Title: Cefepime vs Piperacillin/Tazobactam for Empiric Sepsis Coverage<br/>Author: Ashley Martinelli<br/><a href='mailto:1912'>[Click to email author]</a><hr/><p> Debating between cefepime or piperacillin/tazobactam for your septic patient? Use this table to help you decide.</p> <table border="1" cellpadding="0" cellspacing="0" style="width:0px;" width="0"> <tbody> <tr> <td style="width:173px;height:33px;"> <p> </p> </td> <td style="width:144px;height:33px;"> <p> </p> </td> <td style="width:124px;height:33px;"> <p align="center"> <strong>Cefepime</strong></p> </td> <td style="width:158px;height:33px;"> <p align="center"> <strong>Piperacillin/Tazobactam</strong></p> </td> </tr> <tr> <td rowspan="3" style="width:173px;height:31px;"> <p align="center"> <strong>Gram Negative Spectrum</strong></p> </td> <td style="width:144px;height:31px;"> <p align="center"> Pseudomonas aeruginosa </p> </td> <td style="width:124px;height:31px;"> <p align="center"> <strong>Yes</strong></p> </td> <td style="width:158px;height:31px;"> <p align="center"> <strong>Yes</strong></p> </td> </tr> <tr> <td style="width:144px;height:33px;"> <p align="center"> Aerobic gram negative organisms </p> </td> <td style="width:124px;height:33px;"> <p> E. coli </p> <p> Klebsiella sp. </p> <p> Proteus mirabilis </p> <p> M catarrhalis </p> <p> H. influenza </p> </td> <td style="width:158px;height:33px;"> <p> E. coli </p> <p> Klebsiella sp. </p> <p> Proteus mirabilis </p> <p> M. catarrhalis </p> <p> H. influenza </p> </td> </tr> <tr> <td style="width:144px;height:31px;"> <p align="center"> Anerobic gram negative organisms </p> </td> <td style="width:124px;height:31px;"> <p align="center"> <strong>No</strong></p> </td> <td style="width:158px;height:31px;"> <p> B. fragilis </p> <p> </p> </td> </tr> <tr> <td rowspan="3" style="width:173px;height:33px;"> <p align="center"> <strong>Gram Positive Spectrum</strong></p> </td> <td style="width:144px;height:33px;"> <p align="center"> MRSA </p> </td> <td style="width:124px;height:33px;"> <p align="center"> <strong>No</strong></p> </td> <td style="width:158px;height:33px;"> <p align="center"> <strong>No</strong></p> </td> </tr> <tr> <td style="width:144px;height:33px;"> <p align="center"> Aerobic gram positive organisms </p> </td> <td style="width:124px;height:33px;"> <p> MSSA </p> <p> CoNS </p> <p> Group A Strep </p> <p> S. pneumoniae </p> <p> </p> </td> <td style="width:158px;height:33px;"> <p> MSSA </p> <p> CoNS </p> <p> Group A Strep </p> <p> S. pneumoniae </p> <p> E. faecalis </p> </td> </tr> <tr> <td style="width:144px;height:33px;"> <p align="center"> Anaerobic gram positive organisms </p> </td> <td style="width:124px;height:33px;"> <p> P. acnes </p> <p> Peptostreptococci </p> </td> <td style="width:158px;height:33px;"> <p> P. acnes </p> <p> Peptostreptococci </p> <p> Clostridium sp. </p> </td> </tr> <tr> <td rowspan="3" style="width:173px;height:33px;"> <p align="center"> <strong>Infection Site Concerns</strong></p> </td> <td style="width:144px;height:33px;"> <p align="center"> CNS Penetration </p> </td> <td style="width:124px;height:33px;"> <p align="center"> <strong>Yes</strong></p> </td> <td style="width:158px;height:33px;"> <p align="center"> <strong>No</strong><strong><sup>1</sup></strong></p> </td> </tr> <tr> <td style="width:144px;"> <p align="center"> Urine Penetration </p> </td> <td style="width:124px;"> <p align="center"> <strong>Yes</strong></p> </td> <td style="width:158px;"> <p align="center"> <strong>Yes</strong></p> </td> </tr> <tr> <td style="width:144px;height:33px;"> <p align="center"> Lung Penetration </p> </td> <td style="width:124px;height:33px;"> <p align="center"> <strong>Yes</strong></p> </td> <td style="width:158px;height:33px;"> <p align="center"> <strong>Low</strong><strong><sup>2</sup></strong></p> </td> </tr> <tr> <td colspan="2" style="width:317px;height:33px;"> <p> <strong>Dosing Frequency (Normal Renal Function)</strong></p> </td> <td style="width:124px;height:33px;"> <p align="center"> Q8h </p> </td> <td style="width:158px;height:33px;"> <p align="center"> Q6h </p> </td> </tr> </tbody> </table> <div class="OutlineElement Ltr SCXW80259793" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow: visible; cursor: text; clear: both; position: relative; direction: ltr; color: rgb(0, 0, 0); font-family: "Segoe UI", "Segoe UI Web", Arial, Verdana, sans-serif;"> <p class="Paragraph SCXW80259793" paraeid="{3b59edba-41fa-498b-a518-6be5efec8627}{5}" paraid="1197101909" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; word-wrap: break-word; vertical-align: baseline; background-color: transparent; color: windowtext;"> <span class="TextRun SCXW80259793" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 11pt; font-family: Calibri, Calibri_MSFontService, sans-serif; line-height: 19px;" xml:lang="EN-US">1</span><span class="TextRun SCXW80259793" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 11pt; font-family: Calibri, Calibri_MSFontService, sans-serif; line-height: 19px;" xml:lang="EN-US">. </span><span class="TextRun SCXW80259793" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 11pt; font-family: Calibri, Calibri_MSFontService, sans-serif; line-height: 19px;" xml:lang="EN-US">Tazobactam</span><span class="TextRun SCXW80259793" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 11pt; font-family: Calibri, Calibri_MSFontService, sans-serif; line-height: 19px;" xml:lang="EN-US"> CNS penetration is limited</span><span class="TextRun SCXW80259793" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 11pt; font-family: Calibri, Calibri_MSFontService, sans-serif; line-height: 19px;" xml:lang="EN-US">, thus limiting antipseudomonal activity in the CNS</span><span class="EOP SCXW80259793" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 11pt; line-height: 19px; font-family: Calibri, Calibri_MSFontService, sans-serif;"> </span></p> </div> <div class="OutlineElement Ltr SCXW80259793" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow: visible; cursor: text; clear: both; position: relative; direction: ltr; color: rgb(0, 0, 0); font-family: "Segoe UI", "Segoe UI Web", Arial, Verdana, sans-serif;"> <p class="Paragraph SCXW80259793" paraeid="{3b59edba-41fa-498b-a518-6be5efec8627}{11}" paraid="1495460187" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; word-wrap: break-word; vertical-align: baseline; background-color: transparent; color: windowtext;"> <span class="TextRun SCXW80259793" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 11pt; font-family: Calibri, Calibri_MSFontService, sans-serif; line-height: 19px;" xml:lang="EN-US">2</span><span class="TextRun SCXW80259793" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-variant-ligatures: none !important; font-size: 11pt; font-family: Calibri, Calibri_MSFontService, sans-serif; line-height: 19px;" xml:lang="EN-US">. Low pulmonary penetration, may not achieve therapeutic levels in patients with critical illness</span><span class="EOP SCXW80259793" data-ccp-props="{"201341983":0,"335559739":160,"335559740":259}" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 11pt; line-height: 19px; font-family: Calibri, Calibri_MSFontService, sans-serif;"> </span></p> </div> <p> </p>
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<fieldset><legend>References</legend>
<div class="OutlineElement Ltr SCXW248728527" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow: visible; cursor: text; clear: both; position: relative; direction: ltr; color: rgb(0, 0, 0); font-family: Calibri, sans-serif; font-size: 14.6667px;"> <p style="margin-left:.25in;"> 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. </p> <p style="margin-left:.25in;"> 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. </p> <p style="margin-left:.25in;"> 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. </p> <p style="margin-left:.25in;"> 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. </p> </div> <p> </p> </fieldset>