Renal dosing adjustment for pediatric patients all ages 40mlmin no adjustment crcl. Xx pharmaceutical services extended infusion piperacillintazobactam protocol. Zosyn piperacillin and tazobactam for injection contains a total of 2. May 29, 2019 the usual total daily dose of zosyn for adults is 3. Piperacillin is an antibiotic, and tazobactam is a betalactamase inhibitor, which prevents resistance to. Zosyn extended infusion policy student doctor network. There are now observational studies as well as randomized.
Adjust doses for renal function based on tnmc renal adjustment protocol and infuse over 4 hours. Last updated 11 october 2016 if you work within a hospital in the united states there is a fair chance you are familiar with extendedinfusion piperacillintazobactam zosyn, whereby the drug is infused over three or four hours, instead of infusing it over 30 minutes i. Extended infusions ei, with the dose delivered over several hours, and continuous. In order to provide you with relevant and meaningful content we need to know more about you. For additional information or clarification, call pharmacy. Initial presumptive treatment of patients with nosocomial pneumonia should start with zosyn at a dosage of 4. Clinical pharmacists will also be available to assist. Piperacillintazobactam is traditionally given over a halfhour intravenous infusion. Implementation of an extendedinfusion piperacillin. Zosyn piperacillin and tazobactam is a combination product. Prolonged and continuous infusion provided higher pta than bolus for all regimens. Scipione, b donald chen, a john papadopoulos, b michael s. Dailymed zosyn piperacillin sodium and tazobactam sodium. Zosyn piperacillin and tazobactam for injection rx only.
Administering piptaz as a prolonged infusionthat is, either administering the antibiotic over half the dosing interval e. Each dose was reconstituted and diluted to a volume of 37. Medication scheduling andor drug compatibility conflicts. Please choose the category that best describes you. Pharmacodynamic concepts should be applied to optimize antibiotic dosing regimens. Apr 28, 2020 initial presumptive treatment of patients with nosocomial pneumonia should start with zosyn at a dosage of 4. Iv ysite infusion solutioncompatibility data infusion solution compatible. Postmenstrual agedirected dosing red book aap 2018. Draw peak 30 min after infusion ends once daily dosing. Webmd provides common contraindications for zosyn intravenous. Find out what health conditions may be a health risk when taken with zosyn intravenous. Acute pulmonary exacerbations secondary to chronic bacterial colonization of the respiratory tract are estimated to cause 90% of deaths in patients with cystic fibrosis cf. Decreased morbidity, mortality, length of hospital stay, and cost. Clinical pharmacokinetics of 3h extended infusion of meropenem in.
In one study, 222 patients were treated with zosyn in a dosing regimen of 4. Oct 26, 2009 for extended infusion tzp dosing with a base regimen of 3. Optimizing betalactam pharmacodynamics against pseudomonas. Increasing the loading dose to 200 mg, paired with a continuous infusion of 6. Results of the 84 total patients, data on appropriateness of dosing with respect to renal function were available on only 53 patients. Side effects of zosyn piperacillin and tazobactam injection. Piperacillintazobactam for pseudomonas aeruginosa infection. Renal function crcl 40 mlmin crcl 2040 mlmin crcl 40 mlmin, 3. In renal failure, the liver picks up the slack so no dose adjustment needed. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Although the use of pharmacodynamics to design antibiotic dosing regimens, such as the continuous infusion of betalactams, has. Apr 16, 2015 since the maximum concentration of drug c max is lower and the time for maximum concentration of drug t max is delayed with prolonged infusion, all dosing regimens should be initiated with a loading dose dose infused over 30 minutes. Oct 11, 2016 the use of extended infusion betalactam dosing strategies is becoming more common and its relevance to clinical practice more relevant in the setting of a limited antibiotic development pipeline.
The usual duration of zosyn treatment is from 7 to 10 days. Clinical pharmacology adults peak plasma concentrations of piperacillin and tazobactam are attained immediately after completion of an intravenous infusion of zosyn. Antibiotic dosing in critically ill adult patients receiving. Zosyn piperacillin and tazobactam for injection, usp. Continuous infusion piperacillintazobactam for the. Piperacillintazobactam zosyn extendedinfusion dosing.
Adults peak plasma concentrations of piperacillin and tazobactam are attained immediately after completion of an intravenous infusion of zosyn. Piperacillin plasma concentrations, following a 30minute infusion of zosyn piperacillin and tazobactam for injection, usp, were similar to those attained when equivalent doses of piperacillin were administered alone, with mean peak plasma concentrations of approximately 4. Clinical implications of an extended infusion dosing strategy. Identification of optimal renal dosage adjustments for traditional and extendedinfusion. Extendedinfusion piperacillintazobactam zosyn protocol. The development and implementation of an extendedinfusion piperacillintazobactam program at an urban teaching hospital are described. Only the concentration and diluents for amikacin or gentamicin with the dosages of zosyn listed above have been established as compatible for coadministration via ysite infusion. Zosyn is a combination medication that contains two drugs, piperacillin and tazobactam. Zosyn is not compatible with tobramycin for simultaneous coadministration via ysite infusion. Antiinfective pregnancy risk category b action piperacillin inhibits bacterial cellwall synthesis, resulting in cell death. Two trials of nosocomial lower respiratory tract infections were conducted. Zosyn piperacillin and tazobactam for injection, usp the. Oct 15, 2005 continuous renal replacement therapy crrt is frequently used to treat critically ill patients with acute renal failure or chronic renal failure.
We need to optimize piperacillintazobactam dosing in. An alternative way to give piperacillintazobactam is by a continuous infusion. However, in times of renal dysfunction doses are routinely decreased due to the risk of accumulation. We started a new zosyn extended infusion policy at our hospital and the doctorsnurses are flipping out about it. Therapeutic drug monitoring of betalactams in critically ill patients. Recommended dosing of zosyn in patients with normal renal function and renal insufficiency as total grams piperacillintazobactam for patients on hemodialysis, the maximum dose is 2.
Ucsf medical center extended infusion zosyn protocol 16. Network mediakit reprints and eprints sponsored supplements branded books. Renal function crcl 40 mlmin crcl 2040 mlmin crcl extended infusion piperacillintazobactam in hospitalized patients with nosocomial infections. Zosyn should be administered by intravenous infusion over 30 minutes. Continuousinfusion antipseudomonal betalactam therapy in. In adult oncology patients, is an extended infusion of zosyn more effective than a standard infusion. Rationale and evidence for extended infusion of piperacillintazobactam. The usual total daily dose of zosyn for adults is 3. The standard way to administer piperacillintazobactam is to give several grams 4 times each day as a 30 minute infusion. Piperacillintazobactam clearance was proportionalized to. Pharmacokinetics and pharmacodynamics of extendedinfusion. Jmh extended infusion piperacillintazobactam protocol. Extendedinfusion versus standardinfusion piperacillin.
Compatibility of zosyn with other aminoglycosides has not been established. Zosyn piperacillin and tazobactam for injection, usp contains a total of 2. Crrt is better tolerated by hemodynamically unstable patients and is as effective at removing solutes during a 2448h period as a single session of conventional hemodialysis 1. May 04, 2020 zosyn should be administered by intravenous infusion over 30 minutes. For pediatric patients between 2 months and 9 months of age, the recommended zosyn dosage based on pharmacokinetic modeling, is 80 mg piperacillin10 mg tazobactam per kilogram of body weight, every 8 hours see use in specific populations 8. The effectiveness of an extended 4hour infusion of 3.
Penicillin extended spectrum, betalactamase inhibitor therapeutic class. Zosyn piperacillin, tazobactam adverse reactions pfizer. Prolonged infusions attain the pharmacodynamic efficacy target defined for. Identification of optimal renal dosage adjustments for traditional and extendedinfusion piperacillintazobactam dosing regimens in hospitalized patients. Patients with cystic fibrosis cf exhibit increased clearance of betalactams. October 5, 2010 quality assurance audit october 531, 2010 evaluating administration technique and identifying areas for improvement creatinine clearance intermittent dosing extended infusion dosing 4. Use with caution in patients with renal impairment or in. Identification of optimal renal dosage adjustments for. Both the piperacillin and tazobactam are eliminated by glomerular filtration, tubular secretion, and also into the bile with a halflife of 0. Dosing is usually based on the piperacillin component. Pharmacists will assess, interchange and renally adjust standard doses of zosyn with extendedinfusions as described in the adult dosing chart below. Identification of optimal renal dosage adjustments for traditional and extended infusion piperazillintazobactam dosing regimens in hospitalized patients.
Adult extended infusion piperacillintazobactam protocol policy xx. Piperacillintazobactam ptz is a formulary agent at the nebraska medical center. Continuous infusion of betalactam antibiotics in severe sepsis. Dosing of combination betalactam betalactamase inhibitors is listed separately, and the dosing should be modified in the setting of renal failure for piperacillintazobactam, an extended acute appendicitis in children.
A 74yearold woman on continuous renal replacement therapy developed severe. Zosyn piperacillintazobactam dose, indications, adverse. Red book for windows, version 61127 updated february 2009. Initial presumptive treatment of patients with nosocomial. Impact of loading doses on the time to adequate predicted beta. Twentynine of those 53 patients 55% had piperacillintazo bactam dosing regimens appropriately adjusted for renal dysfunction. Drug shortages are a significant obstacle in providing excellent patient care, especially when shortages impact workhorse agents such as piperacillintazobactam. Piperacillintazobactam an overview sciencedirect topics. In this trial, treatmentemergent adverse events were reported by 402 patients, 204 91. Piperacillin and tazobactam drug monograph pediatric care. Stability of zosyn in an ambulatory intravenous infusion pump has been demonstrated for a period of 12 hours at room temperature. Many studies assessing the efficacy of continuousinfusion betalactams in. Mandell, 2007 red book, 2012 zobell jt, waters cd, young dc, et al, optimization of antipseudomonal antibiotics for cystic fibrosis pulmonary exacerbations.
It also identified optimal renal dosage adjustments for traditional and extendedinfusion dosing schemes that yielded. Consider extended infusion 3 hours or more frequent dosing intervals for pseudomonas or resistant pathogens crcl 50 crcl 2650. Extended infusion versus standard infusion piperacillintazobactam for sepsis syndromes at a tertiary medical center scott r. The motivation behind the widespread use of longer piperacilintazobactam infusion times. Zosyn reconstituted from bulk and single vials can be used in ambulatory intravenous infusion pumps. Extended infusion dosing 4hour infusion general, pseudomonas, nosocomial pna,cf 3. Cutro, a, robert holzman, a yanina dubrovskaya, b xian jie cindy chen, b tania ahuja, b marco r. The retrospective cohort of extended infusion piperacillintazobactam receipt study.
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