Commonly used antibiotic brings more complications, death in the sickest patients (Zosyn responsible for 5% more deaths than cefepime)

Medical Xpress / University of Michigan / JAMA Internal Medicine ^ | May 13, 2024 | Rishi Chanderraj et al

[ConservativeMind]

In emergency rooms and intensive care units across the country, clinicians make split-second decisions about which antibiotics to give a patient. A new study reveals that these decisions may have unintended consequences for patient outcomes.

Beginning in 2015, a 15-month national shortage of a commonly prescribed antibiotic, piperacillin/tazobactam--known by the brand name Zosyn--provided a unique opportunity to compare rates of death in hospitalized patients with sepsis who were administered two different types of antibiotics—one that spares the gut microbiome and one that profoundly alters it.

Piperacillin/tazobactam is a broad-spectrum antibiotic that is commonly administered for sepsis, a life-threatening complication from infection. In its absence, clinicians commonly instead use another antibiotic, cefepime, which has similar activity against common sepsis pathogens but, unlike piperacillin/tazobactam, has minimal effects on anaerobic gut bacteria.

In health, the gut microbiome is largely populated by anaerobic bacteria that rarely cause disease. Prior work by the study team has revealed that even a single dose of piperacillin/tazobactam kills most of these anaerobic gut bacteria, which play important roles in the body's metabolism, immunity, and prevention of infections.

Rishi Chanderraj, M.D. used patient record data to look at outcomes in 7,569 patients. The team compared 4,523 patients who were treated were piperacillin/tazobactam with 3,046 patients who received cefepime.

They found marked differences: Treatment with piperacillin-tazobactam was associated with a 5% increase in 90-day mortality, more days on a ventilator, and more time with organ failure.

The study builds on previous work by the study team that suggested critically ill patients might do worse when given antibiotics that deplete the gut of anaerobes. The researchers have also seen similar effects when studying animal models.

[ConservativeMind]

If you or a loved one needs treatment for sepsis or other serious infection, consider pushing for cefepime over piperacillin/tazobactam (Zosyn)

[ConservativeMind]

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[Migraine]

Beware also of Levaquin or fluouroquinolones of any kind for bronchitis or pneumonia. It has strong possibilities of ruining your lower extremities via neuropathy or ruptured achilles tendons. Not worth it.

[tired&retired]

Excellent article.

Thank you for sharing.

🙏🙏🙏

[DallasGal]

Interesting. They attempted to give me Zosyn in the hospital a week ago. Hung the IV bag and in less than 3 minutes, I was vomiting. They killed the drip, flushed the line and added it to my list of allergies. Sounds like I’m lucky to be allergic