Please check your internet connection and try again.
# Piperacillin-Tazobactam (Zosyn)
## Overview
Piperacillin-tazobactam is a combination penicillin-class antibacterial and beta-lactamase inhibitor. It is active against a broad spectrum of aerobic and anaerobic gram-positive and gram-negative bacteria, including Pseudomonas aeruginosa.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin-structure infections
* Community-acquired pneumonia
* Hospital-acquired pneumonia, including ventilator-associated pneumonia
* Febrile neutropenia (often as part of combination therapy)
## Adult Dosing
Standard dose: 3.375 grams (piperacillin 3 grams / tazobactam 0.375 grams) intravenously every 6 hours or 4.5 grams (piperacillin 4 grams / tazobactam 0.5 grams) intravenously every 8 hours.
Doses may be increased based on severity of infection and indication (e.g., 4.5 grams IV every 6 hours or 4 hours for serious infections, febrile neutropenia, or Pseudomonas coverage, especially with continuous infusion).
## Pediatric Dosing
Dosing varies significantly by age and indication.
* **Children 2 months to 12 years:** Dosing is typically based on piperacillin weight. A common regimen is 90 mg piperacillin/11.25 mg tazobactam per kg per dose administered intravenously every 6 hours. Maximum dose is 4.5 grams per dose.
* **Neonates and Infants < 2 months:** Dosing is complex and often guided by institutional protocols or specialized pediatric infectious disease consultation due to immature renal and hepatic function.
## Dose Adjustments
* **Renal Impairment:**
* CrCl ≥ 40 mL/min: No adjustment needed.
* CrCl 20-39 mL/min: Administer usual dose every 8 hours.
* CrCl < 20 mL/min: Administer usual dose every 12 hours.
* Hemodialysis: Administer usual dose every 8 hours and supplement with an additional dose after each dialysis session.
* **Hepatic Impairment:** No specific adjustment recommended, but caution is advised.
## Contraindications
Hypersensitivity to piperacillin, tazobactam, other penicillins, or cephalosporins.
## Adverse Effects
Common: Diarrhea, nausea, vomiting, rash, headache, insomnia.
Serious: *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures (especially with high doses or renal impairment), leukopenia, thrombocytopenia, eosinophilia, elevated liver enzymes.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin-tazobactam serum concentrations.
* **Neuromuscular blocking agents:** Piperacillin may prolong the action of rocuronium and vecuronium.
* **Warfarin:** Piperacillin may decrease the efficacy of warfarin. Monitor INR closely.
* **Methotrexate:** Piperacillin may decrease methotrexate levels. Monitor methotrexate levels.
## Monitoring
* Renal function (baseline and periodically)
* Liver function tests (periodically)
* Complete blood count (periodically, especially with prolonged therapy)
* Signs and symptoms of hypersensitivity reactions
* Signs and symptoms of *Clostridioides difficile*-associated diarrhea
* INR if patient is on warfarin
## Clinical Pearls
* Consider continuous infusion for critically ill patients or those with infections due to less susceptible organisms to maintain higher drug concentrations. Dosing typically involves administering the total daily dose over 24 hours.
* Tazobactam protects piperacillin from degradation by many beta-lactamases but not all.
* Ensure adequate hydration to minimize the risk of crystalluria.
***
*This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines for complete details and to ensure patient safety.*
