Anaerobic Coverage with Piperacillin-Tazobactam

Guideline-Based Evidence for Monotherapy

• The Infectious Diseases Society of America recommends piperacillin-tazobactam as single-agent therapy for high-risk or severely ill adults with complicated intra-abdominal infections 1
• The World Society of Emergency Surgery guidelines state that piperacillin-tazobactam's broad-spectrum activity, including anti-P. aeruginosa effect and anaerobic coverage, makes it an interesting option for management of severe intra-abdominal infections as single-agent therapy 2, 3
• The 2010 IDSA/SIS guidelines list piperacillin-tazobactam as appropriate single-agent therapy for community-acquired infections in pediatric patients 1

When Metronidazole IS Required

• The Infectious Diseases Society of America recommends adding metronidazole to agents that lack intrinsic anaerobic activity, such as third-generation cephalosporins, fluoroquinolones, and aminoglycosides 1, 2
• The World Health Organization guidelines list piperacillin-tazobactam as monotherapy for severe intra-abdominal infections, while explicitly requiring metronidazole addition only when using cephalosporins or fluoroquinolones 4, 5
• Metronidazole should be added to ceftazidime, cefepime, or aztreonam for severe infections with Pseudomonas risk 6, 7
• Metronidazole should be added to newer beta-lactams like ceftolozane-tazobactam or ceftazidime-avibactam, and to meropenem-vaborbactam 8