RATIONALE OF WHY CEFTRIAXONE WAS
REPLACED BY PIPERACILLIN + TAZOBACTAM
• Indication:
→ Empirical Antibiotic Treatment of Hospital-Acquired
and Ventilator-Associated Pneumonia for NO
RISK FACTORS FOR RESISTANT GRAM-
NEGATIVE PATHOGEN
→ Since the patient developed bilateral pneumonia
• Rationale:
→ Piperacillin/tazobactam is a beta-lactam/beta-
lactamase inhibitor combination with a broad
spectrum of antibacterial activity encompassing most
Gram-positive and Gram-negative aerobic bacteria
and anaerobic bacteria, including many pathogens
producing beta-lactamases.
→ Because of the broad spectrum of antibacterial
activity provided by piperacillin/tazobactam, it is
useful for the treatment of patients with polymicrobial
infections caused by aerobic or anaerobic beta-
lactamase-producing bacteria.
→ 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.
→ The combination of piperacillin and tazobactam
(Zosyn) is used to treat a variety of bacterial
infections, including:
o Pneumonia
o Appendicitis
o Pelvic inflammatory disease
o E. coli infection
o Cellulitis
o Postpartum endometriosis
→ Ceftriaxone is a third-generation
cephalosporin with broad-spectrum gram-
negative activity.
• Dosage:
→ Intravenous
→ Nosocomial pneumonia
→ Adult: Each vial contains 4.5 g (piperacillin 4 g and
tazobactam 0.5 g): 4.5 g 6 hrly for 5-14 days by
infusion over 30 min. When used empirically,
combination w/ aminoglycoside or antipseudomonal
fluoroquinolone is recommended.
→ Child: 2-12 yr 90 mg/kg (piperacillin 80 mg/kg and
tazobactam 10 mg/kg) 6 hrly for 5-14 days by
infusion over 30 min. Max: 4.5 g per dose; >12 yr
Same as adult dose.
• Action:
→ Piperacillin inhibits bacterial septum formation and
cell wall synthesis in susceptible bacteria.
→ Tazobactam is a penicillanic acid sulfone derivative
w/ β-lactamase inhibitory properties. In combination,
tazobactam enhances the activity of piperacillin
against β-lactamase-producing bacteria.
→ Piperacillin and tazobactam has a wide range of
activity and is active against gm+ve and gm-ve
aerobic and anaerobic bacteria.
→ The piperacillin and tazobactam sodium combination
is an antipseudomonal penicillin plus beta-lactamase
inhibitor. This agent inhibits biosynthesis of cell
wall mucopeptide and is effective during stage of
active multiplication.
• Organisms that produce β-lactamase that can
cause pneumonia
→ Streptococcus pneumoniae
→ Staphylococcus aureus
→ Haemophilus influenzae
→ Moraxella catarrhalis
→ M. tuberculosis**
• Why did our patient develop pneumonia?
→
WHAT IS THE RATIONALE BETWEEN QUADRUPLE
AND TRIPLE THERAPY?
QUADRUPLE THERAPY
Nelson’s
• The standard therapy of intrathoracic tuberculosis (pulmonary
disease and/or hilar lymphadenopathy) in children, as
recommended by the CDC and American Academy of
Pediatrics, is a 6 mo regimen of isoniazid and rifampin
supplemented in the 1st 2 mo of treatment by pyrazinamide
and ethambutol.
• Extrapulmonary tuberculosis is usually caused by small
numbers of mycobacteria. In general, the treatment for most
forms of extrapulmonary tuberculosis in children, including
cervical lymphadenopathy, is the same as for pulmonary
tuberculosis.
→ EXCEPT bone and joint, and CNS tuberculosis → treated
for 9-12 mo.
