Revotaz Injection (Pipercillin and Tazobactam)
Revotaz (Pipercillin and Tazobactam) Injection is used for the treatments of patients with moderate to severe infections caused by susceptible isolates of the designated bacteria in the conditions listed below –
Revotaz (Pipercillin and Tazobactam) Uses
- Severe Pneumonia including hospital-acquired and ventilator – associated pneumonia.
- Complicated urinary tract infections (including pyelonophritis).
- Intra abdominal infections.
- Skin and soft tissue infections (including diabetic foot infections).
Treatment of patients with bacteriamia that occurs in association with or is suspected to be associated with any of the infections listed above. Piperacillin/Tazobactam may be used in the management of neutropenic patients with fever suspected to be due to a bacterial infection.
Revotaz (Pipercillin and Tazobactam) Pharmacological properties and Mechanism of Action
Pharmocotherapeutic group : Antibacterials for systemic use, Combinations of penicillins incl. beta-lactamase inhibitors
Mechanism of Action
Piperacillin, a broad spectrum, semisynthetic penicillin exerts bactercidal activity by inhibition of both septum and cell wall synthesis. Tazobactam, a beta-lactam structurally related to penicillins, is an inhibitor of many beta-lactamases, which commonly cause resistance to penicillin and cephalosporins, but it does not inhibit AmpC enzymes or metallo beta-lactamases. Tazobactum extends the antibiotic spectrum of piperacillin to include many beta-lactamase-producing bacteria that have acquired resistance to piperacilliln alone.
Mechanism of resistance
The two main mechanisms of resistance to piperacillin are – Inactivation of the piperacillin component by those beta-lacamases that are not inhibited by tazobactam : beta-lactamases in the Molecular class B, C and D. In additon, tazobactam does not provide protection against extended spectrum beta-lactamases in the Molecular class A and D enzyme groups.
Alteration of penicillin- binding proteins , which results in the reduction of the affenity of piperacillin for the molecular target in bacteria. Additionally, alterations in bacterial membrane permeability, as well as expression of multy-drug efflux pumps, may cause or contribute to bacterial resistance to piperacillin/ tazobactam, especially in Gram negatice bacteria.
The most commonly reported adverse reaction is is diarrhoea (occurring in 1 patient out of 10). Among the most serious adverse reactions pseudo-membranous colitis and toxic epidermal necrolysis occur in 1 to 10 patients in 10000. The frequencies for pancytopenia, anaphylactic shock and Stevens-Johnson syndrome cannot be estimated from the currently available data.
The salection of piperacillin / tazobactam to treat an individual patient should take into account the appropriateness of using a broad-spectrum semi-synthetic penicillin based on factors such as the severity of the infection and the prevalence of resistance to othe suitable antibacterial agents.
Before initialing therapy with piperacillin careful inquiry should be made concerning previous hypersensitivity reaction to penicillins, other beta-lactam agents (e.g. – cephalosporin, monobactam or carbapenem) and other allergens, Serious and occasionally fatal hypersesitivity reactions have been reported in patients receiving therapy with penicillins, including pepercillin . These reactions are more likely to occur in persons with a history of sensitivity to multiple allergens. Serious hypersensitivity reactions require the discontinuation of the antiviotic, and may require administration of epinephrine and other emergency measures.
Serious skin reaction, such as Stevens-Johnson syndrome and toxic epidermal necrolysis, have been reported in patients receiving piperacillin / tazobactam. If patients develop a skin rash they should be monitored closely and piperacillin discontinued if lesions progress.
- Symptoms – There have been post – marketing reports of overdose with piperacillin / tazobactam. The majority of those events experienced. including nausea, vomiting and diarrhea, have also been reported with the usual recommended dose. Patients may experience neuromuscular excitability or convulsions if higher than recommended doses are given intravenously .
- Treatment – In the event of an overdose Piperacillin / tazobactam treatments should be discontinued. No specific antidote is known. Treatment should be supportive and symptomatic according to the patients clinical presentation.