Piperacillin tazobactam - An updated review of its use in the treatment ofbacterial infections

Piperacillin/tazobactam is a beta-lactam/beta-lactamase inhibitor combinati on with a broad spectrum of antibacterial activity encompassing most Gram-p ositive and Gram-negative aerobic bacteria and anaerobic bacteria, includin g many pathogens producing beta-lactamases. Evidence from clinical trials in adults has shown that piperacillin/tazobac tam, administered in an 8 : 1 ratio, is an effective treatment for patients with lower respiratory tract, intra-abdominal, urinary tract, gynaecologic al and skin/soft tissue infections, and for fever in patients with neutrope nia. Combination regimens of piperacillin/tazobactam plus an aminoglycoside are used to treat patients with severe nosocomial (hospital-acquired) infe ctions. In clinical trials, piperacillin/tazobactam was significantly more effectiv e than ticarcillin/clavulanic acid in terms of clinical and microbiological outcome in patients with community-acquired pneumonia. In patients with in tra-abdominal infections, clinical and bacteriological response rates were significantly higher with piperacillin/tazobactam than with imipenem/cilast atin (administered at a dosage lower than is recommended in countries outsi de Scandinavia). Piperacillin/tazobactam in combination with amikacin was at least as effect ive as ceftazidime plus amikacin in the treatment of ventilator-associated pneumonia and was significantly more effective than ceftazidime plus amikac in in the empirical treatment of febrile episodes in patients with neutrope nia or granule; cytopenia. In other trials, the efficacy of piperacillin/ta zobactam was similar to that of standard aminoglycoside-containing and othe r treatment regimens in patients with intra-abdominal, skin/soft tissue or gynaecological infections. Piperacillin/tazobactam is generally well tolerated. The most frequent adve rse events are gastrointestinal symptoms (most commonly diarrhoea) and skin reactions. The incidence of adverse events with piperacillin/tazobactam is higher when the combination is given in combination with an aminoglycoside than when given as monotherapy. Conclusion: Because of the broad spectrum of antibacterial activity provide d by piperacillin/tazobactam, it is useful for the treatment of patients wi th polymicrobial infections caused by aerobic or anaerobic beta-lactamase-p roducing bacteria. Piperacillin/tazobactam appears to have a particularly u seful role in the treatment of patients with intra-abdominal infections and , in combination with amikacin, in the treatment of patients with febrile n eutropenia, especially given the current prevalence of Gram-positive infect ions in this group.