Structural characterization of the tobramycin-piperacillin reaction product formed at pH 6.0

Tobramycin is an aminoglycoside antibiotic that loses a significant amount of activity in the presence of Zosyn at pH 6. As part of our investigation into ways to improve the compatibility of tobramycin with Zosyn (which contains piperacillin and tazobactam in an 8:1 ratio buffered at pH 6 by sodium citrate) by lowering the pH, we identified the reaction product of tobramycin and piperacillin at pH 6.0 and the order of the pK(a) values of tobramycin. The structure of the main reaction product of tobramycin and piperacillin at pH 6.0 was determined by 2D NMR to be the product of 3″-NH(2) reacting with the β-lactam of piperacillin. The order of the pK(a) values of the nitrogens of tobramycin was determined by (1)H and (15)N NMR titrations to be 6'-NH(2)>2'-NH(2)>1-NH(2)≈3″-NH(2)>3-NH(2). At pH 4.0, the reaction between tobramycin and Zosyn was almost negligible for a period of up to 2 h. The pH can be lowered by adding an acid such as HCl or citric acid to Zosyn to make a pH 4.0 buffer.