ASHP Midyear: Appropriate Use of Broad-Spectrum Antibiotic Can Prevent Antimicrobial Resistance

Piperacillin/tazobactam (Zosyn; Pfizer), is a broad-spectrum antibiotic used to treat a variety of serious infections, including sepsis, pneumonia, and skin/soft tissue infections. While it provides effective coverage against a wide range of bacteria, including gram-positive, gram-negative, anaerobes, and pseudomonas, its prolonged use can increase the risk of antibiotic-associated diarrhea and Clostridioides difficile infection. Additionally, the overuse or inappropriate use of antibiotics can contribute to the development of antimicrobial resistance, which can lead to more severe illnesses and higher mortality rates. Chandani Honest, PharmD. PGY1 resident at St. Francis Hospital and Heart Center, discussed the pharmacist's role in antibiotics and preventing resistance.

Pharmacy Times: What are common indications for piperacillin/tazobactam?

Chandani Honest: Some of the common indications for piperacillin/tazobactam, or the brand name Zosyn [(Pfizer)], is bacteremia, like sepsis, septic shock. It can also be used for UTIs, pneumonia, commonly used for intra-abdominal infections, diabetic foot infections, skin and soft tissue infections, and many more.

Pharmacy Times: What are the benefits of this regimen for skin and soft tissue infections?

Honest: Zosyn is a broad spectrum antibiotic. It does have good gram positive and gram negative coverage. It also has anaerobe coverage and pseudomonal coverage. So it makes it desirable for empiric coverage for many different infections, especially a lot of skin and soft tissue infections. Specifically in skin and soft tissue infections, Zosyn is used because a lot of the cultures are polymicrobial, so you get adequate coverage with Zosyn. Another reason is like, let's say if the patient is diabetic, you tend to see a lot of multi drug resistant, gram negative bacteria. So Zosyn is also used commonly for this type of infection.

Pharmacy Times: What are some of the potential adverse effects with this therapy, specifically for skin and soft tissue infections?

Honest: Common [adverse effects] with Zosyn is diarrhea, and specifically in skin and soft tissue infections, depending on the severity of the infection, the medication could be used for a longer period of time, making the patient more at risk for severe diarrhea, leading into C difficile diarrhea, or C. Diff infection. So that's one of the concerns with the antibiotic.

Pharmacy Times: Generally speaking, what are broad-spectrum antibiotics?

Honest: Broad spectrum antibiotics are essentially antibiotics that have a wide range of bacteria that they cover, like I mentioned before, it has a wide spectrum of different organisms that it covers.

Pharmacy Times: How can the inappropriate use lead to resistance?

Honest: Prolonged use is one of the examples of like inappropriate use of antibiotic. It can lead to drug antibiotic resistance, and this can be done through different mechanisms, for example, like the organism can become resistant through gene mutations. So this is just one of the many ways that bacteria, after prolonged use or exposure to the antibiotic has a mechanism of becoming resistant.

Pharmacy Times: Why is preventing antimicrobial resistance important, and what are the effects of resistance?

Honest: Preventing antimicrobial resistant is important because bacterias that cause infections that are resistant to antibiotics can lead to severe complications. They have an increase in mortality rate, they cause more severe illnesses, and later on the line, cause more risk of complications with the more comorbidities, and so it is really crucial to tackle any antibiotic resistance you can.

Pharmacy Times: How can pharmacists help to mitigate this resistance and counsel patients on their medication?

Honest: Antibiotic resistance definitely is a topic that you should counsel patients on. You want to provide education on how to take your antibiotics and the appropriate use of it, making sure to not stop it early and to take the prescribed duration of therapy as well, and also working with other health care workers with an antimicrobial stewardship promotion you want to make sure that the appropriate drug is selected, the route, the dose duration. So that's kind of what the little bit of what the stewardship does, and work with other health care professionals on how we can prevent antimicrobial resistance, and also monitor it, such as a using like a monitoring parameter for resistance through an antibiogram.