Names and pronunciation
(pip′er-ah-sill′in/ta-zoe-bak′tam) , Zosyn
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Drug reference
(pip′er-ah-sill′in/ta-zoe-bak′tam) , Zosyn
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Func. class.: Antiinfective, broad spectrum
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Chem. class.: Extended-spectrum penicillin, β-lactamase inhibitor
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ACTION: Interferes with cell-wall replication of susceptible organisms; tazobactam is a β-lactamase inhibitor that protects piperacillin from enzymatic degradation
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USES: Moderate to severe infections caused by piperacillin-resistant, piperacillin- tazobactam–susceptible, beta- lactamase–producing strains of the fol- lowing: Acinetobacter baumannii, Bacteroides fragilis, Bacteroides ova tus, Bacteroides thetaiotaomicron, Bacteroides vulgatus, Citrobacter koseri, Clostridium perfringens, Enterococcus faecalis, Escherichia coli, Haemophilus influenzae (beta- lactamase negative), Haemophilus influenzae (beta-lactamase positive), Klebsiella pneumoniae, Moraxella catarrhalis, Morganella morganii, Neisseria gonorrhoeae, Parabacteroi des distasonis, Prevotella melanino genica, Proteus mirabilis, Proteus vul garis, Providencia rettgeri, Providencia stuartii, Pseudomonas aeruginosa, Salmonella enteritidis, Serratia marc escens, Staphylococcus aureus (MSSA), Staphylococcus epidermidis, Strepto coccus agalactiae (group B strepto cocci), Streptococcus pneumoniae, Streptococcus pyogenes (group A beta- hemolytic streptococci), and Viridans streptococci This drug may also be effective against the following: Bacillus anthracis, Enterobacter sp., Fusobacterium nucleatum, Klebsiella oxytoca, and Neisseria meningitidis
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Unlabeled uses: Endocarditis, bactere- mia, cystic fibrosis, febrile neutropenia, peritoneal dialysis–related peritonitis, pleural empyema, pyelonephritis, sepsis, UTI
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CONTRAINDICATIONS: Hyper sensitivity to penicillins; neonates; car bapenem allergy Precautions: Pregnancy, breastfeeding, renal insufficiency in neonates, hyper- sensitivity to cephalosporins, seizures, GI disease, electrolyte imbalances, biliary obstruction
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SIDE EFFECTS CNS: Lethargy, hallucinations, anxiety, depression, twitching, insomnia, head- ache, fever, dizziness, seizures, vertigo CV: Cardiac toxicity, edema GI: Nausea, vomiting, diarrhea; increased AST, ALT; abdominal pain, glos- sitis, CDAD, constipation, pancreatitis GU: Oliguria, proteinuria, hematuria, vaginitis, moniliasis, glomerulonephri- tis, renal failure HEMA: Anemia, increased bleeding time, bone marrow depression, agranulocyto- sis, hemolytic anemia INTEG: Rash, pruritus, exfoliative dermatitis META: Hypokalemia, hypernatremia SYST: Serum sickness, anaphylaxis, Stevens-Johnson syndrome
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INTERACTIONS Increase: effect of neuromuscular block- ers, oral anticoagulants, methotrexate Increase: piperacillin concentrations— aspirin, probenecid Decrease: antimicrobial effect of piper- acillin—tetracyclines, aminoglycosides IV Drug/Lab Test Increase: eosinophilia, neutropenia, leukopenia, serum creatinine, PTT, AST, ALT, alk phos, bilirubin, BUN, electrolytes Decrease: Hct, HB, electrolytes False positive: urine glucose, urine pro- tein, Coombs’ test
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TREATMENT OF OVERDOSE: Withdraw product, maintain airway, administer EPINEPHrine, aminophylline, O2, IV corticosteroids for anaphylaxis
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DOSAGE AND ROUTES Nosocomial pneumonia • Adult: IV 4.5 g q6hr or 3.375 g q4hr with an aminoglycoside or antipseudo- monal fluoroquinolone × 1-2 wk Most infections • Adult: IV 3.375 g (3 g pipercillin/0.375 g tazobactam) q6hr × 7-10 days Renal dose • Adult: IV CCr 20-40 mL/min, give 3.375 g q6hr (nosocomial pneumonia); give 2.25 g q6hr (all other indications); CCr <20 mL/ min, give 2.25 g q6hr (nosocomial pneu- monia); give 2.25 g q8hr (all other indications)
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Available forms: Powder for inj 2 g piperacillin/0.25 g tazobactam, 3 g piperacillin/0.375 g tazobactam, 4 g piperacillin/0.5 g tazobactam, 36 g piperacillin/4.5 g tazobactam
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Administer: • Separate aminoglycoside from piper- acillin to avoid inactivation • Product after C&S is complete Intermittent IV INFUSION route • Reconstitute each 1 g of product/5 mL 0.9% NaCl for inj or sterile water for inj, dextrose 5%; shake well; further dilute in ≥50 mL compatible IV sol, run as int infusion over ≥30 min • Store: Diluted solution may be stored for ≤24 hr at room temperature Y-site compatibilities: Alfentanil, allopuri- nol, amifostine, amikacin, aminocaproic acid, aminophylline, amphotericin B lipid complex, amphotericin B liposome, anidu- lafungin, argatroban, atenolol, aztreonam, bivalirudin, bleomycin, bumetanide, bu- prenorphine, busulfan, butorphanol, cal- cium acetate/chloride/gluconate, CARBO- platin, carmustine, cefepime, chloramphenicol, cimetidine, clindamycin, cyclophosphamide, cycloSPORINE, cytara- bine, DACTINomycin, DAPTOmycin, dexa- methasone, dexrazoxane, diazePAM, di- goxin, diphenhydrAMINE, DOCEtaxel, DOPamine, doxacurium, enalaprilat, ePHEDrine, EPINEPHrine, eptifibatide, erythromycin, esmolol, etoposide, fenoldo- pam, fentaNYL, floxuridine, fluconazole, fludarabine, fluorouracil, foscarnet, fos- phenytoin, furosemide, gallium, granise- tron, heparin, hydrocortisone, HYDROmor- phone, ifosfamide, isoproterenol, ketorolac, lansoprazole, lepirudin, leucov- orin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechloretha- mine, melphalan, meperidine, mesna, metaraminol, methotrexate, methylPRED- NISolone, metoclopramide, metoprolol, metroNIDAZOLE, milrinone, morphine, naloxone, nitroglycerin, nitroprusside, nor- epinephrine, octreotide, ondansetron, oxy- tocin, PACLitaxel, palonosetron, pamidro- nate, pancuronium, PEMEtrexed, PENTobarbital, PHENobarbital, phentol- amine, phenylephrine, plicamycin, potas- sium chloride/phosphates, procainamide, raNITIdine, remifentanil, riTUXimab, sar- gramostim, sodium acetate/bicarbonate/ phosphate, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tacroli- mus, telavancin, teniposide, theophylline, thiotepa, tigecycline, tirofiban, trimetho- benzamide, vasopressin, vinBLAStine, vin- CRIStine, voriconazole, zidovudine, zole- dronic acid
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Assess: • Infection: temperature, stools, urine, sputum, wounds • GU status: I&O ratio; report hematu- ria, oliguria because penicillin in high doses is nephrotoxic; maintain hydration unless contraindicated • Hepatic studies: AST, ALT before treat- ment and periodically thereafter P • Blood studies: WBC, RBC, Hct, HB, bleeding time before treatment and periodically thereafter; serum potas- sium • Renal studies: urinalysis, protein, blood, BUN, creatinine before treatment and periodically thereafter • C&S before product therapy; product may be given as soon as culture is taken • CDAD: diarrhea, bloody stools, fever, abdominal cramps; may occur ≤2 mo af- ter treatment; bowel pattern before and during treatment • Skin eruptions after administration of penicillin to 1 wk after discontinuing product • Respiratory status: rate, character, wheezing, tightness in chest • Anaphylaxis: wheezing, laryngeal edema, rash, itching; discontinue product, have emergency equipment nearby • Pregnancy/breastfeeding: use only if clearly needed; cautious use in breastfeeding
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Evaluate: • Therapeutic response: absence of fe- ver, purulent drainage, redness, inflam- mation; culture shows decreased organ- isms
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That culture may be taken after com- pleted course of medication • To report sore throat, fever, fatigue (su- perinfection); CNS effects (anxiety, de- pression, hallucinations, seizures); pseu- domembranous colitis (fever, diarrhea with blood, pus, mucus) • To wear or carry emergency ID if al- lergic to penicillins • CDAD: to notify nurse of diarrhea with blood, pus
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PHARMACOKINETICS Half-life 0.7-1.2 hr; excreted in urine, bile, breast milk; crosses placenta; 33% bound to plasma proteins IV: Peak completion of IV
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• Adult: IV 4.5 g q6hr or 3.375 g q4hr with an aminoglycoside or antipseudo- monal fluoroquinolone × 1-2 wk Most infections
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• Adult: IV 3.375 g (3 g pipercillin/0.375 g tazobactam) q6hr × 7-10 days Renal dose
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• Adult: IV CCr 20-40 mL/min, give 3.375 g q6hr (nosocomial pneumonia); give 2.25 g q6hr (all other indications); CCr <20 mL/ min, give 2.25 g q6hr (nosocomial pneu- monia); give 2.25 g q8hr (all other indications)
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