What is the treatment for pneumonia with Tazocin (piperacillin/tazobactam) and Azithromycin?

From the Guidelines

For pneumonia requiring hospitalization, a combination of Tazocin (piperacillin-tazobactam) and azithromycin is an appropriate empiric therapy, as recommended by the most recent guidelines 1. This regimen should be considered for patients with low risk for MDR pathogens and low mortality risk, where antibiotic monotherapy with ertapenem, ceftriaxone, cefotaxime, moxifloxacin, or levofloxacin is recommended, but a combination of Tazocin and azithromycin can also be used as an alternative. The dosing for Tazocin should be 4.5g IV every 6-8 hours, while azithromycin is typically given as 500mg IV or orally once daily. This combination provides coverage against common respiratory pathogens including Streptococcus pneumoniae, Haemophilus influenzae, atypical organisms like Mycoplasma and Legionella, and many gram-negative bacteria. Tazocin offers broad-spectrum coverage against many bacterial pathogens including Pseudomonas, while azithromycin adds coverage for atypical pathogens and has anti-inflammatory properties. Renal dose adjustments may be needed for Tazocin in patients with impaired kidney function. Monitor for clinical improvement including decreased fever, respiratory rate, and oxygen requirements. Consider de-escalation of therapy based on culture results if available, as recommended by the guidelines 1. It's worth noting that the guidelines from 2017 1 provide the most recent and highest quality evidence for the management of hospital-acquired pneumonia and ventilator-associated pneumonia, and should be prioritized in clinical decision-making.

From the FDA Drug Label

1. 5 Community-acquired Pneumonia Piperacillin and tazobactam for injection, USP is indicated in adults for the treatment of community-acquired pneumonia (moderate severity only) caused by beta-lactamase producing isolates of Haemophilus influenzae. Treatment of pneumonia In the treatment of pneumonia, azithromycin has only been shown to be safe and effective in the treatment of community-acquired pneumonia due to Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy

Treatment of Pneumonia with Tazocin and Azithromycin:

• Tazocin (piperacillin/tazobactam) is indicated for the treatment of community-acquired pneumonia (moderate severity only) caused by beta-lactamase producing isolates of Haemophilus influenzae 2.
• Azithromycin is indicated for the treatment of community-acquired pneumonia due to Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy 3.
• The combination of Tazocin and Azithromycin may be considered for the treatment of community-acquired pneumonia, but the choice of therapy should be based on the severity of the illness, the causative pathogen, and the patient's ability to tolerate oral therapy.
• Key Considerations:
  • Tazocin is administered intravenously, while Azithromycin is administered orally.
  • The patient's renal function should be considered when using Tazocin, as the dose may need to be adjusted in patients with renal impairment 2.
  • Azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, elderly or debilitated patients, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia) 3.

From the Research

Treatment of Pneumonia with Tazocin and Azithromycin

• The combination of piperacillin/tazobactam (Tazocin) and azithromycin is not directly mentioned in the provided studies, but the efficacy of piperacillin/tazobactam in treating pneumonia is well-documented 4, 5, 6, 7, 8.
• Piperacillin/tazobactam has been shown to be effective in treating various types of infections, including lower respiratory tract infections, such as pneumonia 4.
• In clinical trials, piperacillin/tazobactam was significantly more effective than ticarcillin/clavulanic acid in terms of clinical and microbiological outcome in patients with community-acquired pneumonia 4.
• The combination of piperacillin/tazobactam and an aminoglycoside has been used to treat patients with severe nosocomial (hospital-acquired) infections, including pneumonia 4, 5, 7, 8.
• Azithromycin is a macrolide antibiotic that is often used to treat respiratory tract infections, including pneumonia, but its combination with piperacillin/tazobactam is not specifically mentioned in the provided studies.

Efficacy of Piperacillin/Tazobactam in Pneumonia Treatment

• Studies have shown that piperacillin/tazobactam is effective in treating nosocomial pneumonia, with clinical cure rates ranging from 63.9% to 71% 5, 7, 8.
• Piperacillin/tazobactam has been compared to other antibiotics, such as imipenem/cilastatin and ceftazidime, in the treatment of nosocomial pneumonia, and has been shown to be equally effective 5, 7, 8.
• The bacteriological efficacy of piperacillin/tazobactam in treating pneumonia has also been demonstrated, with eradication rates ranging from 45.8% to 64% 5, 7, 8.

Safety and Tolerability of Piperacillin/Tazobactam

• Piperacillin/tazobactam is generally well-tolerated, with the most common adverse events being gastrointestinal symptoms and skin reactions 4, 5, 7, 8.
• The incidence of adverse events with piperacillin/tazobactam is higher when the combination is given with an aminoglycoside than when given as monotherapy 4.