From the Guidelines
For post-obstructive hospitalization pneumonia, Zosyn (piperacillin-tazobactam) is the preferred empiric antibiotic therapy due to its broad-spectrum activity, including coverage against Pseudomonas aeruginosa and other gram-negative organisms. According to the 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society 1, the recommended initial empiric antibiotic therapy for hospital-acquired pneumonia (non-ventilator-associated pneumonia) includes piperacillin-tazobactam 4.5 g IV q6h, among other options.
Key Considerations
- The dosage of Zosyn should be adjusted for renal impairment, and treatment duration typically ranges from 7-14 days depending on clinical response.
- Post-obstructive pneumonia often involves mixed bacterial pathogens, including anaerobes and gram-negative organisms, which Zosyn provides excellent coverage against.
- While certain cephalosporins (like ceftazidime or cefepime) could be alternatives, they generally require addition of anaerobic coverage.
- It is essential to monitor for clinical improvement within 48-72 hours, including fever resolution, improved oxygenation, and decreasing white blood cell count.
- Consider narrowing therapy based on culture results if available, and ensure the underlying obstruction has been adequately addressed to prevent recurrence.
Empiric Antibiotic Therapy Options
- Piperacillin-tazobactam 4.5 g IV q6h
- Cefepime 2 g IV q8h
- Levofloxacin 750 mg IV daily
- Imipenem 500 mg IV q6h
- Meropenem 1 g IV q8h
- Aztreonam 2 g IV q8h (if patient has severe penicillin allergy)
Note that the choice of empiric antibiotic therapy should be based on the patient's risk of mortality, factors increasing the likelihood of MRSA, and local antimicrobial resistance patterns, as outlined in the guidelines 1.
From the FDA Drug Label
- 2 Nosocomial Pneumonia Piperacillin and tazobactam for injection, USP is indicated in adults and pediatric patients (2 months of age and older) for the treatment of nosocomial pneumonia (moderate to severe) caused by beta-lactamase producing isolates of Staphylococcus aureus and by piperacillin and tazobactam-susceptible Acinetobacter baumannii, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa (Nosocomial pneumonia caused by P. aeruginosa should be treated in combination with an aminoglycoside)
The answer to the question of using Zosyn (piperacillin/tazobactam) for post obstructive hospitalization pneumonia is that it is indicated for the treatment of nosocomial pneumonia, which may include post obstructive pneumonia, caused by susceptible organisms, and should be used in combination with an aminoglycoside if P. aeruginosa is suspected or confirmed 2.
- Key points:
- Indication: Nosocomial pneumonia
- Organisms: Beta-lactamase producing isolates of Staphylococcus aureus, Acinetobacter baumannii, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa
- Combination therapy: Aminoglycoside for P. aeruginosa
- Dosage: 4.5 g every six hours plus an aminoglycoside, administered by intravenous infusion over 30 minutes 2
From the Research
Post-Obstructive Pneumonia Treatment
- Post-obstructive pneumonia can complicate lung cancer, particularly in more advanced stages of the disease, producing significant clinical decline and a poorer prognosis 3.
- The treatment of post-obstructive pneumonia includes the use of broad-spectrum antibiotics to cover the wide variety of microorganisms involved and the use of different interventional modalities to relieve the obstruction 3, 4.
Cephalosporin Use in Pneumonia Treatment
- Cephalosporins, such as cefepime, are recommended in international and German guidelines for the treatment of severe community-acquired pneumonia (CAP), nosocomial pneumonia (NP), and septicemia, either as monotherapy or as combination therapy 5.
- Piperacillin/tazobactam, a beta-lactam/beta-lactamase inhibitor combination, is also effective in treating patients with lower respiratory tract infections, including pneumonia 6.
Zosyn (Piperacillin/Tazobactam) Use in Pneumonia Treatment
- Zosyn (piperacillin/tazobactam) has a broad spectrum of antibacterial activity and is effective in treating patients with polymicrobial infections caused by aerobic or anaerobic beta-lactamase-producing bacteria 6.
- Piperacillin/tazobactam is still an option for severe pneumonia patients with imipenem-resistant ceftazidime-susceptible Pseudomonas aeruginosa infection, especially when the MIC of piperacillin/tazobactam is very low 7.
Hospitalization and Treatment
- Infections in intensive care unit (ICU) patients, such as severe pneumonia, must be treated promptly and effectively because of the ensuing high mortality 5.
- The treatment of post-obstructive pneumonia in hospitalized patients requires broad-spectrum antibiotics and interventional modalities to relieve the obstruction 3, 4.