Microbiological and Clinical Issues on the Use of Piperacillin/Tazobactam in the Treatment of Severe Infections

Abstract

Piperacillin/tazobactam, penicillin/beta-lactamase inhibitor combination, has a broad antimicrobial spectrum, including most gram-positive cocci and gram-negativeaerobic and anaerobic bacteria (including beta-lactamase producing microorganisms). Results of clinical studies showed efficacy of piperacillin/tazobactam in the treatment of lower respiratory tract infections, intra-abdominal infections, urogenital tract infections, skin and skin structure infections, and febrile neutropenia as a monotherapy or in combination with other antimicrobial agents. Clinical trials have demonstrated higher or comparable clinical efficacy and eradication rate of piperacillin/tazobactam compared to ticarcillin/clavulanate and to imipenem in the treatment of intra-abdominal infections. Combination therapy with piperacillin/tazobactam and amikacin was non-inferior to ceftazidime plus amikacin in the treatment of ventilator-associated pneumonia and superior to ceftazidime plus amikacin in febrile neutropenia episodes. Piperacillin/tazobactam has a favorable safety profile and good tolerability. The most common adverse drug reactions are gastointestinal symptoms (mainly diarrhea) and skin reactions. Because of a broad antimicrobial spectrum piperacillin/tazobactam may be used for the treatment of patients with polymicrobial infections caused by aerobic and anaerobic bacteria, especially in patients with ntra-abdominal infections or febrile neutropenic patients (when combined with aminoglycosides).