Zosyn


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piperacillin sodium and tazobactam sodium

Tazocin (UK), Zosyn

Pharmacologic class: Penicillin (extended-spectrum), beta-lactamase inhibitor

Therapeutic class: Anti-infective

Pregnancy risk category B

Action

Piperacillin inhibits bacterial cell-wall synthesis, resulting in cell death. Tazobactam increases piperacillin efficacy.

Availability

Powder for injection: 2 g piperacillin and 0.25 g tazobactam/vial, 3 g piperacillin and 0.375 g tazobactam/vial, 4 g piperacillin and 0.5 g tazobactam/vial

Indications and dosages

Community-acquired pneumonia; ruptured appendix; peritonitis; pelvic inflammatory disease; skin and skin-structure infections

Adults and children older than age 12: 3.375 g (3 g piperacillin and 0.375 g tazobactam) I.V. q 6 hours for 7 to 10 days

Nosocomial pneumonia

Adults and children ages 12 and older: 3.375 g (3 g piperacillin and 0.375 g tazobactam) I.V. over 30 minutes q 4 hours for 7 to 14 days, given with an aminoglycoside

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to penicillins, cephalosporins, imipenems, or beta-lactamase inhibitors
• Neonates

Precautions

Use cautiously in:
• heart failure, renal insufficiency (in children), seizures, bleeding disorders, uremia, hypokalemia, cystic fibrosis
• patients with sodium restrictions
• pregnant or breastfeeding patient
• children younger than age 12 (safety and efficacy not established).

Administration

• Ask patient about allergy to penicillins, cephalosporins, imipenems, or beta-lactamase inhibitors before giving.
• Dilute each gram with 5 ml of diluent, such as sterile or bacteriostatic water for injection, normal saline solution for injection, dextrose 5% in water, dextrose 5% in normal saline solution for injection, or 6% dextran in normal saline solution. Don't use lactated Ringer's solution.
• Shake vial until drug dissolves. Dilute again to a final volume of 50 ml; infuse over 30 minutes.
• Don't mix with other drugs. If possible, stop primary infusion while piperacillin infuses.
• Don't mix in same container with aminoglycosides, which are chemically incompatible with piperacillin.

Adverse reactions

CNS: headache, insomnia, agitation, dizziness, anxiety, lethargy, hallucinations, depression, twitching, coma, seizures

CV: hypertension, chest pain, tachycardia

EENT: rhinitis, glossitis

GI: nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain, pseudomembranous colitis

GU: proteinuria, hematuria, vaginal candidiasis, vaginitis, oliguria, interstitial nephritis, glomerulonephritis

Hematologic: anemia, increased bleeding, bone marrow depression, leukopenia, thrombocytopenia

Metabolic: hypokalemia, hypernatremia

Respiratory: dyspnea

Skin: rash, pruritus

Other: fever; pain, edema, inflammation, or phlebitis at I.V. site; superinfection; hypersensitivity reactions including serum sickness and anaphylaxis

Interactions

Drug-drug.Aminoglycosides: aminoglycoside inactivation

Aspirin, probenecid: increased piperacillin blood level

Hormonal contraceptives: decreased contraceptive efficacy

Methotrexate: increased risk of methotrexate toxicity

Tetracyclines: decreased piperacillin efficacy

Vecuronium: prolonged neuromuscular blockade

Drug-diagnostic tests.Coombs' test, urine glucose tests using copper reduction method (Clinitest, Benedict's or Fehling's solution), urine protein: false-positive results

Eosinophils: increased count

Granulocytes, hemoglobin, platelets, white blood cells: decreased levels

Patient monitoring

• Assess neurologic status, especially for seizures.
• Monitor vital signs and fluid intake and output.
• Evaluate electrolyte levels, CBC with white cell differential, and culture and sensitivity tests. Watch for evidence of hypokalemia and blood dyscrasias.
• In patients receiving high doses or prolonged therapy, monitor for signs and symptoms of bacterial or fungal superinfection and pseudomembranous colitis.
• Monitor patient's dietary sodium intake (drug has high sodium content).

Immediately report rash, hives, severe diarrhea, black tongue, sore throat, fever, or unusual bleeding or bruising.

Patient teaching

• Tell patient to monitor urinary output and report significant changes.
• Instruct patient to report unusual pain, redness, swelling, or other changes at infusion site.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

piperacillin/tazobactam

(pi-per-a-sill-in/tay-zoe-bak-tam) ,

Tazocin

(trade name),

Zosyn

(trade name)

Classification

Therapeutic: anti infectives
Pharmacologic: extended spectrum penicillins
Pregnancy Category: B

Indications

Appendicitis and peritonitis.Skin and skin structure infections.Gynecologic infections.Community-acquired and nosocomial pneumonia caused by piperacillin-resistant, beta-lactamase–producing bacteria.

Action

Piperacillin: Binds to bacterial cell wall membrane, causing cell death. Spectrum is extended compared with other penicillins.
Tazobactam: Inhibits beta-lactamase, an enzyme that can destroy penicillins.

Therapeutic effects

Death of susceptible bacteria.
Active against piperacillin-resistant, beta-lactamase–producing:
  • Bacteroides fragilis,
  • E. coli,
  • Acinetobacter baumanii,
  • Klebsiella pneumoniae,
  • Pseudomonas aeruginosa,
  • Staphylococcus aureus,
  • Haemophilus influenzae.

Pharmacokinetics

Absorption: Piperacillin is well absorbed (80%) from IM sites.
Distribution: Widely distributed. Enter CSF well only when meninges are inflamed. Crosses the placenta and enters breast milk in low concentrations.
Metabolism and Excretion: Piperacillin (68%) and tazobactam (80%) are mostly excreted unchanged by the kidneys.
Half-life: Adults: 0.7–1.2 hr; Children 6 mo–12 yr: 0.7–0.9 hr; Infants 2–5 mo: 1.4 hr.

Time/action profile (piperacillin blood levels)

ROUTEONSETPEAKDURATION
IVrapidend of infusion4–6 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity to penicillins, beta-lactams, cephalosporins, or tazobactam (cross-sensitivity may occur).
Use Cautiously in: Renal impairment (dosage reduction or increased interval recommended if CCr <40 mL/min);Sodium restriction; Obstetric / Lactation: Safety not established.

Adverse Reactions/Side Effects

Central nervous system

  • seizures (higher doses) (life-threatening)
  • confusion
  • dizziness
  • headache
  • insomnia
  • lethargy

Gastrointestinal

  • pseudomembranous colitis (life-threatening)
  • diarrhea (most frequent)
  • constipation
  • drug-induced hepatitis
  • nausea
  • vomiting

Genitourinary

  • interstitial nephritis

Dermatologic

  • stevens-johnson syndrome (life-threatening)
  • toxic epidermal necrolysis (life-threatening)
  • rashes (↑ in cystic fibrosis patients) (most frequent)
  • urticaria

Hematologic

  • bleeding
  • leukopenia
  • neutropenia
  • thrombocytopenia

Local

  • pain (most frequent)
  • phlebitis at IV site (most frequent)

Miscellaneous

  • hypersensitivity reactions, including anaphylaxis and serum sickness (life-threatening)
  • fever (↑ in cystic fibrosis patients)
  • superinfection

Interactions

Drug-Drug interaction

Probenecid ↓ renal excretion and ↑ blood levels.May alter excretion of lithium.Potassium-losing diuretics, corticosteroids, or amphotericin B may ↑ risk of hypokalemia.↑ risk of hepatotoxicity with other hepatotoxic agents.May ↓ levels/effects of aminoglycosides in patients with renal impairment.May ↑ levels and risk of toxicity from methotrexate.

Route/Dosage

Contains 2.79 mEq (64 mg) sodium/g of piperacillin; adult doses below expressed as combined piperacillin/tazobactam content
Intravenous (Adults) Most infections—3.375 g q 6 hr. Nosocomial pneumonia—4.5 g q 6 hr.
Intravenous (Adults) Nosocomial pneumonia—4.5 g q 6 hr.
Intravenous (Adults and Children >40 kg) Appendicitis and/or peritonitis—3.375 g q 6 hr.
Intravenous (Children ≥9 mo and ≤40 kg) Appendicitis and/or peritonitis—300 mg piperacillin component/kg/day divided q 8 hr.
Intravenous (Infants 2–9 mo) Appendicitis and/or peritonitis—240 mg piperacillin component/kg/day divided q 8 hr.
Intravenous (Infants and Children ≥6 mo) 240–400 mg/piperacillin component/kg/day divided q 6–8 hr (higher end of dosing range for serious pseudomonal infections); Max dose: 16 g piperacillin/day.
Intravenous (Infants <6 mo) 150–300 mg/piperacillin component/kg/day divided q 6–8 hr.

Renal Impairment

Intravenous (Adults) CCr 20–40 mL/min—2.25 g q 6 hr (3.375 g q 6 hr for nosocomial pneumonia); CCr <20 mL/min—2.25 g q 8 hr (2.25 g q 6 hr for nosocomial pneumonia); Hemodialysis—2.25 g q 12 h (2.25 g q 8 hr for nosocomial pneumonia).

Availability (generic available)

Powder for injection: 2-g piperacillin/0.25-g tazobactam vials and 50-mL premixed frozen containers, 3-g piperacillin/0.375-g tazobactam vials and 50-mL premixed frozen containers, 4-g piperacillin/0.5-g tazobactam vials and 50-mL premixed frozen containers, 36-g piperacillin/4.5-g tazobactam bulk vials

Nursing implications

Nursing assessment

  • Assess patient for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy.
  • Obtain a history before initiating therapy to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response.
  • Obtain specimens for culture and sensitivity prior to initiating therapy. First dose may be given before receiving results.
  • Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify health care professional immediately if these occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.
  • Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
  • Assess for skin reactions (rash, fever, edema, mucosal erosions or ulcerations, red or inflamed eyes). Monitor patient with mild to moderate rash for progression. If rash becomes severe or systemic symptoms occur, discontinue piperacillin/tazobactam.
  • Lab Test Considerations: Evaluate renal and hepatic function, CBC, serum potassium, and bleeding times prior to and routinely during therapy.
    • May cause positive direct Coombs’ test result.
    • May cause ↑ BUN, creatinine, AST, ALT, serum bilirubin, alkaline phosphatase, and LDH.
    • May cause leukopenia and neutropenia, especially with prolonged therapy or hepatic impairment.
    • May cause prolonged prothrombin and partial thromboplastin time.
    • May cause ↓ hemoglobin and hematocrit and thrombocytopenia, eosinophilia, leukopenia, and neutropenia. It also may cause proteinuria; hematuria; pyuria; hyperglycemia; ↓ total protein or albumin; and abnormalities in sodium, potassium, and calcium levels.

Potential Nursing Diagnoses

Risk for infection (Indications,  Side Effects)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Intravenous Administration
  • pH: 4.5–6.8.
  • Intermittent Infusion: Reconstitute each 1 g of piperacillin with at least 5 mL of 0.9% NaCl, sterile water for injection, or D5W. Diluent: Dilute further in 50–100 mL of 0.9% NaCl, D5W, D5/0.9% NaCl, or LR. Reconstituted vials stable for 24 hr at room temperature or 48 hr if refrigerated. Infusion stable for 24 hr at room temperature or 7 days if refrigerated.
  • Rate: Infuse over 30 min.
  • Y-Site Compatibility: alfentanil, allopurinol, amifostine, aminocaproic acid, aminophylline, amphotericin B lipid complex, amphotericin B liposome, anidulafungin, argatroban, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium acetate, calcium chloride, calcium gluconate, carboplatin, carmustine, cefepime, chloramphenicol, clindamycin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexamethasone, dexmedetomidine, dexrazoxane, diazepam, digoxin, diphenhydramine, docetaxel, dopamine, doxacurium, enalaprilat, ephedrine, epinephrine, eptifibatide, erythromycin, esmolol, etoposide, etoposide phosphate, fenoldopam, fentanyl, floxuridine, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, granisetron, heparin, hetastarch, hydrocortisone, hydromorphone, ifosfamide, isoproterenol, ketamine, ketorolac, leucovorin calcium, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, mesna, metaraminol, methotrexate, methylprednisolone, metoclopramide, metoprolol, metronidazole, milrinone, morphine, naloxone, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxytocin, paclitaxel, palonosetron, pancuronium, pantoprazole, pemetrexed, pentobarbital, phenobarbital, phentolamine, phenylephrine, potassium acetate, potassium chloride, potassium phosphates, procainamide, ranitidine, remifentanil, rituximab, sargramostim, sodium acetate, sodium bicarbonate, sodium phosphates, succinylcholine, sufentanil, tacrolimus, telavancin, teniposide, theophylline, thiotepa, tigecycline, tirofiban, trimethoprim/sulfamethoxazole, vasopressin, vinblastine, vincristine, voriconazole, zidovudine, zoledronic acid
  • Y-Site Incompatibility: acyclovir, alemtuzumab, amiodarone, amphotericin B cholesteryl, amphotericin B colloidal, azithromycin, caspofungin, chlorpromazine, ciprofloxacin, cisplatin, dacarbazine, dantrolene, daunorubicin, diltiazem, dobutamine, doxorubicin, doxorubicin liposome, doxycycline, droperidol, epirubicin, famotidine, ganciclovir, gemcitabine, glycopyrrolate, haloperidol, hydralazine, hydroxyzine, idarubicin, insulin, irinotecan, labetalol, levofloxacin, methyldopate, midazolam, mitomycin, mitoxantrone, nalbuphine, nesiritide, nicardipine, pentamidine, pentazocine, phenytoin, prochlorperazine, promethazine, propranolol, quinupristin/dalfopristin, rocuronium, streptozocin, thiopental, tobramycin, tranexamic acid, trastuzumab, vecuronium, verapamil, vinorelbine

Patient/Family Teaching

  • Advise patient to report rash and signs of superinfection (black furry overgrowth on tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy.
  • Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medication.

Evaluation/Desired Outcomes

  • Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.

Zosyn

(zō′sĭn)
A trademark for a drug consisting of a combination of piperacillin sodium and tazobactam sodium.

Zosyn®

Infectious disease A broad-spectrum IV antibiotic containing piperacillin and tazobactam packaged in the ADD-Vantage® drug-delivery system. See Piperacillin.
References in periodicals archive ?
Pfizer's Zosyn Injection is a combination penicillin-class antibacterial and beta-lactamase inhibitor indicated for the treatment of patients with moderate to severe infections caused by susceptible isolates of certain bacteria.
But if I give Zosyn, and 12 hours later she's deteriorating, I don't wait for 48 hours.
Jeffrey Yordon, chief executive officer, founder, and chairman of the board of Sagent, said that the introduction of generic Zosyn will add a very significant anti-infective to the company's rapidly expanding product portfolio.
Zosyn will now be available in a dosing regimen of four times a day for patients with nosocomial pneumonia, a serious condition representing about 15% of all hospital-associated infections.
These brands include several blockbusters, such as Glaxo's Zantac and Zofran; Hoffmann La-Roche's Xenical; and Wyeth's Zosyn and Tazocin.
million), Zosyn ($264 million) and the Premarin family ($256 million).
Effexor sales were $819 million (-20%) and Zosyn sales $310 million (-9%), due to increased generic competition.
The branded antibacterial drugs are Levaquin (levofloxacin), Zosyn (piperacillin/tazobactam), Zyvox (linezolid), Cipro (ciprofloxacin) and Doripenem (doripenem monohydrate).
However, the recent 'black box' warning applied to quinolones for risk of Achilles tendon rupture may temper their use and pave the way for Zosyn to continue its growth in the market, provided it maintains a favorable position on the hospital formulary, which its superior efficacy should help to do," said Sue Ramspacher, senior vice president and category business leader, antibiotics, GfK Market Measures.
Prior to joining Cubist, Frank also played an important role in the development of three other antibiotics: Suprax, Zosyn, and what now has been introduced as Tygacil.
Wyeth's rating reflects strong operational performance, driven by its human pharmaceutical portfolio including the key products, Protonix, Effexor, Prevnar, Enbrel, and Zosyn.