What is the coverage of Zosyn (Piperacillin/Tazobactam)?

From the Guidelines

Zosyn (piperacillin-tazobactam) is a broad-spectrum antibiotic that covers many gram-positive, gram-negative, and anaerobic bacteria, including Streptococcus species, Enterococcus species, Escherichia coli, Klebsiella species, Pseudomonas aeruginosa, and Bacteroides fragilis, as supported by the 2022 study published in the Journal of Microbiology, Immunology and Infection 1.

Key Points:

• Zosyn is effective against a wide range of pathogens, making it a suitable option for moderate to severe infections such as intra-abdominal infections, pneumonia, skin and soft tissue infections, and febrile neutropenia.
• The standard adult dose is usually 3.375g or 4.5g every 6-8 hours, with adjustments needed for patients with renal impairment, as recommended by the 2010 guidelines published in Clinical Infectious Diseases 1.
• Zosyn works by inhibiting bacterial cell wall synthesis, causing bacterial cell death, but it does not cover MRSA, most Enterococcus faecium, or ESBL-producing organisms, so additional coverage may be needed if these pathogens are suspected, as noted in the 2017 guidelines published in the World Journal of Emergency Surgery 1.
• The choice of empiric antibiotic regimens, including Zosyn, should be based on the clinical condition of the patients, the individual risk for infection by resistant pathogens, and the local resistance epidemiology, as recommended by the 2017 guidelines published in the World Journal of Emergency Surgery 1.

Spectrum of Activity:

• Gram-positive bacteria: Streptococcus species, Enterococcus species
• Gram-negative bacteria: Escherichia coli, Klebsiella species, Pseudomonas aeruginosa
• Anaerobic bacteria: Bacteroides fragilis

Limitations:

• Does not cover MRSA, most Enterococcus faecium, or ESBL-producing organisms
• May require additional coverage for these pathogens if suspected

Dosage and Administration:

• Standard adult dose: 3.375g or 4.5g every 6-8 hours
• Adjustments needed for patients with renal impairment

Clinical Use:

• Moderate to severe infections: intra-abdominal infections, pneumonia, skin and soft tissue infections, febrile neutropenia
• Typically administered intravenously in hospital settings

From the FDA Drug Label

ZOSYN 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)

Zosyn covers the treatment of intra-abdominal infections, nosocomial pneumonia, skin and skin structure infections, female pelvic infections, and community-acquired pneumonia in adults and pediatric patients 2 months of age and older 2.

• Key indications include:
  • Intra-abdominal infections
  • Nosocomial pneumonia
  • Skin and skin structure infections
  • Female pelvic infections
  • Community-acquired pneumonia

From the Research

Zosyn Coverage

Zosyn, also known as piperacillin-tazobactam, is a broad-spectrum antibiotic used to treat various bacterial infections. The coverage of Zosyn includes:

• Gram-positive bacteria, such as Staphylococcus spp. and Streptococcus spp. 3
• Gram-negative bacteria, including Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae 4, 5, 6, 3
• Anaerobic bacteria, such as Bacillus spp. and Corynebacterium spp. 3

Specific Organisms Covered

Some specific organisms that Zosyn has been shown to be effective against include:

• Pseudomonas aeruginosa, with a susceptibility rate of 79.5% 3
• Escherichia coli, including ESBL-producing strains 5, 3
• Klebsiella pneumoniae, including ESBL-producing strains 5, 3
• Streptococcus spp., including penicillin-resistant strains 3
• Haemophilus influenzae, including ampicillin-resistant strains 3

Resistance and Limitations

However, Zosyn may not be effective against all bacterial strains, particularly those with certain resistance mechanisms, such as:

• ESBL-producing strains of Enterobacteriaceae, which may require alternative treatments 5, 3
• AmpC hyperproducing strains, which may have reduced susceptibility to Zosyn 3
• Vancomycin-resistant enterococci, which may require alternative treatments 3