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