From the FDA Drug Label
12 CLINICAL PHARMACOLOGY
12.1 Mechanism of Action Piperacillin and tazobactam is an antibacterial drug [see Microbiology (12.4)].
Distribution Both piperacillin and tazobactam are widely distributed into tissues and body fluids including intestinal mucosa, gallbladder, lung, female reproductive tissues (uterus, ovary, and fallopian tube), interstitial fluid, and bile. Mean tissue concentrations are generally 50% to 100% of those in plasma Distribution of piperacillin and tazobactam into cerebrospinal fluid is low in subjects with non-inflamed meninges, as with other penicillins Table 9: Piperacillin and Tazobactam Concentrations in Selected Tissues and Fluids after Single 4 gram/0. 5 gram 30-min IV Infusion of Piperacillin and Tazobactam for Injection Proximal Intestinal Mucosa 7 1.5 to 2.5 31.4 0.55 10.3 1.15 Distal Intestinal Mucosa 7 1.5 to 2.5 31.2 0.59 14.5 2.1
Piperacillin-tazobactam can be used for the treatment of stercoral colitis due to its distribution into intestinal mucosa.
- The drug is distributed into proximal and distal intestinal mucosa, with mean tissue concentrations generally 50% to 100% of those in plasma.
- Piperacillin and tazobactam achieve therapeutic concentrations in the intestinal mucosa, which may be effective against the bacteria causing stercoral colitis 1
From the Research
Antibiotics for stercoral colitis should include broad-spectrum coverage targeting gram-negative, gram-positive, and anaerobic bacteria, with a recommended regimen being piperacillin-tazobactam 3.375g IV every 6 hours or 4.5g IV every 8 hours, or alternatively, a combination of ceftriaxone 1-2g IV daily plus metronidazole 500mg IV every 8 hours, as supported by the most recent study 2.
Key Considerations
- Treatment duration typically ranges from 7-14 days depending on clinical response.
- These antibiotics are essential because stercoral colitis involves fecal impaction causing pressure necrosis of the colon wall, which can lead to bacterial translocation and potential perforation, as described in 3 and 2.
- However, antibiotics alone are insufficient; treatment must also include fecal disimpaction, bowel regimen optimization, and IV fluids.
- Surgical consultation is necessary for cases with signs of perforation or clinical deterioration, as highlighted in 4 and 2.
Important Factors
- Patients should be monitored closely with serial abdominal exams and laboratory studies to assess treatment response and detect complications early.
- The choice of antibiotics should consider the risk of Clostridium difficile infection, as discussed in 5.
- The most recent study 2 provides the highest quality evidence for guiding the management of stercoral colitis, including the use of broad-spectrum antibiotics and the importance of prompt diagnosis and treatment.
Management Approach
- A thorough history and physical examination are crucial in diagnosing stercoral colitis, as emphasized in 3 and 2.
- Imaging, especially CT, plays a vital role in the diagnosis of stercoral colitis, demonstrating hallmark features such as fecal impaction and a large colorectal stool burden, as described in 2.
- The overlap of findings between stercoral colitis and other colonic diseases can sometimes make diagnosis challenging, as noted in 2.