UMEM Educational Pearls

Question

Debating between cefepime or piperacillin/tazobactam for your septic patient? Use this table to help you decide.

 

 

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 

1Tazobactam 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 

 

Answer

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.