms 1.

From the FDA Drug Label

Piperacillin and tazobactam for injection is a combination of piperacillin, a penicillin-class antibacterial and tazobactam, a beta-lactamase inhibitor, indicated for the treatment of: Intra-abdominal infections in adult and pediatric patients 2 months of age and older (1.1) Nosocomial pneumonia in adult and pediatric patients 2 months of age and older (1. 2) Skin and skin structure infections in adults (1.3) Female pelvic infections in adults (1.4) Community-acquired pneumonia in adults (1. 5)

Piperacillin/Tazobactam (Zosyn) is a combination antibiotic used to treat various infections, including:

• Intra-abdominal infections
• Nosocomial pneumonia
• Skin and skin structure infections
• Female pelvic infections
• Community-acquired pneumonia 2

From the Research

Overview of Piperacillin/Tazobactam

Piperacillin/Tazobactam, also known as Zosyn, is a beta-lactam/beta-lactamase inhibitor combination with a broad spectrum of antibacterial activity 3, 4, 5, 6, 7. This combination encompasses most Gram-positive and Gram-negative aerobic bacteria and anaerobic bacteria, including many pathogens producing beta-lactamases.

Spectrum of Activity

The spectrum of activity of Piperacillin/Tazobactam includes:

• Gram-positive organisms such as staphylococci and streptococci
• Gram-negative aerobic and anaerobic bacteria
• Many beta-lactamase-producing bacteria, including those with extended-spectrum beta-lactamases 3, 4, 5, 6, 7

Clinical Efficacy

Piperacillin/Tazobactam has been shown to be effective in the treatment of various infections, including:

• Lower respiratory tract infections
• Intra-abdominal infections
• Urinary tract infections
• Gynaecological infections
• Skin and soft tissue infections
• Fever in patients with neutropenia 3, 4, 5, 6, 7

Comparison with Other Antibiotics

Piperacillin/Tazobactam has been compared to other antibiotics in clinical trials, with results showing:

• Superiority to ticarcillin/clavulanic acid in the treatment of lower respiratory tract infections 3, 7
• Equivalent or better efficacy than imipenem/cilastatin and clindamycin plus gentamicin in the treatment of intra-abdominal infections 3, 7
• Comparable efficacy to ceftazidime plus amikacin in the treatment of ventilator-associated pneumonia and febrile neutropenia 3

Safety and Tolerability

Piperacillin/Tazobactam is generally well tolerated, with common adverse events including:

• Gastrointestinal symptoms (most commonly diarrhea)
• Skin reactions
• The incidence of adverse events is higher when the combination is given with an aminoglycoside than when given as monotherapy 3, 4, 5, 6, 7