Infectious Disease Compendium

Ceftolozane/tazobactam (Zerbaxa®)

Dosing

CrCl Formula

CrCl > 50: 1.5 g - 3 gm every 8 hours

CrCl 30 to 50 mL/minute: 1.5 g IV every 8 hours.

CrCl 15 to 29 mL/minute: 750 mg IV every 8 hours.

Hemodialysis: give after dialysis.

Peritoneal dialysis:

Can be given either 4.5 or 9 grams of continuous infusion C/T every 24 hours as well. Easier for outpatient (Pubmed)ipsum">Pubmed).

Important side effects

Important drug interactions

Rants and Screeds

$2,490/day. Really. I know it costs real money to bring a drug to market and all but WTF?!?

Pearls

"Clinicians must remember that the addition of tazobactam does not always increase the susceptibility of P. aeruginosa and other Gram-negative bacilli expressing AmpC β-lactamases. However, tazobactam does extend piperacillin's activity against most β-lactamase producing strains of Enterobacteriaceae, H. influenzae, N. gonorrhoeae, and M. catarrhalis and has the potential to lower MICs against these strains expressing ESBLs (PubMed)."

The best outcome with Pseudomonas are high dose and an MIC ≤2 mg/L (PubMed).

Treatment of choice

Use for

Enhanced activity against Pseudomonas aeruginosa and activity against ESBL organisms.

Ceftolozane/tazobactam is more potent against P. aeruginosa compared to ceftazidime, cefepime, meropenem, piperacillin/tazobactam, aztreonem, levofloxacin, gentamicin, and colistin. Second to colistin, had the best activity against 310 multidrug-resistant strains of P. aeruginosa (PubMed). Similarly 175 extensively drug-resistant strains showed susceptibility, while they were resistant to most other agents. Ceftolozane/tazobactam has activity against Bacteroides fragilis but not the remainder of Bacteroides spp.

Don't use for

Class

Cephalosporin plus beta-lactamase inhibitor.

Last Update: 02/16/20.