Piperacillin/tazobactam: a critical review of the evolving clinical literature.

Piperacillin/tazobactam is the most recently approved combination of a beta-lactam agent with an inhibitor of bacterial beta-lactamases. It has a broader spectrum than do preceding inhibitor-drug combinations, and it is generally more potent. In terms of clinical and microbiological outcomes, comparative studies have shown that piperacillin/tazobactam was comparable to imipenem (1.0 g q8h) and to clindamycin plus gentamicin for intraabdominal infections, to clindamycin plus gentamicin for infections of the skin and skin structures and pelvic tissues in women, and to ticarcillin/clavulanate for skin and soft-tissue infections. Piperacillin/tazobactam was statistically superior to imipenem (0.5 g q8h) for intraabdominal infections, to ticarcillin/clavulanate for community-acquired lower respiratory tract infections, and to ceftazidime for nosocomial lower respiratory tract infections and febrile episodes in neutropenic patients. Adverse effects with piperacillin/tazobactam were generally of only mild-to-moderate severity. Piperacillin/tazobactam may be especially useful for the treatment of infections that are likely to be polymicrobial or to be due to any one of an array of aerobic or anaerobic bacteria; this agent may also be useful in situations where organisms with plasmid-mediated beta-lactamases have become problematic.