From the Guidelines
Yes, a patient can be treated with Zosyn (piperacillin/tazobactam) for a urinary tract infection, specifically complicated urinary tract infections, as it is listed as a recommended treatment option for infections due to carbapenem-resistant Pseudomonas aeruginosa (CRPA) susceptible to other antimicrobial agents, with a suggested treatment duration of 5-10 days 1.
Key Points
- The recommended dose of piperacillin/tazobactam is 3.375-4.5 g IV q6h (every 6 hours) 1.
- Aminoglycoside monotherapy, such as amikacin, is only indicated for urinary tract infections, but anti-pseudomonal penicillins or cephalosporins combined with aminoglycosides may be considered when the antimicrobial susceptibility testing results are interpreted as susceptible 1.
- The treatment duration should be individualized according to infection sites, source control, underlying comorbidities, and the initial response to therapy, with a suggested treatment course of 5-10 days for complicated urinary tract infections 1.
Considerations
- The use of piperacillin/tazobactam should be guided by antimicrobial susceptibility testing results, and the treatment should be adjusted accordingly 1.
- The patient's renal function, specifically creatinine clearance, should be considered when determining the dose of colistin, which may be used in combination with other antimicrobial agents for the treatment of CRPA infections 1.
From the Research
Treatment of Urinary Tract Infections with Zosyn (Piperacillin/Tazobactam)
- Zosyn (piperacillin/tazobactam) has been studied as a treatment for urinary tract infections (UTIs) in several clinical trials 2, 3, 4, 5, 6.
- The studies have shown that piperacillin/tazobactam is effective against a broad range of gram-negative and gram-positive bacteria, including Escherichia coli, Proteus mirabilis, and Pseudomonas aeruginosa 2, 3, 4.
- In a study of 217 patients with complicated UTIs, piperacillin/tazobactam was administered intravenously at a dosage of 4 g/500 mg every 8 hours, resulting in a clinical cure or improvement in 86% of patients and a bacteriological response rate of 73% at endpoint 2.
- Another study compared the antibacterial activity of tazobactam-piperacillin with that of sulbactam-ampicillin, clavulanic acid-ticarcillin, sulbactam-cefoperazone, and piperacillin against beta-lactamase-producing bacteria isolated from patients with complicated UTIs, and found that tazobactam-piperacillin had a broad antibacterial spectrum and was at least 4- to 64-fold stronger than the other antibiotics tested 3.
- A multicentered, prospective, and open study of 79 adult patients with complicated UTIs requiring hospitalization found that piperacillin/tazobactam (4g/500 mg IV tid) resulted in a favorable clinical response in 83.6% of patients and bacteriological eradication in 85.3% of patients 4.
- A randomized clinical trial comparing cefepime/enmetazobactam with piperacillin/tazobactam in patients with complicated UTIs or acute pyelonephritis found that cefepime/enmetazobactam was superior to piperacillin/tazobactam in terms of clinical cure and microbiological eradication 5.
- Piperacillin-tazobactam has been shown to be effective for the treatment of patients with complicated UTIs, and has an excellent safety and tolerability profile 6.