Cefoperazone + Sulbactam is a fixed-dose combination injectable antibiotic. Cefoperazone is a third-generation cephalosporin with a broad spectrum of activity against Gram-positive and Gram-negative bacteria, including Pseudomonas aeruginosa. Sulbactam is a β-lactamase inhibitor that irreversibly inhibits a wide range of β-lactamase enzymes (including Richmond-Sykes Class II to V), thereby protecting cefoperazone from enzymatic degradation and restoring its activity against many resistant strains. This combination is particularly valuable in the Indian context for treating hospital-acquired infections where β-lactamase-producing organisms are prevalent.
Adult: 1.5 g (Cefoperazone 1g + Sulbactam 0.5g) IV every 12 hours. For severe/life-threatening infections (e.g., nosocomial pneumonia, septicemia): 3 g (2g + 1g) IV every 12 hours or 1.5 g every 8 hours. Maximum daily dose: Sulbactam should not exceed 4g/day.
Note: For IV use: Reconstitute with Sterile Water for Injection. Further dilute in 50-100 mL of compatible IV fluid (0.9% NaCl, 5% Dextrose, RL). Infuse over 15-30 minutes. For IM use: Reconstitute with Sterile Water for Injection or 1% Lidocaine HCl (without epinephrine) to reduce pain. Administer deep IM into a large muscle mass. Do not mix with aminoglycosides in the same syringe or infusion bag.
Cefoperazone binds to penicillin-binding proteins (PBPs) on the bacterial cell wall, inhibiting the final transpeptidation step of peptidoglycan synthesis, leading to cell lysis and death. Sulbactam has weak intrinsic antibacterial activity but acts as a 'suicide' inhibitor. It binds irreversibly to a wide spectrum of beta-lactamase enzymes (including plasmid-mediated TEM-1 and chromosomal-mediated enzymes from Gram-negative bacteria), preventing them from hydrolyzing and inactivating cefoperazone.
Pregnancy: Pregnancy Category B. Animal studies show no risk, but adequate and well-controlled studies in pregnant women are lacking. Use only if clearly needed, especially during first trimester. Crosses the placenta.
Driving: Generally safe. However, dizziness has been reported rarely. Patients should be cautioned if they experience such effects.
| Alcohol (Ethanol) & Alcohol-containing preparations | Disulfiram-like reaction: flushing, sweating, headache, tachycardia, nausea, vomiting. | Major |
| Oral Anticoagulants (Warfarin, Acenocoumarol) and Heparin | Increased risk of bleeding due to hypoprothrombinemia and possible platelet dysfunction. | Major |
| Aminoglycosides (Gentamicin, Amikacin) | Synergistic antibacterial effect against some organisms, but physical incompatibility if mixed in same IV line/syringe. Increased risk of nephrotoxicity. | Moderate |
| Probenecid | Does not significantly affect renal excretion of cefoperazone but may increase sulbactam levels. | Minor |
| Furosemide and other potent diuretics | Potential increased risk of nephrotoxicity. | Moderate |
| Live Bacterial Vaccines (Typhoid, Cholera) | Antibiotics may diminish the therapeutic effect of these vaccines. | Moderate |
Same composition (Cefoperazone (1000mg) + Sulbactam (500mg)), different brands: