Indications for ZOSYN 4.5g:
Susceptible intra-abdominal infections (eg, appendicitis, peritonitis), skin and skin structure, moderate community-acquired pneumonia, moderate-to-severe nosocomial pneumonia, postpartum endometritis, pelvic inflammatory disease.
Infuse over 30 mins. Usually 3.375g every 6hrs for 7–10 days; renal impairment (CrCl 20–40mL/min): 2.25g every 6hrs; CrCl <20mL/min: 2.25g every 8hrs; hemodialysis or peritoneal dialysis: 2.25g every 12hrs, give additional 0.75g at end of hemodialysis. Nosocomial pneumonia: 4.5g every 6hrs for 7–14 days (give with an aminoglycoside for P. aeruginosa); renal impairment (CrCl 20–40mL/min): 3.375g every 6hrs; CrCl <20mL/min: 2.25g every 6hrs; hemodialysis or peritoneal dialysis: 2.25g every 8hrs, give additional 0.75g at end of hemodialysis.
<2 months: not established. Infuse over 30 mins. Appendicitis/peritonitis: 2 months–9 months: 80mg/10mg per kg every 8hrs. ≥9 months: (≤40kg): 100mg/12.5mg per kg every 8hrs; (>40kg): use Adult dose. Renal impairment: not determined.
Penicillin, cephalosporin, or β-lactamase inhibitor allergy.
Discontinue if hypersensitivity occurs or severe skin reactions (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis, DRESS) progress; monitor closely. Higher doses increase seizure risk. Nephrotoxicity in critically ill patients: consider alternative treatments; if inadequate or unavailable, monitor renal function. Cystic fibrosis (increased fever/rash risk). Renal impairment. Monitor electrolytes, hematopoiesis; discontinue if bleeding disorders occur. Elderly. Pregnancy. Nursing mothers.
Broad-spectrum penicillin + β-lactamase inhibitor.
Potentiated by probenecid. May antagonize aminoglycosides (eg, tobramycin); monitor. May potentiate non-depolarizing muscle relaxants (eg, vecuronium). Monitor methotrexate, heparin, anticoagulants. Monitor renal function with concomitant vancomycin. May cause false (+) Clinitest, Coomb's or Bio-Rad Aspergillus EIA test.
Diarrhea, constipation, nausea, headache, insomnia; rash (may be severe), pruritus, local reactions, C. difficile-associated diarrhea; rare: bleeding.