Category: Infectious Disease
Keywords: sepsis, pseudomonas (PubMed Search)
Posted: 2/3/2018 by Ashley Martinelli
(Updated: 12/26/2024)
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Debating between cefepime or piperacillin/tazobactam for your septic patient? Use this table to help you decide.
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|
| Cefepime | Piperacillin/Tazobactam |
| Gram Negative Spectrum | Pseudomonas aeruginosa | Yes | Yes |
| Aerobic gram negative organisms | E. coli Klebsiella sp. Proteus mirabilis M catarrhalis H. influenza | E. coli Klebsiella sp. Proteus mirabilis M. catarrhalis H. influenza | |
| Anerobic gram negative organisms | No | B. fragilis
| |
| Gram Positive Spectrum | MRSA | No | No |
| Aerobic gram positive organisms | MSSA CoNS Group A Strep S. pneumoniae
| MSSA CoNS Group A Strep S. pneumoniae E. faecalis | |
| Anaerobic gram positive organisms | P. acnes Peptostreptococci | P. acnes Peptostreptococci Clostridium sp. | |
| Infection Site Concerns | CNS Penetration | Yes | No1 |
| Urine Penetration | Yes | Yes | |
| Lung Penetration | Yes | Low2 | |
| Dosing Frequency (Normal Renal Function) | Q8h | Q6h | |
1. Tazobactam CNS penetration is limited, thus limiting antipseudomonal activity in the CNS
2. Low pulmonary penetration, may not achieve therapeutic levels in patients with critical illness
Take home points:
-Piperacillin/tazobactam differs in spectrum with its ability to cover enterococcus and anaerobes. Consider for sepsis with gastrointestinal source
-Cefepime can be used for CNS infections and readily achieves therapeutic concentrations in the lungs. Metronidazole can be added to ensure anaerobic organism coverage.
-Piperacillin/tazobactam should be dosed every 6 hours in patients with normal renal function to achieve therapeutic concentration.
1. Gilbert, D. N., Chambers, H. F., Eliopoulos, G. M., Saag, M. S., & Pavia, A. T. (2016). Sanford guide to antimicrobial therapy 2016. 46th edition. Sperryville, VA, USA: Antimicrobial Therapy, Inc.
2. Nau R, Kinzig-Schippers M, Sörgel F, et al. Kinetics of piperacillin and tazobactam in ventricular cerebrospinal fluid of hydrocephalic patients.?Antimicrobial Agents and Chemotherapy. 1997;41(5):987-991.
3. Felton T, McCalman K, Malagon I, et al. Pulmonary penetration of piperacillin and tazobactam in critically ill patients. Clinical pharmacology and therapeutics. 2014;96(4):438-448. doi:10.1038/clpt.2014.131.
4. Boselli E, Breilh D, Duflo F, et al. Steady-state plasma and intrapulmonary concentrations of cefepime administered in continuous infusion critically ill patients with severe nosocomial pneumonia. Critical Care Medicine.2003;31:2102-2106.
