Dangerous antibiotics?

Sepsis is a condition where the body responds improperly to an infection, and this often occurs in neglected vulnerable adults. A new study, published by JAMA Internal Medicine, found that people who are believed to have sepsis who take piperacillin-tazobactam (Zosyn) and vancomycin have a 5% higher absolute morality rate at 90 days compared to those who take cefepime and vancomycin. This is incredible. The study showed that the increased mortality rate translates to one additional death for every 20 people. Wow.

Piperacillin-tazobactam is a mix of penicillin and a beta-lactamase inhibitor, which has potent activity against anaerobic gut bacteria. Piperacillin-tazobactam mixed with vancomycin, is used to treat sepsis patients when wanting to cover as many pathogens as possible.

After the nationwide shortage of piperacillin-tazobactam in 2015, clinicians were forced to use vancomycin and cefepime. Those together do not work against anaerobic bacteria. Because of the shortage, they were able to test if using piperacillin-tazobactam was linked to higher death rates compared to cefepime. The authors of the study had conducted another trial and found that early treatment with anti anaerobic antibiotics may harm patients.

Robert Dickson, MD, co-author and researcher said:

“We saw this Zosyn shortage as a one-of-a-kind opportunity to ask whether this antibiotic, which we know depletes the gut of anaerobic bacteria, makes a difference in terms of patient outcomes.”

The research team then analyzed data from adults with suspected sepsis, with a median age of 63 years old and were treated with either medicine in the
emergency department of the University of Michigan from July 2014 through December 2018. There was a 22.5% 90-day mortality in patients that took piperacillin-tazobactam and a 17.5% in those who took cefepime. This resulted in an absolute increase in 90-day morality of 5%.

Piperacillin-tazobactam was found to be linked with 2.1 fewer organ failure-free days. Additionally, there were also 1.1 fewer ventilator-free days, as well as 1.5 fewer vasopressor-free days. Authors wrote:

“These findings suggest that broad-spectrum antibiotics with anti-anaerobic activity, such as piperacillin-tazobactam, may cause harm in patients without a clear indication.”