Piperacillin/tazobactam in modern clinical practice

General practitioner, Infectious disease, Orthopaedic Trauma, Surgeon, The anesthesiologist and specialist on medical emergency conditions
Piperacillin/tazobactam in modern clinical practice

Abstract: Piperacillin/tazobactam represents a combination of the ureidopenicillin and the β-lactamase inhibitor. The antibiotic is the drug of choice for the treatment of severe infections, primarily in surgical and intensive care units. The area of clinical use of piperacillin/tazobactam includes intra-abdominal infections, skin and soft tissues infections, late nosocomial pneumonias, including ones in the context of the covid-19 pandemic, and infections of other localizations.

The effectiveness of the intervention increases with intravenous administration of the drug by the method of prolonged infusions. A high susceptibility of most causative pathogens of wound infection to piperacillin/tazobactam has been established in Ukraine (with the exception of Klebsiella spp. and non-fermenting bacteria). The drug can be used in patients with a history of allergic reactions to β-lactams; preliminary allergological testing is indicated only in cases of allergy to aminopenicillins and aminocephalosporins. The first domestic piperacillin/tazobactam under the name Refex is registered on the Ukrainian market.

Key words: piperacillin/tazobactam, prolonged infusions, susceptibility to antibiotics, nosocomial pneumonias, Refex.

Authors:

I.G. Bereznyakov, Kharkov Medical Academy of Postgraduate Education

Literature:

  1. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/050684s88s89s90_050750s37s38s39lbl.pdf. Посещение 07.12.2021 г.
  2. Craig W.A. Basic pharmacodynamics of antibacterials with clinical applications to the use of beta-lactams, glycopeptides, and linezolid. Infect.Dis.Clin. North Am. 2003; 17:479–501.
  3. Drusano G.L. Antimicrobial pharmacodynamics: critical interactions of ‘bug and drug’. Nat.Rev.Microbiol. 2004; 2:289–300.
  4. McKinnon P.S., Paladino J.A., Schentag J.J. Evaluation of area under the inhibitory curve (AUIC) and time above the minimum inhibitory concentration (T > MIC) as predictors of outcome for cefepime and ceftazidime in serious bacterial infections. Int. J.Antimicrob. Agents 2008; 31:345–351.
  5. Abdul-Aziz M.H., Lipman J., Mouton J.W., et al. Applying pharmacokinetic/pharmacodynamic principles in critically ill patients: optimizing efficacy and reducing resistance development. Semin.Respir. Crit. Care Med. 2015;36(1):136–153.
  6. Roberts J.A., Abdul-Aziz M.H., Lipman J., et al. Individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions. Lancet Infect. Dis. 2014;14 (6):498–509.
  7. Imani S., Buscher H., Day R., et al. An evaluation of risk factors to predict target concentration non-attainment in critically ill patients prior to empiric β-lactam therapy. Eur. J. Clin. Microbiol. Infect. Dis. 2018; 37 (11): 2171–2175.
  8. Alobaid A.S., Brinkmann A., Frey O.R., et al. What is the effect of obesity on piperacillin and meropenem trough concentrations in critically ill patients? J.Antimicrob.Chemother. 2016;71(3):696–702.
  9. Evans L., Rhodes A., Alhazzani W., et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intens. Care Med. https://doi.org/10.1007/s00134-021-06506-y.
  10. Fawaz S., Barton S., Nabhani-Gebara S. Comparing clinical outcomes of piperacillin-tazobactam administration and dosage strategies in critically ill adult patients: a systematic review and metaanalysis. BMC Infect. Dis. 2020; 20: 430.
  11. Yang H., Cui X., Ma Z., et al. Clinical outcomes with alternative dosing strategies for piperacillin/tazobactam: a systematic review and meta-analysis. PLoS One. 2015; 19 (2): 274–89.
  12. Abdulla A., Ewoldt T.M.J., Purmer I.M., et al. A narrative review of predictors for β-lactam antibiotic exposure during empirical treatment in critically ill patient. Expert Opin. Drug Metabol. Toxicol. 2021; 17 (4): 359-368.
  13. Протоколнаданнямедичноїдопомогихворимнанегоспітальнутанозокоміальну (госпітальну) пневмоніюудорослихосіб: етіологія, патогенез, класифікація, діагностика, антибактеріальнатерапія. Затверджений наказом МОЗ Українивід 19 березня 2007 р. № 128. Доступно за адресою: http://www.ifp.kiev.ua/doc/staff/MOZ-128-19032007.pdf.
  14. Kalil A.C., Metersky M.L., Klompas M., et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin. Infect. Dis. 2016; 63 (5): e61–111.
  15. Torres A., Niederman M.S., Chastre J., et al. International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia.Eur.Respir. J. 2017; 50: 1700582.
  16. Pneumonia (hospital-acquired): antimicrobial prescribing. NICEguideline [NG139]. Доступно по адресу: https://www.nice.org.uk/guidance/ng139
  17. Протокол «надання медичної допомоги для лікування коронавірусної хвороби (covid-19)». Оновлений 11.11.2021 р. Доступно за адресою:https://moz.gov.ua/article/ministry–mandates/nakaz–moz–ukraini–vid-11112021–2495-pro–vnesennja–zmin–do–protokolu–nadannja–medichnoi–dopomogi–dlja–likuvannja—koronavirusnoi–hvorobi–covid-19
  18. SfeirM.M., AskinG., ChristosP. Beta-lactam/beta-lactamase inhibitors versus carbapenem for bloodstream infections due to extended-spectrum beta-lactamase-producing Enterobacteriaceae: systematic review and meta-analysis. Int. J. Antimicrob. Agents. 2018;52(5):554-570.
  19. Harris P.N.A., Tambyah P.A., Lye D.C., et al. Effect of piperacillin-tazobactam vs meropenem on 30-daymortality for patients with E coli or Klebsiellapneumoniaebloodstream infection and ceftriaxone resistance. A randomized clinical trial. JAMA 2018; 320: 984–94.
  20. Andersen M.G., Thorsted A., Storgaard M., et al. Population pharmacokinetics of piperacillin in sepsis patients: should alternative dosingstrategies be considered? Antimicrob. Agents Chemother. 2018; 62: e02306–17.
  21. Pitout J.D., Le P., Church D.L., et al. Antimicrobial susceptibility of well-characterisedmultiresistant CTX-M-producing Escherichia coli: failure of automated systems to detect resistance to piperacillin/tazobactam. Int. J. Antimicrob. Agents 2008; 32: 333–8.
  22. Henderson A., Paterson D.L., Chatfield M.D., et al. Association between minimum inhibitory concentration, β-lactamase genes and mortality for patientstreated with piperacillin/tazobactam or meropenem from the MERINO study.Clin. Infect. Dis. 2020; doi: 10.1093/cid/ciaa1479
  23. Rodríguez-Baño J., Gutiérrez-Gutiérrez B., Pascual A. CON: Carbapenems are NOT necessary for all infections caused by ceftriaxone-resistant Enterobacterales. JAC Antimicrob. Resist. 2021. doi:10.1093/jacamr/dlaa112
  24. Takimoto K., Wang Q., Suzuki D., et al. Clinical efficacy of piperacillin/tazobactam in the treatment of complicated skin and soft tissue infections. Expert Opinion Pharmacother., 2017. doi:10.1080/14656566.2017.1341491
  25. Stevens D.L., Bisno A.L., Chambers H.F., et al. Practice guidelines for the diagnosis andmanagement of skin and soft tissue infections: 2014 update by the Infectious Diseases Society ofAmerica. Clin. Infect. Dis. 2014;59:e10–52.
  26. Lipsky B.A., Berendt A.R., Cornia P.B., et al. 2012 Infectious Diseases Society of Americaclinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin. Infect .Dis. 2012;54:e132–73.
  27. Diabetic foot problems: prevention and management. NICE guideline. Last updated 11 October 2019. Доступно по адресу: www.nice.org.uk/guidance/ng19
  28. Березняков І.Г. Стан антибіотикорезистентності в Україні: результати дослідження АУРА. Здоров’я України ХХІ вік. 2020; тематичний номер (4): 31-34.; тематичний номер (5): 21-23.
  29. Macy E., Contreras R. Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: a cohort study. J. Allergy Clin. Immunol. 2014; 133: 790-6.
  30. Zagursky R.J., Pichichero M.E. Cross-reactivity in β-lactam allergy J. Allergy Clin. Immunol. Pract. 2018; 6: 72-81.e1.
  31. Березняков И.Г. Аллергические реакции на антибиотики. Харьков: ГО УАДВА, 2021. – 58 с.
1 March, 2022

Authors:

I.G. Bereznyakov

Products:

Refex

Learn more

The anesthesiologist and specialist on medical emergency conditions

Severe community-acquired pneumonia: principles of diagnostics and intensive therapy

Surgeon

The piperacillin/tazobactam role in the treatment of complicated intra-abdominal infections (cIAI) in Ukrainian hospitals: 40 clinical cases series analysis

Surgeon

The first results of the international multicenter clinical study RheoSTAT-CP0669 on the effectiveness and safety of infusion solution Rheosorbilact® in the complex treatment of patients with burns

Surgeon

Application of “Refex” at patients with purulent infections of pararectal areas

Surgeon

Feedback on Revul hemostatic bandage based on chitosan from the Main Directorate of the National Guard of Ukraine

Surgeon

Feedback on Revul hemostatic bandage from the Chief Surgeon of the Armed Forces of Ukraine