piperacillin and tazobactam (Zosyn)

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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What is piperacillin/tazobactam sodium-injection, and how does it work (mechanism of action)?

Zosyn is an injectable combination of two antibiotics, piperacillin and tazobactam, with broad spectrum activity against an extended range of bacterial species. Piperacillin is an extended-spectrum penicillin antibiotic, but it can be destroyed by an enzyme produced by bacteria called beta lactamase. Tazobactam inhibits beta lactamase and prevents the destruction of piperacillin. Therefore, tazobactam is given with piperacillin to enhance the activity of piperacillin in eradicating bacterial infections.

Piperacillin kills bacteria by inhibiting the synthesis of bacterial cell walls. It binds preferentially to specific penicillin-binding proteins (PBPs) located inside bacterial cell walls. PBPs vary among bacterial species, and thus susceptibility to piperacillin depends on the ability of piperacillin to bind to each species' specific PBPs.

In-vitro studies of piperacillin and tazobactam have shown that the combination has activity against a variety of gram-positive and gram-negative aerobic and anaerobic bacteria.

Susceptible bacteria include:

  • Aerobic and facultative gram-positive microorganisms: Staphylococcus aureus
  • Aerobic and facultative gram-negative microorganisms: Acinetobacter baumannii, Escherichia coli, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa
  • Gram-negative anaerobes: Bacteroides fragilis group (B.fragilis, B. ovatus, B. thetaiotaomicron, and B. vulgatus)
  • Piperacillin and tazobactam was approved by the US Food and Drug Administration (FDA) in October 1993.

What brand names are available for piperacillin/tazobactam sodium-injection?

Zosyn

Is piperacillin/tazobactam sodium-injection available as a generic drug?

GENERIC AVAILABLE: Yes

Do I need a prescription for piperacillin/tazobactam sodium-injection?

Yes

What are the side effects of piperacillin/tazobactam sodium-injection?

Common side effects associated with piperacillin/tazobactam include:

Rare side effects occurring with a frequency of less than 1% are:

Which drugs or supplements interact with piperacillin/tazobactam sodium-injection?

  • Probenecid may inhibit the renal tubular secretion (elimination via the kidneys) of piperacillin/tazobactam. This may cause higher, prolonged blood levels of piperacillin/tazobactam. The half-life of piperacillin is prolonged by 21% and the half-life of tazobactam by 71%.
  • Piperacillin/tazobactam may inhibit platelet aggregation (formation of a blood clot) which may increase the risk for bleeding. Co-administration with blood thinning agents such as warfarin (Coumadin) requires close monitoring for signs or symptoms of bleeding.
  • Piperacillin/tazobactam may prolong the neuromuscular blockade of vecuronium (Norcuron).
  • Piperacillin/tazobactam may decrease the renal (kidney) elimination of methotrexate (Trexall). Patients on concurrent therapy with methotrexate should be monitored frequently for signs or symptoms of methotrexate toxicity.

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Is piperacillin/tazobactam sodium-injection safe to take if I'm pregnant or breastfeeding?

No evidence of fetal harm has been reported from use of piperacillin/tazobactam, piperacillin alone, and tazobactam alone in mice and rats (animal studies). Piperacillin/tazobactam is known to cross the placenta. Piperacillin/tazobactam is approved for the treatment of postpartum infections. As with all medications, piperacillin/tazobactam should be used cautiously in pregnancy. Potential benefits of treatment should be weighed against any potential risk to the fetus. Piperacillin and tazobactam is classified as FDA pregnancy risk category C.

Piperacillin is excreted into human milk in small amounts. Excretion of tazobactam in human milk has not been studied. Due to the lack of safety data, piperacillin/tazobactam should be used cautiously in females who are breastfeeding.

What else should I know about piperacillin/tazobactam sodium-injection?

What preparations of piperacillin/tazobactam sodium-injection are available?

  • Piperacillin and tazobactam for injection is supplied as a powder for reconstitution (mixing).
  • Powder for solution for injection: 2.25, 3.375, 4.5, 40.5 g

How should I keep piperacillin/tazobactam sodium-injection stored?

Piperacillin and tazobactam vials should be stored at controlled room temperature, between 20 C to 25 C (68 F to 77 F), before reconstitution.

Medically reviewed by John P. Cunha, DO, FACOEP

REFERENCE:

FDA Prescribing information.

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Reviewed on 5/15/2017
References
Medically reviewed by John P. Cunha, DO, FACOEP

REFERENCE:

FDA Prescribing information.

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