Piperacillin Sodium and Tazobactam Sodium and Varicella

• Generic Name: piperacillin / tazobactam
• Dosage Forms: n.a.
• Other Brand Names: Zosyn

Treatment of postpartum endometritis or pelvic inflammatory disease (PID) caused by susceptible β-lactamase-producing Escherichia coli.

Not included in CDC recommendations for treatment of PID; if a penicillin used for empiric treatment of PID, CDC and others recommend a parenteral regimen that includes the fixed combination of ampicillin and sulbactam (ampicillin/sulbactam) in conjunction with doxycycline.

Treatment of appendicitis (complicated by rupture or abscess) and peritonitis caused by susceptible β-lactamase-producing E. coli, Bacteroides fragilis, B. ovatus, B. thetaiotaomicron, or B. vulgatus.

Has been used for treatment of various intra-abdominal infections; recommended as one of several options for initial empiric treatment of high-risk or severe community-acquired extrabiliary intra-abdominal infections (e.g., in patients with advanced age, immunocompromise, severe physiologic disturbance), community-acquired biliary tract infections (e.g., acute cholecystitis), and complicated healthcare-associated intra-abdominal infections.

Treatment of moderately severe community-acquired pneumonia (CAP) caused by susceptible β-lactamase-producing Haemophilus influenzae. Also used for treatment of CAP caused by susceptible Enterobacteriaceae or anaerobic bacteria.

Recommended as one of several options for empiric treatment of CAP in hospitalized patients requiring treatment in an intensive care unit (ICU). If Pseudomonas aeruginosa known or suspected to be involved, use in conjunction with a fluoroquinolone with antipseudomonal activity (ciprofloxacin, levofloxacin) with or without an aminoglycoside or in conjunction with an aminoglycoside and azithromycin. Factors that increase risk of Ps. aeruginosa infection in CAP patients include severe CAP requiring treatment in an ICU, structural lung disease (e.g., bronchiectasis), repeated COPD exacerbations, alcoholism, chronic corticosteroid therapy, and frequent anti-infective therapy.

Treatment of moderate to severe nosocomial pneumonia caused by susceptible β-lactamase-producing Staphylococcus aureus or susceptible Acinetobacter baumannii, H. influenzae, Klebsiella pneumoniae, or Ps. aeruginosa. If Ps. aeruginosa involved, use in conjunction with an aminoglycoside or a fluoroquinolone with antipseudomonal activity (e.g., ciprofloxacin, levofloxacin) recommended.

One of several options recommended for initial empiric treatment of hospital-acquired pneumonia (HAP) not associated with mechanical ventilation and initial empiric treatment of ventilator-associated pneumonia (VAP).

In patients with HAP not at high risk of mortality, can consider use of piperacillin/tazobactam alone (monotherapy) for initial empiric treatment if no factors are present that increase likelihood of methicillin-resistant S. aureus (MRSA; also known as oxacillin-resistant S. aureus or ORSA); use in conjunction with an antibacterial active against MRSA (vancomycin, linezolid) recommended if such factors are present or if patient is at high risk of mortality or has received IV anti-infectives during prior 90 days.

In patients with clinically suspected VAP, can consider use of piperacillin/tazobactam alone (monotherapy) for initial empiric treatment in patients not at increased risk for MRSA; in those with factors that increase risk of MRSA or multidrug-resistant gram-negative bacteria, use in conjunction with an anti-infective active against MRSA (vancomycin, linezolid) plus an antipseudomonal fluoroquinolone (ciprofloxacin, levofloxacin), aminoglycoside (amikacin, gentamicin, tobramycin), or polymyxin B recommended.

Treatment of septicemia. Recommended as one of several options for initial empiric treatment of sepsis and bacteremia.

Treatment of uncomplicated and complicated skin and skin structure infections (including cellulitis, cutaneous abscess, ischemic/diabetic foot infections) caused by susceptible β-lactamase-producing S. aureus. Recommended as a possible option for empiric monotherapy of complicated skin and skin structure infections that could be polymicrobial and unlikely to involve MRSA; do not use alone in infections that may be caused by MRSA.

Although fixed combination of amoxicillin and clavulanate (amoxicillin/clavulanate) usually drug of choice, piperacillin/tazobactam suggested as an alternative for treatment of infected human or animal (e.g., dog, cat, reptile) bite wounds when a parenteral anti-infective used. Purulent bite wounds usually are polymicrobial and broad-spectrum anti-infective coverage recommended; nonpurulent infected bite wounds usually caused by staphylococci and streptococci, but can be polymicrobial.

Possible option for empiric treatment of severe cellulitis or treatment of clostridial myonecrosis (gas gangrene); used in conjunction with vancomycin.

Possible option for empiric treatment of necrotizing fasciitis; used in conjunction with vancomycin or linezolid.

Treatment of UTIs in hospitalized patients; used with or without an aminoglycoside.

Has been used alone (monotherapy) or in conjunction with other anti-infectives (e.g., aminoglycosides) for empiric anti-infective therapy in febrile neutropenic patients.

Recommended as one of several options for initial outpatient management of febrile neutropenia in adults receiving treatment for malignancy.

Has been used for perioperative prophylaxis to decrease postoperative infections in patients undergoing various urologic procedures (e.g., prostate biopsy), gastroduodenal procedures (e.g., pancreatic duodenectomy), or liver transplantation. Not generally recommended for perioperative prophylaxis.