From the Guidelines
Piperacillin-tazobactam is generally preferred over cefpirome for empiric treatment of severe infections due to its broader coverage against gram-negative organisms, anaerobes, and many resistant pathogens. Cefpirome is a fourth-generation cephalosporin with good gram-positive and gram-negative coverage but lacks activity against anaerobes and certain resistant organisms. Piperacillin-tazobactam is typically dosed at 4.5g IV every 6-8 hours (adjusted for renal function), while cefpirome is usually given as 1-2g IV every 12 hours. According to the most recent guidelines for the treatment of infections due to multidrug-resistant organisms 1, piperacillin-tazobactam is recommended for the treatment of infections due to carbapenem-resistant Pseudomonas aeruginosa (CRPA) and difficult-to-treat P. aeruginosa (DTR-PA).
Some key points to consider when choosing between cefpirome and piperacillin-tazobactam include:
- Piperacillin-tazobactam has broader coverage against gram-negative organisms, anaerobes, and many resistant pathogens, making it a better choice for empiric treatment of severe infections.
- Cefpirome may be more appropriate for less severe infections or when narrower spectrum coverage is desired.
- Local resistance patterns should always guide antibiotic selection, as regional variations in susceptibility can significantly impact clinical effectiveness.
- Piperacillin-tazobactam is particularly valuable for intra-abdominal infections, healthcare-associated pneumonia, and febrile neutropenia due to its anti-pseudomonal activity and beta-lactamase inhibition from tazobactam.
- Both medications can cause allergic reactions, particularly in patients with penicillin allergies, though cefpirome may sometimes be used cautiously in patients with non-anaphylactic penicillin allergies.
It's also worth noting that the WHO's essential medicines and aware recommendations on first- and second-choice antibiotics for empiric treatment of clinical infections 1 list piperacillin-tazobactam as a first-choice antibiotic for necrotizing fasciitis, while cefpirome is not mentioned. Additionally, the guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia 1 suggest that combination therapy with piperacillin-tazobactam may be effective in the treatment of these infections.
From the Research
Comparison of Cefpirome and Piperacillin-Tazobactam
- Cefpirome is a fourth-generation cephalosporin with a broad spectrum of activity against Gram-positive and Gram-negative bacteria, including Pseudomonas aeruginosa 2.
- Piperacillin-tazobactam is a beta-lactam/beta-lactamase inhibitor combination with a broad spectrum of antibacterial activity, including activity against Pseudomonas aeruginosa 3, 4, 5, 6.
- Studies have shown that piperacillin-tazobactam is effective in the treatment of various infections, including lower respiratory tract infections, intra-abdominal infections, and urinary tract infections 3, 4, 5, 6.
- Cefpirome has been shown to have activity against a wide range of bacteria, including those resistant to other cephalosporins, but there is limited information available on its comparison with piperacillin-tazobactam.
- Piperacillin-tazobactam has been shown to be effective in the treatment of Pseudomonas aeruginosa infections, and extended-infusion dosing strategies have been found to improve clinical outcomes 3, 5.
Spectrum of Activity
- Cefpirome has a broad spectrum of activity against Gram-positive and Gram-negative bacteria, including Pseudomonas aeruginosa.
- Piperacillin-tazobactam has a broad spectrum of antibacterial activity, including activity against Pseudomonas aeruginosa, and is effective against a wide range of Gram-positive and Gram-negative bacteria.
- Piperacillin-tazobactam has been shown to be active against bacteria that produce beta-lactamases, including extended-spectrum beta-lactamases (ESBLs) and ampC cephalosporinases 6.
Clinical Use
- Piperacillin-tazobactam is commonly used in the treatment of various infections, including lower respiratory tract infections, intra-abdominal infections, and urinary tract infections.
- Cefpirome may be used as an alternative to piperacillin-tazobactam in certain situations, but there is limited information available on its comparison with piperacillin-tazobactam.
- Extended-infusion dosing strategies of piperacillin-tazobactam have been found to improve clinical outcomes in the treatment of Pseudomonas aeruginosa infections 3, 5.