Spedali Civili di Brescia
Question
Asked 17 November 2015
Ceftriaxone vs Pip tazo: Which one is the bigger culprit for collateral damage?
Hi all
May I ask whether there is any data that pits these two against each others in term of collateral damage
Reason for asking: say you are faced with a lactose fermentor bacteremia
and the results than show:
R to ampicillin
S to ceftriaxone and pip tazobactam
And the patient is on carbapenem for 3 days and now better clinically
the source: perhaps lung
What would you do?
Would you downgrade to pip tax/ ceftriaxone or it does not matter?
If it matters, can someone lead me to a specific papers that pit these 2 in term of collateral damage
Most recent answer
Juan Luis Muñoz Bellido and Robert Mokszycki are both right, also is very interesting what Bhoj R Singh said. I wish to add another thing which is: consider even if the bacterial strain is capsulated or not. The capsule, can also be a very hard resistance mechanism. This makes even more crucial to know what bacterial strain did you have.
Other important thing is: have you considered the MIC? You should use the more distant MIC possible from the antibiotic's break-point for each (TZP and CRO), if you have the chance to know the MIC.
Anyway, from personal experience, I would use Pipera/tazo, against gram negative fermentant.
Greetings.
All Answers (6)
Hospital Universitario de Salamanca
Hi Helmi,
if with collateral damage you mean side effects, both antibiotics are quite safe antibiotics. The susceptibility profile you report does not suggest any of the most usual non-fermenter Gram negatives (Pseudomonas, Acinetobacter, Stenotrophomonas), and having accurate identification would help. Anyway, de-escalating antibiotic treatment when beta-lactams other than carbapenems are active is a good measure having in account the current spread of carbapenemase-producing microorganisms.
1 Recommendation
Though Juan's and other answers are good enough. I want to add another dimension for opting to use ceftriaxone or pip-taz, in our recent studies we found that some (~5%) strains of bacteria causing bacteremia are there which show imipenem/ meropenem induced resistance towards both ceftriaxone and pip-taz and before exposure to imipenem those strains were tested sensitive to both of the drugs (might be due to change in expression of PBPs).
1 Recommendation
Spedali Civili di Brescia
Juan Luis Muñoz Bellido and Robert Mokszycki are both right, also is very interesting what Bhoj R Singh said. I wish to add another thing which is: consider even if the bacterial strain is capsulated or not. The capsule, can also be a very hard resistance mechanism. This makes even more crucial to know what bacterial strain did you have.
Other important thing is: have you considered the MIC? You should use the more distant MIC possible from the antibiotic's break-point for each (TZP and CRO), if you have the chance to know the MIC.
Anyway, from personal experience, I would use Pipera/tazo, against gram negative fermentant.
Greetings.
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