This CE activity is jointly provided by ProCE, Inc. and Hospital Pharmacy. ProCE, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. ACPE Universal Activity Number 0221-9999-15-082-H01-P has been assigned to this knowledge-based home-study CE activity (initial release date 06-01-2015). This CE activity is approved for 1.5 contact hours (0.15 CEUs) in states that recognize ACPE providers. This CE activity is provided at no cost to participants. Completion of the evaluation and the post-test with a score of 70% or higher are required to receive CE credit. No partial credit will be given.

Faculty: Dennis J. Cada, PharmD, FASHP, FASCP (Editor), Founder and Contributing Editor, The Formulary; Jesse Wageman, PharmD, PGY1 Resident, Kootenai Health & Medical Center; Danial E. Baker, PharmD, FASHP, FASCP, Director, Drug Information Center, and Professor of Pharmacy Practice, College of Pharmacy, Washington State University and Terri L. Levien, PharmD, Clinical Professor, College of Pharmacy, Washington State University. The authors indicate no relationships that could be perceived as a conflict of interest. This activity is self-funded by Hospital Pharmacy.

Release Date: June 1, 2015

Expiration Date: June 1, 2017

Continuing Education for this activity is processed through the ProCE online CE Center. To receive CE credit, please go to:

www.ProCE.com/HPJFDR

Click to access the activity page to enroll and complete the Post-Test and Evaluation

For questions related to registering for and obtaining CE credit, contact ProCE at 630-540-2848 or Info@ProCE.com.

1. Ceftolozane/tazobactam is US Food and Drug Administration (FDA)–approved for use:
   1. In combination with metronidazole in the treatment of complicated urinary tract infection (UTI) and as monotherapy in the treatment of complicated intra-abdominal infection.
   2. In combination with levofloxacin in the treatment of complicated UTI and in combination with metronidazole in the treatment of complicated intra-abdominal infection.
   3. As monotherapy in the treatment of complicated UTI and complicated intra-abdominal infection.
   4. As monotherapy in the treatment of compli­cated UTI and in combination with metronidazole in the treatment of complicated ­intra-abdominal infection.
      
      
2. Ceftolozane/tazobactam is best described as:
   1. A penicillin/beta-lactamase inhibitor antibiotic. 
   2. A cephalosporin/beta-lactamase inhibitor antibiotic.
   3. A cephalosporin/penicillin antibiotic.
   4. An aminoglycoside antibiotic.
      
      
3. Ceftolozane/tazobactam has demonstrated efficacy in infections caused by which of the following bacteria?
   1. Citrobacter freundii
   2. Enterobacter aerogenes
   3. Haemophilus influenzae
   4. Pseudomonas aeruginosa
      
      
4. How does moderate renal impairment affect exposure to ceftolozane and tazobactam?
   1. Increases exposure to both by at least 1.5-fold
   2. Increases ceftolozane exposure 2-fold, but decreases tazobactam exposure by 50%
   3. Decreases exposure to both by 50%
      
      
5. Which of the following is a contraindication to use of ceftolozane/tazobactam?
   1. Serious hypersensitivity to vancomycin
   2. Serious hypersensitivity to gentamicin
   3. Serious hypersensitivity to clindamycin
   4. Serious hypersensitivity to penicillin
      
      
6. Ceftolozane/tazobactam is in Pregnancy ­Category:
   1. A.
   2. B.
   3. C.
   4. X.
      
      
7. Ceftolozane/tazobactam powder should be reconstituted with: 
   1. Bacteriostatic water for injection or sterile water for injection.
   2. Dextrose 5% or sodium chloride 0.9%.
   3. Dextrose 5% or sterile water for injection.
   4. Sodium chloride 0.9% or sterile water for injection.
      
      
8. Once diluted for infusion, ceftolozane/tazobactam solution can be stored:
   1. Up to 1 hour maximum.
   2. At room temperature for up to 7 days.
   3. In the refrigerator for up to 7 days.
   4. In the freezer for up to 14 days.
      
      

Case History

B.T. is a 44 year-old female patient with no known drug allergies. B.T. has no chronic conditions and is not currently taking any medications. She presented to the emergency department with a ruptured appendix and will undergo an appendectomy. Her provider is interested in starting her on ceftolozane/tazobactam. She has an elevated white blood cell count (18.2 x 10⁹/L), elevated temperature (39°C), abdominal tenderness, and variable pain (3/10 to 9/10).

9. What other antibiotic should B.T. be started on at the same time as ceftolozane/tazobactam?
   1. Meropenem
   2. Metronidazole
   3. Piperacillin/tazobactam
   4. Cefepime
      
      
10. What is the recommended dose of ceftolozane/tazobactam for B.T.?
    1. 0.5 g ceftolozane/0.25 g tazobactam every 8 hours
    2. 1 g ceftolozane/0.5 g tazobactam every 8 hours
    3. 2 g ceftolozane/0.5 g tazobactam every 8 hours
    4. 4 g ceftolozane/0.75 g tazobactam every 12 hours
       
       
11. How should ceftolozane/tazobactam be administered to B.T.?
    1. By intramuscular injection
    2. By intravenous (IV) bolus over 15 seconds
    3. By IV infusion over 1 hour
    4. By IV infusion over 4 hours
       
       
12. The most common side effects associated with ceftolozane/tazobactam include: 
    1. Nausea, diarrhea, and headache.
    2. Nausea, pruritus, and insomnia.
    3. Fatigue, renal failure, and nausea.
    4. Acute renal failure, nausea, and pyrexia.
       
       
13. What is an appropriate duration of therapy for B.T.?
    1. 3 days
    2. 7 days
    3. 15 days
    4. 22 days
       
       
14. Postoperatively B.T.’s serum creatinine is noted to be elevated. What frequency of renal monitoring is recommended during ceftolozane/tazobactam therapy in B.T.?
    1. Renal function should be monitored at least twice daily
    2. Renal function should be monitored daily
    3. Renal function should be monitored every other day
    4. Renal function monitoring is not necessary
       
       
15. B.T. has been experiencing nausea and an unpleasant metallic taste which has prompted her to refuse treatment with metronidazole. Which of the following would be an appropriate choice for continuing treatment?
    1. Discontinue metronidazole and double the dose of ceftolozane/tazobactam.
    2. Reduce the dose of metronidazole.
    3. Discontinue both ceftolozane/tazobactam and metronidazole and initiate therapy with another antibiotic.
    4. Infuse metronidazole over a longer duration of time.