From the Guidelines
Piperacillin-tazobactam is an effective treatment for E. coli infections, and the recommended dose is 4.5 g every 6 hours for critically ill patients, as stated in the 2017 WSES guidelines for management of intra-abdominal infections 1.
Treatment Considerations
When treating E. coli infections with piperacillin-tazobactam, it is essential to consider the severity of the infection, the patient's renal function, and the potential for resistance.
- The typical treatment duration is 7-14 days, depending on the infection severity and site.
- Dose adjustments are necessary for patients with renal impairment, with reduced dosing or extended intervals based on creatinine clearance.
- Piperacillin-tazobactam works by piperacillin inhibiting bacterial cell wall synthesis while tazobactam prevents bacterial beta-lactamase enzymes from inactivating piperacillin.
Resistance and Susceptibility
Piperacillin-tazobactam is particularly valuable for treating resistant E. coli strains, including many extended-spectrum beta-lactamase (ESBL) producers, though susceptibility testing is still recommended to confirm effectiveness 1.
- The use of piperacillin-tazobactam in patients with ESBLs infections is still controversial, even if in stable patients, it may be still a therapeutic chance.
- Carbapenems offer a wide spectrum of antimicrobial activity against gram-positive and gram-negative aerobic and anaerobic pathogens, but their use should be limited to preserve activity of this class of antibiotics due to the concern of emerging carbapenem-resistance 1.
Monitoring and Side Effects
Patients should be monitored for allergic reactions, especially those with penicillin allergies.
- Blood tests to monitor kidney function and complete blood counts are recommended during treatment.
- Common side effects include diarrhea, headache, and nausea.
From the FDA Drug Label
Piperacillin and Tazobactam for Injection is indicated in adults and pediatric patients (2 months of age and older) for the treatment of appendicitis (complicated by rupture or abscess) and peritonitis caused by beta-lactamase producing isolates of Escherichia coli Piperacillin and Tazobactam for Injection is indicated in adults for the treatment of postpartum endometritis or pelvic inflammatory disease caused by beta-lactamase producing isolates of Escherichia coli.
Treatment of E. coli with Piperacillin-Tazobactam:
- Piperacillin-Tazobactam is indicated for the treatment of infections caused by beta-lactamase producing isolates of E. coli, including:
- Intra-abdominal infections (such as appendicitis and peritonitis)
- Female pelvic infections (such as postpartum endometritis or pelvic inflammatory disease)
- The usual total daily dosage of piperacillin and tazobactam for injection for adult patients with indications other than nosocomial pneumonia is 3.375 grams every six hours, totaling 13.5 grams (12.0 grams piperacillin and 1.5 grams tazobactam) 2
From the Research
Treatment of E. coli with Piperacillin-Tazobactam
- The efficacy of piperacillin-tazobactam in treating E. coli infections has been studied in various clinical trials 3, 4, 5, 6.
- A study published in 1994 found that piperacillin-tazobactam was effective in treating complicated urinary tract infections, including those caused by E. coli, with a clinical cure rate of 86% and a bacteriological response rate of 73% 3.
- Another study published in 2020 found that piperacillin-tazobactam was effective in treating nonbacteremic urinary tract infections caused by ESBL-producing Enterobacteriaceae, including E. coli, with a clinical response rate of 74.4% 4.
- A randomized controlled trial published in 2017 found that piperacillin-tazobactam was effective in treating urinary tract infections caused by ESBL-producing E. coli, with a clinical response rate of 94% 5.
- A multicenter observational study published in 2020 found that piperacillin-tazobactam was a reasonable alternative to carbapenems for the management of ESBL-producing pyelonephritis, including those caused by E. coli, with no differences in clinical outcomes or recurrence rates 6.
Efficacy against ESBL-Producing E. coli
- The efficacy of piperacillin-tazobactam against ESBL-producing E. coli has been studied in several clinical trials 7, 4, 5, 6.
- A study published in 2017 found that ceftolozane-tazobactam was effective against ESBL-producing E. coli, with a clinical cure rate of 97.4% 7.
- Another study published in 2020 found that piperacillin-tazobactam was effective against ESBL-producing E. coli, with a clinical response rate of 74.4% 4.
- A randomized controlled trial published in 2017 found that piperacillin-tazobactam was effective against ESBL-producing E. coli, with a clinical response rate of 94% 5.
- A multicenter observational study published in 2020 found that piperacillin-tazobactam was a reasonable alternative to carbapenems for the management of ESBL-producing pyelonephritis, including those caused by E. coli, with no differences in clinical outcomes or recurrence rates 6.
Comparison with Other Antibiotics
- The efficacy of piperacillin-tazobactam has been compared to other antibiotics, including carbapenems and cefepime, in several clinical trials 7, 4, 5, 6.
- A study published in 2017 found that ceftolozane-tazobactam was more effective than levofloxacin and meropenem against ESBL-producing E. coli 7.
- Another study published in 2020 found that piperacillin-tazobactam was as effective as carbapenems in treating nonbacteremic urinary tract infections caused by ESBL-producing Enterobacteriaceae, including E. coli 4.
- A randomized controlled trial published in 2017 found that piperacillin-tazobactam was more effective than cefepime in treating urinary tract infections caused by ESBL-producing E. coli 5.
- A multicenter observational study published in 2020 found that piperacillin-tazobactam was a reasonable alternative to carbapenems for the management of ESBL-producing pyelonephritis, including those caused by E. coli, with no differences in clinical outcomes or recurrence rates 6.