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piperacillin tazobactam (Zosyn)
Tradename: Zosyn.
Indications:
- serious bacterial infections cause by susceptible organisms
- osteomyelitis [3]
- skin or soft tissue infection
- ecthyma gangrenosum
- diabetic foot infection
- urogenital infection
- pelvic inflammatory disease
- lower respiratory tract infection
- pneumonia
- nosocomial pneumonia
- intra-abdominal infection
- appendicitis
- diverticulitis
- abdominal abscess
- bacterial peritonitis
- empiric treatment of febrile neutropenia [3]
Contraindications:
- meningitis/encephalitis: poor penetration into CSF
pregnancy-category B
safety in lactation ?
Dosage:
- 3.375 g IV every 6 hours.
- continuous infusion lowers mortality (RR=0.63) NNT=11 & improves clinical cure rate (RR=1.32) NNT=8 relative to every 6 hour dosing in patients with sepsis [5]
Pharmacokinetics: elimination: kidney.
Dosage adjustment in renal failure:
creatinine clearance dosage
> 50-90 mL/min 3.375 g IV every 6 hours
10-50 mL/min 2.25 g IV every 6 hours
< 10 mL/min* 2.25 g IV every 8 hours
* 0.75 g after hemodialysis
Antimicrobial activity:
Gram positive
- Streptococcus
- Streptococcus group A
- Streptococcus group B
- Streptococcus group C
- Streptococcus group G
- Streptococcus pneumonia
- Streptococcus viridans, milleri
- Enterococcus faecalis (+/-)
- Enterococcus faecium (+/-)
- Staphylococcus aureus (MSSA)
- Staphylococcus epidermidis
Gram negative
- Neisseria gonorrhoeae
- Neisseria meningitidis
- Moraxella catarrhalis
- Haemophilus influenzae
- Escherichia coli
- Klebsiella species
- Enterobacter species
- Serratia species
- Proteus mirabilis
- Proteus vulgaris
- Providencia species
- Morganella species
- Citrobacter species
- Aeromonas species
- Acinetobacter species
- Pseudomonas aeruginosa
Anaerobes
- Bacteroides fragilis
- Bacteroides melaninogenicus
- Clostridium species
- Peptostreptococcus species
Adverse effects:
- risk of acute kidney injury (acute interstitial nephritis)* similar to cefepime with or without vancomycin [6]
- also see piperacillin
* generally complete recovery of renal function (may take months) if Zosyn discontinued immediately after onset of acute kidney injury [7]
Drug interactions:
- increased nephrotoxicity when used in combination with vancomycin [4]
Related
beta lactamase
General
beta-lactam/beta-lactamase inhibitor
Database Correlations
PUBCHEM correlations
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- The Pharmacological Basis of Therapeutics, 8th ed.
Gilman et al, eds. Permagon Press/McGraw Hill
pg 1093.
- Deprecated Reference
- Rutter WC et al.
Acute kidney injury in patients treated with vancomycin and
piperacillin-tazobactam: A retrospective cohort analysis.
J Hosp Med 2017 Feb; 12:77
PMID: 28182801
http://www.journalofhospitalmedicine.com/jhospmed/article/130044/hospital-medicine/acute-kidney-injury-patients-treated-vancomycin-and
- Luther MK, Timbrook TT, Caffrey AR et al
Vancomycin Plus Piperacillin-Tazobactam and Acute Kidney Injury
in Adults: A Systematic Review and Meta-Analysis.
Crit Care Med. 2018 Jan;46(1):12-20. Review.
PMID: 29088001
- Roberts JA, Abdul-Aziz MH, Davis JS et al.
Continuous versus intermittent beta-lactam infusion in
severe sepsis. A meta-analysis of individual patient data from
randomized trials.
Am J Respir Crit Care Med 2016 Sep 15; 194:681
PMID: 26974879
- Qian ET, Casey JD, Wright A et al
Cefepime vs Piperacillin-Tazobactam in Adults Hospitalized With Acute Infection.
The ACORN Randomized Clinical Trial/.
JAMA. Published online October 14, 2023
PMID: 37837651
https://jamanetwork.com/journals/jama/fullarticle/2810592
- Tong SYC et al.
Acute kidney injury with empirical antibiotics for sepsis.
JAMA. 2023;330(16):1531-1533. Oct 14
PMID: 37837650
https://jamanetwork.com/journals/jama/fullarticle/2810593
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022
Components
piperacillin (Pipracil)
tazobactam