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INTRODUCTION

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piperacillin/tazobactam (pi-per-a-sil-in/taye-zoe-bak-tam)

Zosyn

Classification

Therapeutic: anti-infectives

Pharmacologic: extended spectrum penicillins

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Indications
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Appendicitis and peritonitis. Skin and skin structure infections. Gynecologic infections. Community-acquired and nosocomial pneumonia caused by piperacillin-resistant, beta-lactamase–producing bacteria.

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Action
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Piperacillin: Binds to bacterial cell wall membrane, causing cell death. Spectrum is extended compared with other penicillins. Tazobactam: Inhibits betalactamase, an enzyme that can destroy penicillins. Therapeutic Effects: Death of susceptible bacteria. Spectrum: Active against piperacillin-resistant, beta-lactamase–producing Bacteroides fragilis, E. coli, Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenzae.

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Adverse Reactions/Side Effects
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CNS: SEIZURES (HIGHER DOSES), confusion, dizziness, headache, insomnia, lethargy. GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, constipation, drug-induced hepatitis, nausea, vomiting. GU: interstitial nephritis. Derm: rashes (↑ in cystic fibrosis patients), urticaria. Hemat: bleeding, leukopenia, neutropenia, thrombocytopenia. Local: pain, phlebitis at IV site. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS AND SERUM SICKNESS, fever (↑ in cystic fibrosis patients), superinfection.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Watch for seizures; notify physician immediately if patient develops or increases seizure activity.

  • Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, pus or mucus in stools, and other severe or prolonged GI problems (nausea, vomiting, heartburn). Notify physician or nursing staff immediately of these signs.

  • Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

  • Assess muscle aches and joint pain (arthralgia) that may be caused by serum sickness. Notify physician if these symptoms seem to be drug-related rather than caused by musculoskeletal injury, or if muscle and joint pain are accompanied by allergyc-like reactions (fever, rashes, etc.)

  • Monitor signs of blood dyscrasias such as leukopenia and neutropenia (fever, sore throat, signs of infection) or thrombocytopenia (bruising, nose bleeds, and bleeding gums). Report these signs to the physician.

  • Assess dizziness and confusion that might affect gait, balance, and other functional activities (See Appendices C, D). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

  • Monitor injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

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Interventions
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  • Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Use universal precautions or isolation procedures as indicated for specific patients.

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Patient/Client-Related Instruction
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  • Instruct patient to notify physician immediately if signs of the following occur:

    • ∘ Superinfection (black, furry overgrowth on tongue; vaginal itching or discharge; loose or foul-smelling stools).

    • ∘ Interstitial nephritis (blood in urine, decreased urine ...

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