21A16: Exam Report
Describe the pharmacology of piperacillin-tazobactam
62% of candidates passed this question.
Most candidates used a structured approach with the usual major pharmacology headings. Mechanism of action was well described by most, with better answers including mechanisms of resistance. Higher scoring candidates included an explanation as to the combination of the drugs. Likewise, better answers included detailed information on spectrum of activity beyond “gram positive and gram negative”, including relevant groups of organisms which are not covered. There also seemed to be some confusion about coverage for anaerobes, which piperacillin tazobactam covers well.
Specific detail about adverse reactions, other than ‘allergy, rash, GI upset, phlebitis, etc’, is expected for commonly used antibiotics.
Tazocin
Tazocin
Class
Antipseudomonal Penicillin with β-lactamase inhibitor
Dose
4.5g q8h
Mechanism
Cell Wall Inhibitor
MoA
Inhibits cell wall (peptidoglycan) synthesis
Mimics D-Ala-D-Ala (substrate required for cell wall synthesis)
Transpeptidases instead bind to b-lactam nucleus
Time v Conc
Time Dependent -> time spent above minimal inhibitory concentration determines efficacy
Post Dose Effect
Short 2hrs – bactericidal
SPectrum
Covers
Doesnt
- MSSA
- Streptococci & Enterococci
- Neisseria Meningitidis/Gonorrhoea
- Many Gram -ves including Pseudomonas
- Anaerobes
- MRSA
- VRE
- ESCAPIMS
Indications
- V Broad Spectrum
- Hospital acquired infections
- Intra-abdominal infections
- Neutropenic Sepsis
PK
A
IV only
D
- PPB 20%
- Vd 0.2L/kg
M
Minor hepatic metabolism
E
- Renally excreted
- Needs dose adjusted in renal impairment
AE
- High Na+ load
- Interacts w Vecuronium – prolongs neuromuscular blockade
Monitoring
- Renal fn
- LFTs
Author: Krisoula Zahariou