Ceftolozane/Tazobactam for Pseudomonas aeruginosa Infections: Going Beyond the Package Insert

Shmuel Shoham, MD; Patricia J. Simner, PhD; Kathryn E. Dzintars, PharmD


February 09, 2016

In This Article

Use of Precious Antibiotics in the Era of MDR Bacterial Infections

  • What are the implications of using this drug in terms of antimicrobial stewardship efforts?

With the threat of MDR bacteria looming at the forefront of patient care, especially in immunosuppressed persons, it is easy to understand why a drug such as ceftolozane/tazobactam would be used empirically to optimize a practitioner's chances of "getting it right the first time." It is precisely for this reason that proper antimicrobial stewardship practices should be used.

Stewardship, or selection of the appropriate drug at the appropriate dose and route of administration for the appropriate duration, has also become relevant in today's healthcare setting, with practices being endorsed by the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, and the Centers for Disease Control.[13]

With the antimicrobial pipeline for agents active against gram-negative organisms looking bleak, preservation of new antimicrobials, such as ceftolozane/tazobactam, is of utmost importance. Stewardship is optimized through the use of infectious diseases-trained physicians and pharmacists, as well as input from professionals in the clinical microbiology laboratory, to help identify the patient population that is most in need. Working together, these professionals can use known resistance patterns and knowledge of commonly recovered organisms to provide ideal empirical therapy to patients.

Several other factors should be taken into consideration when choosing an appropriate antimicrobial, whether it is for empirical or targeted therapy. These include drug cost and availability, and the feasibility of microbiologic testing. When possible, generic alternatives—which tend to be significantly less expensive than newer, brand-name–only agents, and are often just as safe and effective—should be preferentially used.

Use of antibiotics of last resort, such as ceftolozane/tazobactam, should be restricted to the treatment of infections that are known or suspected to be caused by susceptible organisms, and for which the other options are either not as effective or too toxic. So although ceftolozane/tazobactam is FDA-indicated for use in the treatment of intra-abdominal infections caused by susceptible Enterobacter cloacae, Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae, Proteus mirabilis, P aeruginosa, Bacteroides fragilis, Streptococcus anginosus, Streptococcus constellatus, and Streptococcus salivarius, and UTIs caused by susceptible E coli, K pneumoniae, P mirabilis, and P aeruginosa, its likely niche will be in serious infections caused by susceptible isolates of MDR P aeruginosa.

Caring for patients at risk for invasive infections caused by MDR organisms is a reality of modern medicine. As this discussion illustrates, effective use of antibiotics requires a team effort spanning multiple disciplines. This is particularly important for those precious antimicrobials, including ceftolozane/tazobactam, that constitute the last line against otherwise untreatable and potentially catastrophic infections.


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