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Zosyn Dosage and Administration


Bacteremia ciprofloxacin , metronidazole , clindamycin , vancomycin , Flagyl , More Coagulation —positive direct Coombs' test, prolonged prothrombin time, prolonged partial thromboplastin time. The zone size provides an estimate of the susceptibility of bacteria to antimicrobial compounds. These reports should aid the physician in selecting the most effective antimicrobial. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. Here are a few ways. The effect of race on piperacillin and tazobactam was evaluated in healthy male volunteers.

Indications and Usage for Zosyn


Zosyn should not be mixed with other drugs in a syringe or infusion bottle since compatibility has not been established. Zosyn is not chemically stable in solutions that contain only sodium bicarbonate and solutions that significantly alter the pH. Zosyn should not be added to blood products or albumin hydrolysates. Parenteral drug products should be inspected visually for particulate matter or discoloration prior to administration, whenever solution and container permit.

Zosyn reconstituted from bulk and single vials is stable in glass and plastic containers plastic syringes, I. The pharmacy bulk vial should NOT be frozen after reconstitution. Single dose or pharmacy vials should be used immediately after reconstitution. Vials should not be frozen after reconstitution. Stability studies in the I. Zosyn contains no preservatives. Appropriate consideration of aseptic technique should be used. Zosyn reconstituted from bulk and single vials can be used in ambulatory intravenous infusion pumps.

Stability of Zosyn in an ambulatory intravenous infusion pump has been demonstrated for a period of 12 hours at room temperature.

Each dose was reconstituted and diluted to a volume of One-day supplies of dosing solution were aseptically transferred into the medication reservoir I.

The reservoir was fitted to a preprogrammed ambulatory intravenous infusion pump per the manufacturer's instructions. Stability of Zosyn is not affected when administered using an ambulatory intravenous infusion pump.

Due to the in vitro inactivation of aminoglycosides by piperacillin, Zosyn and aminoglycosides are recommended for separate administration. Zosyn and aminoglycosides should be reconstituted, diluted, and administered separately when concomitant therapy with aminoglycosides is indicated [ see Drug Interactions 7. In circumstances where co-administration via Y-site is necessary, Zosyn formulations containing EDTA are compatible for simultaneous co-administration via Y-site infusion only with the following aminoglycosides under the following conditions:.

Only the concentration and diluents for amikacin or gentamicin with the dosages of Zosyn listed above have been established as compatible for co-administration via Y-site infusion. Simultaneous co-administration via Y-site infusion in any manner other than listed above may result in inactivation of the aminoglycoside by Zosyn. Zosyn is not compatible with tobramycin for simultaneous co-administration via Y-site infusion. Compatibility of Zosyn with other aminoglycosides has not been established.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. These reactions are more likely to occur in individuals with a history of penicillin, cephalosporin, or carbapenem hypersensitivity or a history of sensitivity to multiple allergens.

Before initiating therapy with Zosyn, careful inquiry should be made concerning previous hypersensitivity reactions. If an allergic reaction occurs, Zosyn should be discontinued and appropriate therapy instituted. Zosyn may cause severe cutaneous adverse reactions, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, and acute generalized exanthematous pustulosis.

If patients develop a skin rash they should be monitored closely and Zosyn discontinued if lesions progress. These reactions have sometimes been associated with abnormalities of coagulation tests such as clotting time, platelet aggregation and prothrombin time, and are more likely to occur in patients with renal failure. If bleeding manifestations occur, Zosyn should be discontinued and appropriate therapy instituted. As with other penicillins, patients may experience neuromuscular excitability or convulsions if higher than recommended doses are given intravenously particularly in the presence of renal failure.

Based on this study, alternative treatment options should be considered in the critically ill population. If alternative treatment options are inadequate or unavailable, monitor renal function during treatment with Zosyn [ see Dosage and Administration 2. Zosyn contains a total of 2. This should be considered when treating patients requiring restricted salt intake.

Periodic electrolyte determinations should be performed in patients with low potassium reserves, and the possibility of hypokalemia should be kept in mind with patients who have potentially low potassium reserves and who are receiving cytotoxic therapy or diuretics. Clostridium difficile associated diarrhea CDAD has been reported with use of nearly all antibacterial agents, including Zosyn, and may range in severity from mild diarrhea to fatal colitis.

Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. Hypertoxin producing strains of C.

CDAD must be considered in all patients who present with diarrhea following antibacterial drug use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.

Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C. Prescribing Zosyn in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient and increases the risk of development of drug-resistant bacteria. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

During the initial clinical investigations, patients worldwide were treated with Zosyn in phase 3 trials. Two trials of nosocomial lower respiratory tract infections were conducted. In one study, patients were treated with Zosyn in a dosing regimen of 4. In this trial, treatment-emergent adverse events were reported by patients, Studies of Zosyn in pediatric patients suggest a similar safety profile to that seen in adults.

In this trial, treatment-emergent adverse events were reported by patients, 73 Of the trials reported, including that of nosocomial lower respiratory tract infections in which a higher dose of Zosyn was used in combination with an aminoglycoside, changes in laboratory parameters include:.

Hematologic —decreases in hemoglobin and hematocrit, thrombocytopenia, increases in platelet count, eosinophilia, leukopenia, neutropenia. These patients were withdrawn from therapy; some had accompanying systemic symptoms e. Coagulation —positive direct Coombs' test, prolonged prothrombin time, prolonged partial thromboplastin time. Additional laboratory events include abnormalities in electrolytes i. In addition to the adverse drug reactions identified in clinical trials in Table 3 and Table 4, the following adverse reactions have been identified during post-approval use of Zosyn.

Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Skin and Appendages —erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms DRESS , acute generalized exanthematous pustulosis AGEP , dermatitis exfoliative.

The following adverse reaction has also been reported for piperacillin for injection:. Skeletal —prolonged muscle relaxation [ see Drug Interactions 7. Post-marketing experience with Zosyn in pediatric patients suggests a similar safety profile to that seen in adults. Piperacillin may inactivate aminoglycosides by converting them to microbiologically inert amides.

When aminoglycosides are administered in conjunction with piperacillin to patients with end-stage renal disease requiring hemodialysis, the concentrations of the aminoglycosides especially tobramycin may be significantly reduced and should be monitored. Sequential administration of Zosyn and tobramycin to patients with either normal renal function or mild to moderate renal impairment has been shown to modestly decrease serum concentrations of tobramycin but no dosage adjustment is considered necessary.

Zosyn and aminoglycosides should be reconstituted, diluted, and administered separately when concomitant therapy with aminoglycosides is indicated.

Zosyn, which contains EDTA, is compatible with amikacin and gentamicin for simultaneous Y-site infusion in certain diluents and at specific concentrations. Zosyn is not compatible with tobramycin for simultaneous Y-site infusion [ see Dosage and Administration 2. Probenecid should not be co-administered with Zosyn unless the benefit outweighs the risk. Coagulation parameters should be tested more frequently and monitored regularly during simultaneous administration of high doses of heparin, oral anticoagulants, or other drugs that may affect the blood coagulation system or the thrombocyte function.

Piperacillin when used concomitantly with vecuronium has been implicated in the prolongation of the neuromuscular blockade of vecuronium. Zosyn could produce the same phenomenon if given along with vecuronium. Due to their similar mechanism of action, it is expected that the neuromuscular blockade produced by any of the non-depolarizing muscle relaxants could be prolonged in the presence of piperacillin. Monitor for adverse reactions related to neuromuscular blockade See package insert for vecuronium bromide.

Limited data suggests that co-administration of methotrexate and piperacillin may reduce the clearance of methotrexate due to competition for renal secretion. The impact of tazobactam on the elimination of methotrexate has not been evaluated. If concurrent therapy is necessary, serum concentrations of methotrexate as well as the signs and symptoms of methotrexate toxicity should be frequently monitored.

It is recommended that glucose tests based on enzymatic glucose oxidase reactions be used. Piperacillin and tazobactam cross the placenta in humans.

The background risk of major birth defects and miscarriage for the indicated population is unknown. Piperacillin is excreted in human milk; tazobactam concentrations in human milk have not been studied. No information is available on the effects of piperacillin and tazobactam on the breast-fed child or on milk production.

The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for Zosyn and any potential adverse effects on the breastfed child from Zosyn or from the underlying maternal condition.

Safety and efficacy in pediatric patients less than 2 months of age have not been established [ see Clinical Pharmacology 12 and Dosage and Administration 2 ]. Patients over 65 years are not at an increased risk of developing adverse effects solely because of age.

However, dosage should be adjusted in the presence of renal impairment [ see Dosage and Administration 2 ]. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

Zosyn contains 65 mg 2. The geriatric population may respond with a blunted natriuresis to salt loading. This may be clinically important with regard to such diseases as congestive heart failure.

This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function.

Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. Dosage adjustment of Zosyn is not warranted in patients with hepatic cirrhosis [see Clinical Pharmacology As with other semisynthetic penicillins, piperacillin therapy has been associated with an increased incidence of fever and rash in cystic fibrosis patients.

The majority of those events experienced, including nausea, vomiting, and diarrhea, have also been reported with the usual recommended dosages. Patients may experience neuromuscular excitability or convulsions if higher than recommended doses are given intravenously particularly in the presence of renal failure [ see Warnings and Precautions 5.

Treatment should be supportive and symptomatic according the patient's clinical presentation. Excessive serum concentrations of either piperacillin or tazobactam may be reduced by hemodialysis. Following a single 3. The chemical name of piperacillin sodium is sodium 2 S ,5 R ,6 R [ R 4-ethyl-2,3-dioxopiperazine-carboxamido phenylacetamido]-3,3-dimethyloxothiaazabicyclo[3. The chemical structure of piperacillin sodium is:. Tazobactam sodium, a derivative of the penicillin nucleus, is a penicillanic acid sulfone.

Its chemical name is sodium 2 S, 3 S, 5 R methyloxo 1 H -1,2,3-triazolylmethyl thiaazabicyclo[3. It is said that two out of every three American adults are overweight or obese, with a third of American adults being in the latter camp. You may very well have a body shape that does not feel comfortable, does not feel like who you really are, and even that causes you physical pain.

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A full liver cleanse can be helpful in reversing the damage to some extent. You might not know what too much alcohol means as far as your liver health is concerned. From mild scarring to severe inflammation of the liver cells, an excessive intake of alcohol can cause a severely negative impact on the liver.

Moreover, if the negative impact of alcohol takes a toll on the liver, the ability to break down alcohol further reduces, thus, causing chronic damage.

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