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Piperacillin/tazobactam

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Why Not: CDC Recommends Adding Vanco & Zosyn to the Water

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ATLANTA, GA - Finally accepting the reality that antibiotic stewardship among health care professionals is just a pipe dream, Acting Director of the Centers for Disease Control and Prevention (CDC) Dr. Anne Schuchat officially said "F**k it" and just add vancomycin & Zosyn...

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#Anne Schuchat #cdc #vanco #vancomycin #Zosyn #Infectious Disease #Public Health

(via Amoxicillin, Ampicillin–Sulbactam, Amoxicillin–Clavulanate & Piperacillin–Tazobactam – Uses, Dosage, Side Effects)

#amoxicillin #augmentin #unasyn #zosyn

Piperacillin & Tazobactam

Common Brand Names: Zosyn

Therapeutic Class: A penicillinase-resistant extended spectrum penicillin antibiotic

Common Injectable Dosage Forms:

Powder for Injection: 2 g piperacillin/0.25 g tazobactam, 3 g piperacillin/0.375 g tazobactam, and 4 g piperacillin/0.5 g tazobactam in vials and ADD-Vantage; 36 g piperacillin/4.5 g tazobactam in bulk vials *ADD-Vantage is a trademark of Abbott Labs.

Dosage Ranges:

Treatment of infections due to penicillinase-producing, piperacillin-resistant susceptible organisms in infections including appendicitis, peritonitis, skin and skin structure infections, postpartum endometritis or pelvic inflammatory disease, and moderately severe pneumonia: Usual adult dose is 2.25-4.5 g every 6-8 hours for up to 10 days. Maximum of 18 g per day of piperacillin. Dosage for treating appendicitis in children <40 kg is 80-100 mg/kg every 8 hours. Dosage reductions may be necessary in renal impairment (CrCl <40 mL).

Administration and Stability: Dilute with 5 mL of a compatible solution (Sterile Water, NS) per 1 g piperacillin. For intermittent IV infusion, dilute as described above and further dilute in the desired volume (minimum 50 mL). Administer as IV infusion over 30 minutes. Stability of these concentrations is acceptable for 24 hours at room temperature and 7 days if refrigerated. pH 4.5-6.8

Pharmacology/Pharmacokinetics: Piperacillin acts by inhibiting bacterial wall synthesis via acylation of the transpeptidase enzyme. Piperacillin is susceptible to cleavage by beta-lactamase. It is however active against beta-lactamase-producing gonococci. It is active against many anaerobic, Gram-negative, and non-penicillinase producing strains of Gram-positive bacteria. It is particularly useful for Pseudomonas and Klebsiella, as well as certain indole-positive Proteus species. Tazobactam is an inhibitor of beta-lactamase penicillinase. Peak concentration occurs immediately after an IV infusion and in 30 minutes after an IM injection. The plasma half-life of piperacillin is approximately 1 hour. Up to 30% is bound to plasma proteins. Distribution to the meninges occurs during inflammation. Excretion occurs predominantly through the urine by glomerular filtration and tubular secretion.

Drug and Lab Interactions: May inactivate aminoglycosides when mixed in the same solution. TETRACYCLINES may inhibit actions. May potentiate the actions of warfarin or heparin. May cause false-positive urine glucose tests if Clinitest, Benedict’s Solution or Fehling’s Solution is used. Large doses may cause a positive direct antiglobulin test (DAT).

Contraindications/Precautions: Contraindicated in patients hypersensitive to penicillins and/or cephalosporins. Use bacteriologic studies to determine optimum therapy. Severe neurovascular damage occurred after administration of other penicillins so prompt attention must be given to any sign of a compromise of the blood supply distal, proximal, or at the injection site. Use decreased dose in patients with renal impairment. As with all antibiotics, the possibility superinfections should be considered. Pregnancy Category B.

Monitoring Parameters: Cr, BUN, CBC, PT, signs of bleeding.

Adverse Effects: Common adverse effects in order of decreasing incidence: diarrhea, constipation, headache, insomnia, rash, vomiting, dyspepsia, and pruritus. Large doses may cause reversible neurotoxicity or nephrotoxicity. May cause an increase in prothrombin time. If hypersensitivity reactions occur, manifested by urticaria, edema, laryngospasm, bronchospasm, or hypotension, discontinue use and institute supportive treatment.

Common Clinical Applications: Treatment of moderate-to-severe infections of lower respiratory tract, uncomplicated/complicated skin infections, gynecologic infections, bone and joint infections, intra-abdominal infections as well as septicemia.

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