From the Guidelines
Cefepime and Piperacillin/Tazobactam (Zosyn) have distinct coverage profiles, with Zosyn offering broader coverage, including anaeraders, due to its combination of a penicillin and a beta-lactamase inhibitor, whereas cefepime, a fourth-generation cephalosporin, lacks significant anaer coverage. The choice between these antibiotics should be guided by the suspected pathogens, local resistance patterns, and the need for anaer coverage 1.
Key Differences in Coverage
- Zosyn covers a wide range of gram-positive organisms, gram-negative bacteria including Pseudomonas, and anaerobes, making it suitable for infections where anaeraders are likely, such as intra-abdominal, pelvic, or aspiration pneumonia infections.
- Cefepime has good gram-positive and gram-negative coverage, including Pseudomonas, but it does not provide significant coverage against anaeraders, which may limit its use in certain types of infections.
Dosing Considerations
- Zosyn is typically dosed at 3.375g or 4.5g IV every 6-8 hours, with adjustments for renal function.
- Cefepime is usually dosed at 1-2g IV every 8-12 hours.
Clinical Decision Making
When deciding between cefepime and Zosyn, clinicians should consider the specific needs of the patient, including the type of infection, the likelihood of anaeraders being involved, and local antibiotic resistance patterns 1. For infections where anaer coverage is crucial, Zosyn may be the preferred choice, while cefepime could be considered for infections where anaer coverage is not necessary, or when there are concerns about antibiotic stewardship.
From the Research
Comparative Coverage of Cefepime versus Piperacillin/Tazobactam
- The comparative coverage of Cefepime (Cefepime) versus Piperacillin/Tazobactam (Zosyn) can be understood by examining their effectiveness against various bacterial infections 2.
- Cefepime/tazobactam has been found to be broadly active against Enterobacterales with AmpC enzymes and extended-spectrum β-lactamases (ESBLs), even when they have ertapenem resistance, suggesting porin loss 2.
- At 8+8 mg/L, the activity of cefepime/tazobactam extends to > 90% of Enterobacterales with OXA-48 and KPC carbapenemases, although the MICs for KPC producers belonging to the international Klebsiella pneumoniae ST258 lineage are higher 2.
- Cefepime/tazobactam is less active than ceftolozane/tazobactam against Pseudomonas aeruginosa with AmpC de-repression or high-level efflux but achieves wider antipseudomonal coverage than piperacillin/tazobactam 2.
- The spectrum of cefepime/tazobactam exceeds those of piperacillin/tazobactam and ceftolozane/tazobactam and resembles or exceeds that of carbapenems, making it a potential 'carbapenem-sparing' option 2.
Activity Against Specific Bacteria
- Piperacillin/tazobactam is effective against a broad spectrum of antibacterial activity, including most Gram-positive and Gram-negative aerobic bacteria and anaerobic bacteria, including many pathogens producing beta-lactamases 3.
- Cefepime/tazobactam has been found to be active against Pseudomonas aeruginosa, with a wider antipseudomonal coverage than piperacillin/tazobactam 2.
- The activity of cefepime/tazobactam against other non-fermenters is species-specific 2.
Clinical Implications
- The choice of antibiotic regimen, including cefepime or piperacillin/tazobactam, should be guided by the suspected or confirmed pathogen, the site and severity of infection, and the patient's previous risk of multidrug-resistant (MDR) pathogens 4, 5.
- Optimizing antibiotic use is essential to ensure successful outcomes and to reduce adverse antibiotic effects, as well as preventing drug resistance 5.
- Cefepime/tazobactam may be a useful option for the treatment of patients with infections caused by problem Gram-negative bacteria, including those with carbapenemase-producing organisms 2.