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Extended Infusion Zosyn® (Piperacillin/Tazobactam)
1. Why extended infusion?
· Goal - eradicate organism quickly & maximize the drug’s bactericidal properties
· Empiric therapy for nosocomial pathogens like Pseudomonas aeruginosa
· Shorter infusion time = inconsistencies in serum concentrations. Thus the extended infusion time provides higher serum drug levels = better bacteria killing
2. What benefit(s) will this provide?
· Sicker patients have a decrease in mortality rate with this infusion strategy
· Decrease amount of drug used = Decrease in healthcare costs
3. Can I run other medications at the same time? Yes and No. See Y-site compatibilities below. Most incompatible drugs can be scheduled during times when the Zosyn is not being infused. Or, multilumen PICC can be considered in certain circumstances.
Y-site compatible [Can be y-sited together with these intermittent or continuous IV meds]
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Antibiotics Amikacin (Amikin®) Aztreonam (Azactam®) Cefepime (Maxipime®) Clindamycin (Cleocin®) Daptomycin (Cubicin®) Fluconazole (Diflucan®) Linezolid (Zyvox®) Metronidazole (Flagyl®) SMX/TMP (Bactrim®) Tigecycline (Tygacil®) Vancomycin**
Antifungals Fluconazole (Diflucan®) Voriconazole (Vfend®) |
Anticoagulants Argatroban Bivalirudin (Angiomax®) Heparin
Diuretics Bumetanide (Bumex®) Furosemide (Lasix®)
Drips Fentanyl Lorazepam (Ativan®) Morphine Sodium Bicarbonate |
GI/Reflux Pantoprazole (Protonix®) Metoclopramide (Reglan®) Ondansetron (Zofran®) Pressors Dopamine Epinephrine Milrinone (Primacor®) Norepinephrine (Levophed®) Phenylepherine (Neo-Synephrine®) Vasopressin
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Other Aminophylline Amiodarone** Calcium gluconate Dexmedetomidine (Precedex®) Digoxin (Lanoxin®) Diphenhydramine (Benadryl®) Enalaprilat (Vasotec®) Hydrocortisone (Solu-cortef®) Hydromorphone (Dilaudid®) Lorazepam (Ativan®) Magnesium sulfate Mannitol Methylprednisolone (Solu-Medrol®) Morphine Potassium Chloride/ Potassium phosphate TPN |
INCOMPATIBLE-[Do Not Piggyback Together]
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Antibiotics Azithromycin (Zithromax®)* Ciprofloxacin (Cipro®)* Doxycycline (Vibramycin®)* Gentamicin (Gentak®) Levofloxacin (Levaquin®)* Tobramycin
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Antifungals Amphotericin B Micafungin (Mycamine®) |
Other Diltiazem (Cardizem®) Dobutamine Famotidine (Pepcid®)
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Other Haloperidol (Haldol®) Insulin, regular (Humulin®) Promethazine (Phenergan®) Nalbuphine (Nubain®) Acyclovir (Zovirax®) |
* Give PO form if possible
** Internal compatibility studies confirm Y-site compatibility at concentrations used at MHCS.
4. What if the patient’s renal function changes?
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CrCl (ml/min) |
CrCl > 20 ml/min, CRRT |
CrCl <20, peritoneal, hemodialysis |
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Dose |
3.375 g over 4 hours q8h |
3.375 g over 4 hours q12h |
5. What if I run into a problem with infusing the Zosyn® or I don’t have IV access? If difficulties with adequate IV access or drug incompatibilities, we can modify the dosing regimen back to traditional dosing (3.375 Q6, 4.5 Q6, etc.)