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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
Additional Information
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.
References
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.