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# Piperacillin/Tazobactam (Zosyn)
## Overview
Piperacillin/tazobactam is an extended-spectrum penicillin antibiotic combined with a 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 dosing is typically 3.375 grams (3 g piperacillin/0.375 g tazobactam) every 6 hours or 4.5 grams (4 g piperacillin/0.5 g tazobactam) every 6 or 8 hours intravenously (IV). Dosing frequency and total daily dose can be adjusted based on severity of infection and patient factors. Higher doses may be used for severe infections.
## Pediatric Dosing
Dosing in pediatric patients varies significantly by age, weight, indication, and severity of infection. Dosing is often based on the piperacillin component.
* **Infants and Children (up to 12 years):** Dosing typically ranges from 75 mg/kg to 100 mg/kg of piperacillin component, given every 6 to 8 hours IV. Tazobactam component is dosed proportionally (9.375 mg/kg to 12.5 mg/kg of piperacillin/tazobactam). Maximum doses should not exceed adult equivalents. Specific protocols should be consulted.
* **Adolescents (12 years and older):** Dosing may follow adult regimens.
## Dose Adjustments
* **Renal Impairment:** Dose reduction and/or increased dosing interval is required in patients with significant renal impairment (CrCl < 40 mL/min). Consult prescribing information for specific adjustments. If on hemodialysis, an additional dose is recommended after each dialysis session.
## Contraindications
* Known history of severe allergic reaction to piperacillin, tazobactam, other beta-lactam antibiotics, or penicillin.
## Adverse Effects
Common adverse effects include diarrhea, nausea, vomiting, rash, headache, insomnia, and pruritus. Serious adverse effects include Clostridioides difficile-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures, and hematologic abnormalities.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam serum concentrations.
* **Neuromuscular blocking agents:** Piperacillin may prolong the action of vecuronium.
* **Warfarin:** May decrease INR; increased monitoring of anticoagulant therapy is recommended.
* **Methotrexate:** Piperacillin may decrease methotrexate clearance; monitor methotrexate levels.
## Monitoring
* Renal function (especially with CrCl < 40 mL/min).
* Liver function tests.
* Electrolytes.
* Signs and symptoms of infection.
* For prolonged therapy: complete blood counts.
* For patients on warfarin: INR.
## Clinical Pearls
* Consider the spectrum of activity when choosing empiric therapy.
* Dosing interval may be extended in renal impairment, but total daily dose may be maintained in some situations.
* Tazobactam extends the spectrum of activity by inhibiting beta-lactamases.
* If administered via IV infusion, the infusion rate should be no less than 30 minutes to reduce the incidence of infusion-related reactions.
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*This information is intended for healthcare professionals. Always verify the most current prescribing information and local institutional protocols before administering any medication.*
