piperacillin tazobactam (Zosyn)
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Introduction
Tradename: Zosyn.
Indications
- serious bacterial infections cause by susceptible organisms
- empiric treatment of febrile neutropenia[3]
Contraindications
- meningitis/encephalitis: poor penetration into CSF
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]
Dosage adjustment in renal failure
Table
| 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
Pharmacokinetics
elimination: kidney
Antimicrobial activity
- Streptococcus
- Enterococcus faecalis (+/-)
- Enterococcus faecium (+/-)
- Staphylococcus aureus (MSSA)
- Staphylococcus epidermidis
- 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
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]
More general terms
Additional terms
Components
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.
- ↑ 3.0 3.1 3.2 Deprecated Reference
- ↑ 4.0 4.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28182801 <Internet> 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: https://www.ncbi.nlm.nih.gov/pubmed/29088001 - ↑ 5.0 5.1 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: https://www.ncbi.nlm.nih.gov/pubmed/26974879
- ↑ 6.0 6.1 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/37837650 https://jamanetwork.com/journals/jama/fullarticle/2810593 - ↑ 7.0 7.1 Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022