Zosyn over 4 hrs - page 2

At my hospital we used to infuse Zosyn (2.225, 3.375, and 4.5GM) mixed with 50mL of NS over 30 minutes. Recently our hospital has changed protocol to infuse 3.375GM with 100mL of NS over 4 hrs. At... Read More

  1. by   turnforthenurse
    No matter the concentration (2.225, 3.375, or 4.5GM) the order always states to give Zosyn over 30 minutes, even with renal patients. Frequency is usually Q6H or Q8H.
  2. by   musicnursing
    One of my coworkers the other night had a pt that had a continous Zosyn infusion. As it wasn't my pt, I don't know all the details, but she's a new grad and asked me if I'd ever heard of that. From what I understand, it was dose of 13.5grams infused over 24 hours and then started all over again. This was a Lung Ca/Breast Ca pt with mets; however was at our facility with UTI/Sepsis and had drains everywhere.. JP for the cancer to the breast, 2 chest tubes (one on either side) a Mediport and double lumen PICC line, as well as high flow O2, Foley cath, and PCA hooked up. Really, she was probably too high acuity for our floor, however the ICU was full so we ended up with this pt.
  3. by   Kallie3006
    Sorry for the long message- this is from IB Micromedex, I could not send a link since you have to subscribe to this service. I only searched the compatible and caution variable i.e. vanco up to 1 Gram is compatible with 3.375 d/t the ratio however 1500 mg vanco is not compatible. hope this helps!


    General Dosage Information
    compared to standard intermittent-infusion therapy, piperacillin/tazobactam administered as a continuous (initial bolus of 2 g/0.25 g infused over 30 minutes, then 12 g/1.5 g over 24 hours [1]) or prolonged intermittent infusion (3.375 g over 4 hours every 8 hours [2][3]) achieve higher pharmacokinetic and pharmacodynamic targets, but may only be associated with improved clinical outcomes in critically ill patients [4]
    Acetaminophen
    IV compatibility is compatible. Compatible
    Alfentanil hydrochloride
    IV compatibility is compatible. Compatible
    Allopurinol sodium
    IV compatibility is compatible. Compatible
    Amifostine
    IV compatibility is compatible. Compatible
    Amikacin sulfate
    IV compatibility is compatible. Compatible
    Aminocaproic acid
    IV compatibility is compatible. Compatible
    Aminophylline
    IV compatibility is compatible. Compatible
    Amphotericin B lipid complex
    IV compatibility is compatible. Compatible
    Amphotericin B liposome
    IV compatibility is compatible. Compatible
    Anidulafungin
    IV compatibility is compatible. Compatible
    Argatroban
    IV compatibility is compatible. Compatible
    Arsenic trioxide
    IV compatibility is compatible. Compatible
    Asparaginase
    IV compatibility is compatible. Compatible
    Atenolol
    IV compatibility is compatible. Compatible
    Azithromycin
    Caution: IV compatibility is variable. Caution:Variable
    Aztreonam
    IV compatibility is compatible. Compatible
    Bivalirudin
    IV compatibility is compatible. Compatible
    Bleomycin sulfate
    IV compatibility is compatible. Compatible
    Bretylium tosylate
    IV compatibility is compatible. Compatible
    Bumetanide
    IV compatibility is compatible. Compatible
    Buprenorphine hydrochloride
    IV compatibility is compatible. Compatible
    Busulfan
    IV compatibility is compatible. Compatible
    Butorphanol tartrate
    IV compatibility is compatible. Compatible
    Calcium acetate
    IV compatibility is compatible. Compatible
    Calcium chloride
    IV compatibility is compatible. Compatible
    Calcium gluconate
    IV compatibility is compatible. Compatible
    Cangrelor
    IV compatibility is compatible. Compatible
    Capreomycin sulfate
    IV compatibility is compatible. Compatible
    Carboplatin
    IV compatibility is compatible. Compatible
    Carmustine
    IV compatibility is compatible. Compatible
    Cefepime hydrochloride
    IV compatibility is compatible. Compatible
    Ceftolozane-tazobactam
    IV compatibility is compatible. Compatible
    Chloramphenicol sodium succinate
    IV compatibility is compatible. Compatible
    Cimetidine hydrochloride
    IV compatibility is compatible. Compatible
    Cisatracurium besylate
    Caution: IV compatibility is variable. Caution:Variable
    Clindamycin phosphate
    IV compatibility is compatible. Compatible
    Cloxacillin sodium
    IV compatibility is compatible. Compatible
    Cyclophosphamide
    IV compatibility is compatible. Compatible
    Cyclosporine
    IV compatibility is compatible. Compatible
    Cytarabine
    IV compatibility is compatible. Compatible
    Dactinomycin
    IV compatibility is compatible. Compatible
    Daptomycin
    IV compatibility is compatible. Compatible
    Dexamethasone sodium phosphate
    IV compatibility is compatible. Compatible
    Dexmedetomidine hydrochloride
    IV compatibility is compatible. Compatible
    Dexrazoxane
    IV compatibility is compatible. Compatible
    Diazepam
    IV compatibility is compatible. Compatible
    Digoxin
    IV compatibility is compatible. Compatible
    Dimenhydrinate
    IV compatibility is compatible. Compatible
    Diphenhydramine hydrochloride
    IV compatibility is compatible. Compatible
    Docetaxel
    IV compatibility is compatible. Compatible
    Dopamine hydrochloride
    IV compatibility is compatible. Compatible
    Doxacurium chloride
    IV compatibility is compatible. Compatible
    Enalaprilat
    IV compatibility is compatible. Compatible
    Ephedrine sulfate
    IV compatibility is compatible. Compatible
    Epinephrine hydrochloride
    IV compatibility is compatible. Compatible
    Eptifibatide
    IV compatibility is compatible. Compatible
    Erythromycin lactobionate
    IV compatibility is compatible. Compatible
    Esmolol hydrochloride
    IV compatibility is compatible. Compatible
    Etoposide
    IV compatibility is compatible. Compatible
    Etoposide phosphate
    IV compatibility is compatible. Compatible
    Fenoldopam mesylate
    IV compatibility is compatible. Compatible
    Fentanyl citrate
    IV compatibility is compatible. Compatible
    Floxuridine
    IV compatibility is compatible. Compatible
    Fluconazole
    IV compatibility is compatible. Compatible
    Fludarabine phosphate
    IV compatibility is compatible. Compatible
    Fluorouracil
    IV compatibility is compatible. Compatible
    Foscarnet sodium
    IV compatibility is compatible. Compatible
    Fosphenytoin sodium
    IV compatibility is compatible. Compatible
    Furosemide
    IV compatibility is compatible. Compatible
    Gallium nitrate
    IV compatibility is compatible. Compatible
    Gentamicin sulfate
    Caution: IV compatibility is variable. Caution:Variable
    Granisetron hydrochloride
    IV compatibility is compatible. Compatible
    Heparin sodium
    IV compatibility is compatible. Compatible
    Hetastarch 6% (Hextend)
    IV compatibility is compatible. Compatible
    Hydrocortisone sodium phosphate
    IV compatibility is compatible. Compatible
    Hydrocortisone sodium succinate
    IV compatibility is compatible. Compatible
    Hydromorphone hydrochloride
    IV compatibility is compatible. Compatible
    Ifosfamide
    IV compatibility is compatible. Compatible
    Isavuconazonium sulfate
    Caution: IV compatibility is variable. Caution:Variable
    Isoproterenol hydrochloride
    IV compatibility is compatible. Compatible
    Ketamine hydrochloride
    IV compatibility is compatible. Compatible
    Ketorolac tromethamine
    IV compatibility is compatible. Compatible
    Lansoprazole
    IV compatibility is compatible. Compatible
    Lepirudin
    IV compatibility is compatible. Compatible
    Leucovorin calcium
    IV compatibility is compatible. Compatible
    Lidocaine hydrochloride
    IV compatibility is compatible. Compatible
    Linezolid
    IV compatibility is compatible. Compatible
    Lorazepam
    IV compatibility is compatible. Compatible
    Magnesium sulfate
    IV compatibility is compatible. Compatible
    Mannitol
    IV compatibility is compatible. Compatible
    Mechlorethamine hydrochloride
    IV compatibility is compatible. Compatible
    Melphalan hydrochloride
    IV compatibility is compatible. Compatible
    Meperidine hydrochloride
    IV compatibility is compatible. Compatible
    Mesna
    IV compatibility is compatible. Compatible
    Metaraminol bitartrate
    IV compatibility is compatible. Compatible
    Methotrexate sodium
    IV compatibility is compatible. Compatible
    Methylprednisolone sodium succinate
    IV compatibility is compatible. Compatible
    Metoclopramide hydrochloride
    IV compatibility is compatible. Compatible
    Metoprolol tartrate
    IV compatibility is compatible. Compatible
    Metronidazole
    IV compatibility is compatible. Compatible
    Milrinone lactate
    IV compatibility is compatible. Compatible
    Morphine sulfate
    IV compatibility is compatible. Compatible
    Naloxone hydrochloride
    IV compatibility is compatible. Compatible
    Nitroglycerin
    IV compatibility is compatible. Compatible
    Nitroprusside sodium
    IV compatibility is compatible. Compatible
    Norepinephrine bitartrate
    IV compatibility is compatible. Compatible
    Octreotide acetate
    IV compatibility is compatible. Compatible
    Ondansetron hydrochloride
    IV compatibility is compatible. Compatible
    Oxytocin
    IV compatibility is compatible. Compatible
    Paclitaxel (solvent/surfactant)
    IV compatibility is compatible. Compatible
    Palonosetron hydrochloride
    IV compatibility is compatible. Compatible
    Pamidronate disodium
    IV compatibility is compatible. Compatible
    Pancuronium bromide
    IV compatibility is compatible. Compatible
    Pantoprazole sodium
    Caution: IV compatibility is variable. Caution:Variable
    Pemetrexed disodium
    IV compatibility is compatible. Compatible
    Pentobarbital sodium
    IV compatibility is compatible. Compatible
    Phenobarbital sodium
    IV compatibility is compatible. Compatible
    Phentolamine mesylate
    IV compatibility is compatible. Compatible
    Phenylephrine hydrochloride
    IV compatibility is compatible. Compatible
    Plicamycin
    IV compatibility is compatible. Compatible
    Potassium acetate
    IV compatibility is compatible. Compatible
    Potassium chloride
    IV compatibility is compatible. Compatible
    Potassium phosphates
    IV compatibility is compatible. Compatible
    Procainamide hydrochloride
    IV compatibility is compatible. Compatible
    Ranitidine hydrochloride
    IV compatibility is compatible. Compatible
    Remifentanil hydrochloride
    IV compatibility is compatible. Compatible
    Rituximab
    IV compatibility is compatible. Compatible
    Sargramostim
    IV compatibility is compatible. Compatible
    Sodium acetate
    IV compatibility is compatible. Compatible
    Sodium bicarbonate
    IV compatibility is compatible. Compatible
    Sodium phosphates
    IV compatibility is compatible. Compatible
    Succinylcholine chloride
    IV compatibility is compatible. Compatible
    Sufentanil citrate
    IV compatibility is compatible. Compatible
    Sulfamethoxazole-trimethoprim
    IV compatibility is compatible. Compatible
    Tacrolimus
    IV compatibility is compatible. Compatible
    Tedizolid phosphate
    IV compatibility is compatible. Compatible
    Telavancin hydrochloride
    IV compatibility is compatible. Compatible
    Teniposide
    IV compatibility is compatible. Compatible
    Theophylline
    IV compatibility is compatible. Compatible
    Thiotepa
    IV compatibility is compatible. Compatible
    Tigecycline
    IV compatibility is compatible. Compatible
    Tirofiban hydrochloride
    IV compatibility is compatible. Compatible
    Trimethobenzamide hydrochloride
    IV compatibility is compatible. Compatible
    Vancomycin hydrochloride
    Caution: IV compatibility is variable. Caution:Variable
    Vasopressin
    IV compatibility is compatible. Compatible
    VinBLAStine sulfate
    IV compatibility is compatible. Compatible
    VinCRIStine sulfate
    IV compatibility is compatible. Compatible
    Voriconazole
    IV compatibility is compatible. Compatible
    Zidovudine
    IV compatibility is compatible. Compatible
    Zoledronic acid
    IV compatibility is compatible. Compatible
    0 and 5 mg/mL
    Notes:
    The piperacillin sodium-tazobactam sodium used in this testing was the EDTA-free formulation.

    Two TPN formulas (peripheral-line and central-line formulas) based on Aminosyn II were evaluated for compatibility with the test drug.

    (1) The peripheral-line formula had the following composition per liter:
    Aminosyn II 3.5%
    Dextrose 5%
    Sterile water for injection 517 mL
    Sodium chloride 25 mEq
    Potassium chloride 35 mEq
    Potassium phosphates 3.5 mmol
    Magnesium sulfate 8 mEq
    Calcium gluconate 9.3 mEq
    M.V.I.-12 10 mL
    Trace elements

    (2) The central-line formula had the following composition per liter:
    Aminosyn II 4.25%
    Dextrose 25%
    Sterile water for injection 161 mL
    Sodium chloride 25 mEq
    Potassium chloride 18 mEq
    Potassium phosphates 15 mmol
    Magnesium sulfate 8 mEq
    Calcium gluconate 9.15 mEq
    M.V.I.-12 10 mL
    IV compatibility is compatible. Compatible
    Y-Site

    40 and 5 mg/mL
    Notes:
    The piperacillin sodium-tazobactam sodium used in this testing was the EDTA-free formulation.

    Two TPN formulas (peripheral-line and central-line formulas) based on FreAmine III were evaluated for compatibility with the test drug.

    (1) The peripheral-line formula had the following composition per liter:
    FreAmine III 3.5%
    Dextrose 5%
    Sterile water for injection 517 mL
    Sodium chloride 37.5 mEq
    Potassium chloride 40 mEq
    Magnesium sulfate 8 mEq
    Calcium gluconate 5 mEq
    M.V.I.-12 10 mL
    Trace elements

    (2) The central-line formula had the following composition per liter:
    FreAmine III 4.25%
    Dextrose 25%
    Sterile water for injection 159 mL
    Sodium chloride 40 mEq
    Potassium chloride 25 mEq
    Potassium phosphates 5.75 mmol
    Magnesium sulfate 8 mEq
    Calcium gluconate 7.5 mEq
    M.V.I.-12 10 mL
    Trace elements
    IV compatibility is compatible. Compatible
    Y-Site


    TNA (3-in-1)
    40 and 5 mg/mL
    Notes:
    The piperacillin sodium-tazobactam sodium used in this testing was the EDTA-free formulation.

    Six TNA formulas (2 peripheral-line, 2 central-line, and 2 bone marrow transplant formulas) based on FreAmine III were evaluated for compatibility with the test drug.

    (1) The 2 peripheral-line formulas had the following compositions per liter:
    FreAmine III 3%
    Dextrose 5
    Intralipid or Liposyn II 2%
    Sodium 43 mEq
    Potassium 40 mEq
    Calcium 5 mEq
    Magnesium 8 mEq
    Chloride 45 mEq
    Acetate 51.7 mEq
    Phosphates 7.5 mmol
    M.V.I.-12 10 mL
    Trace elements
    Sterile water for injection in sufficient quantity as needed

    (2) The 2 central-line formulas had the following compositions per liter:
    FreAmine III 4.9%
    Dextrose 20%
    Intralipid or Liposyn II 3.5%
    Sodium 39.8 mEq
    Potassium 40 mEq
    Calcium 7.5 mEq
    Magnesium 8 mEq
    Chloride 45 mEq
    Acetate 67.7 mEq
    Phosphate 10 mmol
    M.V.I.-12 10 mL
    Trace elements

    (3) The 2 bone marrow transplant formulas had the following compositions per liter:
    FreAmine III 6%
    Dextrose 10.7%
    Intralipid or Liposyn II 4%
    Sodium 45 mEq
    Potassium 40.2 mEq
    Calcium 7.5 mEq
    Magnesium 8 mEq
    Chloride 51 mEq
    Acetate 78.4 mEq
    Phosphate 10 mmol
    M.V.I.-12 10 mL
    Trace elements
    IV compatibility is compatible. Compatible
    Y-Site

    40 and 5 mg/mL
    Notes:
    The piperacillin sodium-tazobactam sodium used in this testing was the EDTA-free formulation.

    Three TNA formulas (peripheral-line, central-line, and bone marrow transplant formulas) based on Aminosyn II were evaluated for compatibility with the test drug.

    (1) The peripheral-line formula had the following composition per liter:
    Aminosyn II 3%
    Dextrose 5%
    Liposyn III 2%
    Sodium 41.6 mEq
    Potassium 40 mEq
    Calcium 9.15 mEq
    Magnesium 8 mEq
    Chloride 35 mEq
    Acetate 42 mEq
    Phosphates 15 mmol
    M.V.I.-12 10 mL
    Trace elements
    Sterile water for injection in sufficient quantity as needed

    (2) The central-line formula had the following composition per liter:
    Aminosyn II 4.9%
    Dextrose 20%
    Liposyn III 3.5%
    Sodium 39.7 mEq
    Potassium 40 mEq
    Calcium 9.15 mEq
    Magnesium 8 mEq
    Chloride 35 mEq
    Acetate 45 mEq
    Phosphate 15 mmol
    M.V.I.-12 10 mL
    Trace elements

    (3) The bone marrow transplant formula had the following composition per liter:
    Aminosyn II 6%
    Dextrose 11%
    Liposyn III 4%
    Sodium 45 mEq
    Potassium 40 mEq
    Calcium 9.15 mEq
    Magnesium 8 mEq
    Chloride 35 mEq
    Acetate 53.2 mEq
    Phosphate 15 mmol
    M.V.I.-12 10 mL
    Trace elements
    IV compatibility is compatible. Compatible
    Y-Site

    80 and 10 mg/mL
    Notes:
    Equal quantities of drug solution and parenteral nutrition admixture were combined. One TNA [Nutriflex Lipid Special, B. Braun 3-chamber bag nutritional admixture] was used in this testing. The complete 3-in-1 mixture was tested as well as the mixture without the lipid component to aid in visual observation. The 3-in-1 admixture had the following composition per liter:
    Amino acids 57.4 g
    Dextrose 144 g
    Lipids 40 g (in the complete 3-in-1 formula)
    Sodium 54 mmol
    Potassium 38 mmol
    Calcium 4.2 mmol
    Magnesium 4.2 mmol
    Phosphate 16 mmol
    Chloride 48 mmol
    Acetate 48 mmol
    Zinc 0.03 mmol
    IV compatibility is compatible. Compatible
    Y-Site
  4. by   evilolive07
    Zosyn is given on any unit non-ED over 3 hrs in my hospital. It's been this way for years. Never read any literature about it.
  5. by   chare
    Quote from evilolive07
    Zosyn is given on any unit non-ED over 3 hrs in my hospital. It's been this way for years. Never read any literature about it.
    Rationale and evidence for extended infusion of piperacillin-tazobactam

    Medication Administration: Extended-Infusion Pipercillin/Tazobactam (Zosyn®) Protocol (opens as PDF)

    Extended/Continuous Infusion Beta-lactams for Gram-Negative Infections (opens as PDF)

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