Zosyn over 4 hrs

[OutlawNurse86]

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 first it was just for renal patients with off the wall BUN/Creatine levels, now it is protocol for every patient receiving Zosyn. They say that the therapeutic levels stay in the system longer. I like to verify things myself, but after consulting Almighty Google, I am having trouble finding any science behind this. It makes sense to me, but I just like seeing the data for myself. I am weird.

Anybody heard anything about this?

[aliciadale]

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 first it was just for renal patients with off the wall BUN/Creatine levels, now it is protocol for every patient receiving Zosyn. They say that the therapeutic levels stay in the system longer. I like to verify things myself, but after consulting Almighty Google, I am having trouble finding any science behind this. It makes sense to me, but I just like seeing the data for myself. I am weird.

Anybody heard anything about this?

We do the same at our hospital also. I found the following research point slide,

http://www.pharmacyonesource.com/images/sentri7/PipTazo.pdf

Hope it helps.

[turnforthenurse, MSN, NP]

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.

[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.

[Kallie3006, ADN]

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

orificenic 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

[evilolive07, BSN]

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.

[chare]

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)