From the Guidelines
Oral substitutes for Zosyn (piperacillin-tazobactam) and vancomycin are limited, but potential alternatives include amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily or ciprofloxacin 500-750 mg twice daily plus metronidazole 500 mg three times daily for Zosyn, and linezolid 600 mg twice daily or trimethoprim-sulfamethoxazole (Bactrim DS) one tablet twice daily for vancomycin, with clindamycin 300-450 mg four times daily as an option for certain infections 1. When considering oral substitutes, it's essential to note that these medications have different spectrums of activity and may not provide the same level of coverage as the intravenous antibiotics they're replacing.
- For Zosyn, amoxicillin-clavulanate or ciprofloxacin plus metronidazole can be considered, depending on the infection type.
- For vancomycin, linezolid or trimethoprim-sulfamethoxazole may be options for MRSA infections.
- Clindamycin can sometimes substitute for either medication for certain infections. These substitutions should only be made after confirming the infection's susceptibility through cultures, as the oral alternatives generally have narrower antimicrobial coverage than the IV medications they're replacing 1. Patients should complete the full prescribed course, typically 7-14 days depending on the infection, and report worsening symptoms immediately as this may indicate the oral substitute is inadequate for the infection being treated 1.
From the FDA Drug Label
The recommended dosage for ZYVOX formulations for the treatment of infections is described in Table 14. Vancomycin Hydrochloride Capsules are indicated for the treatment of C. difficile-associated diarrhea. Vancomycin Hydrochloride Capsules are also used for the treatment of enterocolitis caused by Staphylococcus aureus (including methicillin-resistant strains) in adult and pediatric patients less than 18 years of age
Good oral substitutes for Zosyn and vancomycin are:
- Linezolid (ZYVOX) for complicated skin and skin structure infections, community-acquired pneumonia, and vancomycin-resistant Enterococcus faecium infections.
- Vancomycin Hydrochloride Capsules for C. difficile-associated diarrhea and staphylococcal enterocolitis. 2 3
From the Research
Oral Substitutes for Zosyn and Vancomycin
- Zosyn (piperacillin/tazobactam) and vancomycin are antibiotics used to treat various bacterial infections.
- For vancomycin, potential oral substitutes include:
- Linezolid, an oxazolidinone antibiotic, which has been shown to be effective against methicillin-resistant Staphylococcus aureus (MRSA) in several studies 4, 5, 6.
- Quinupristin/dalfopristin, a streptogramin antibiotic, which has been shown to be effective against some strains of gram-positive bacteria that are resistant to vancomycin 4.
- For Zosyn (piperacillin/tazobactam), there is limited information on oral substitutes. However, some studies suggest that the combination of piperacillin and tazobactam with vancomycin may be effective against MRSA 7.
Considerations for Choosing Oral Substitutes
- The choice of oral substitute depends on various factors, including the type of infection, the causative organism, and patient-specific factors such as renal function and allergy history.
- Clinicians should consider the potential benefits and limitations of each antibiotic, including their efficacy, safety, and resistance profiles, when selecting an oral substitute for Zosyn and vancomycin 5, 8.