Piperacillin / Tazobactam

Um, and this is the article, first one of these two, Cefepime versus Zosyn.

So Cefepime versus Piperacillin-Tazobactam for the treatment of Pseudomonas aeruginosa pneumonia was published in CID.

And I saw that title and I thought, "I really wanna know these results." Everyone, right? Everyone's like, "Oh my gosh, head-to-head, who's gonna win?" So these authors performed a single center retrospective cohort study of patients with pneumonia.

Ah, I wish it was like prospective, but all right.

You could also choose a beta-lactam, beta-lactamase inhibitor.

A common example would be Zosyn piperacillin-tazobactam.

If it was an outpatient, you could use Augmentin, amoxicillin clavulanate.

But that beta-lactamase inhibitor is going to convey that anaerobic coverage that you might be looking for.

And that's kind of it.

Yeah.

And then for hospital-acquired pneumonia, we're going to go with the Zosyn pepracillin-tazobactam, which is your beta-lactam, beta-lactamase inhibitor, or cefepim with or without that vancomycin if you have MRSA possibility.

And it just so happens that Zosyn would have the anaerobic coverage, but it doesn't mean that it's like a better choice versus cefepime, which doesn't have anaerobic coverage.

... "Why, what is this question?" And it was, um, you know, the what's supplied, what's ordered, how do you make it happen.

Um, and so it was the order was 3.375 grams of Zosyn, and what was given was 4.5 grams.

And I was like, "That's a med error.

We're not gonna do that.

So people have a tendency to look at those criteria for the trial, and some people hesitate to extend the results or maybe to drop some of the parameters of the trial when it comes to quote-unquote real life.

So as an example from another trial, we had a trial in infectious diseases that found that Piptazo was not non-inferior for meropenem for bloodstream infections with extended spectrum beta-lactamases.

And since that trial, we were comfortable in some cases taking those results and applying them to less serious infections.

So for example, applying them to urine infections.

Although you can get things like a continuous infusion pump that is set up for the patient and they're out of the hospital with it.

for things like Piptaz, or maybe that's the idea.

And penicillin, and

Fluclox for that matter.

Yeah, I think that the last American fuses are maybe a little underused, mostly on grounds of cost, but the advantage of them is that they kind of do this automatically.

Yeah.

And when we start Piptaz, certainly down in Nadal, Shroyland, Fermi, South, we would start Piptaz 13.5 grams a day, so that's four and a half grams, three times a day equivalent, but just in one polyfuser.

And I think there's good data out there to say that pharmacokinetically, that's probably giving you the same time over MIC as 4.5 grams four times a day.