Please check your internet connection and try again.
# Piperacillin/tazobactam (Zosyn)
## Overview
Piperacillin/tazobactam is a combination penicillin-class antibiotic and beta-lactamase inhibitor. It has broad-spectrum activity against many Gram-positive, Gram-negative, and anaerobic bacteria.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin-structure infections
* Community-acquired pneumonia
* Hospital-acquired pneumonia (including ventilator-associated pneumonia)
* Febrile neutropenia (empiric treatment)
## Adult Dosing
Standard dose is 3.375 grams (3g piperacillin/0.375g tazobactam) intravenously every 6 hours.
Higher doses may be used for severe infections: 4.5 grams (4g piperacillin/0.5g tazobactam) intravenously every 6 or 8 hours.
Duration of therapy is typically 7-14 days, depending on the indication and clinical response. Specific duration often dictated by local guidelines or clinical pathways.
## Pediatric Dosing
Dosing is based on piperacillin component.
* **2 months to 12 years:** 100 mg piperacillin/12.5 mg tazobactam per kg per dose IV every 8 hours.
* **Children >12 years:** Same as adult dosing.
* **Neonates and infants <2 months:** Dosing is complex and typically guided by specialist recommendations and pharmacokinetic data due to immature renal and hepatic function.
## Dose Adjustments
* **Renal Impairment:**
* CrCl 20-40 mL/min: Administer 2.25 grams (2g piperacillin/0.25g tazobactam) IV every 6 hours or 4.5 grams IV every 8 hours.
* CrCl <20 mL/min: Administer 2.25 grams (2g piperacillin/0.25g tazobactam) IV every 8 hours.
* Hemodialysis: Administer 2.25 grams (2g piperacillin/0.25g tazobactam) IV every 8 hours, with an additional 0.75g dose after each dialysis session.
* **Hepatic Impairment:** No dose adjustment necessary, but monitor closely.
## Contraindications
* History of immediate or severe allergic reaction to piperacillin, tazobactam, or other beta-lactam antibiotics.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, pruritus, headache, insomnia, fever, injection site reactions.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures (particularly with high doses or renal impairment), hematologic abnormalities (neutropenia, thrombocytopenia), interstitial nephritis, hepatotoxicity.
## Key Drug Interactions
* **Probenecid:** May decrease renal excretion of piperacillin and increase serum concentrations.
* **Neuromuscular blocking agents:** Piperacillin may prolong the action of rocuronium and vecuronium.
* **Warfarin:** May decrease INR. Monitor INR closely.
* **Methotrexate:** Piperacillin may decrease methotrexate clearance; monitor methotrexate levels.
## Monitoring
* Renal function (baseline and during therapy)
* Liver function (baseline and during therapy)
* Complete blood count (especially platelet count and WBC count)
* Signs and symptoms of infection
* Electrolytes
* Signs of hypersensitivity reactions
## Clinical Pearls
* Tazobactam broadens the spectrum of piperacillin to include many beta-lactamase producing organisms, including *Bacteroides fragilis* and some *Pseudomonas aeruginosa* strains.
* Reconstituted solutions should be used within 24 hours when refrigerated or within 12 hours at room temperature.
* Potential for cross-reactivity in patients with penicillin allergy, though the risk is generally considered lower than with other penicillins.
* Consider de-escalation of therapy once culture and sensitivity results are available.
***
*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional guidelines before administering any medication. The information provided here may not be exhaustive and does not replace professional medical judgment.*
