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# Piperacillin/tazobactam (Zosyn)
## Overview
Piperacillin/tazobactam is a combination penicillin-class antibacterial and a beta-lactamase inhibitor.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin-structure infections
* Community-acquired pneumonia
* Hospital-acquired pneumonia (including ventilator-associated pneumonia)
## Adult Dosing
Standard dose: 3.375 grams (piperacillin 3 g / tazobactam 0.375 g) or 4.5 grams (piperacillin 4 g / tazobactam 0.5 g) IV every 6 to 8 hours.
Dosing frequency and duration depend on the indication, severity of infection, and patient's clinical response. Higher doses (e.g., 4.5 g IV every 4 hours) may be used for severe infections or those caused by less susceptible organisms.
## Pediatric Dosing
Dosing is based on piperacillin component.
* **Children 2 to 12 years:** 90-100 mg piperacillin/kg/dose IV every 6 to 8 hours, not to exceed 4.5 grams per dose or 12 grams per day.
* **Infants and children < 2 years:** Dosing is complex and should be guided by institutional protocols or specialist consultation.
## Dose Adjustments
* **Renal Impairment:**
* CrCl 20-40 mL/min: Reduce dose by 33% or increase interval to every 8 hours.
* CrCl < 20 mL/min: Reduce dose by 50% or increase interval to every 8 to 12 hours.
* Hemodialysis: Administer dose every 8 hours, with an additional dose after each dialysis.
## Contraindications
* Known hypersensitivity to piperacillin, tazobactam, other penicillins, or beta-lactamase inhibitors.
* History of immediate or severe allergic reaction to piperacillin/tazobactam or other beta-lactam antibacterials.
## Adverse Effects
* Diarrhea
* Nausea
* Vomiting
* Rash
* Headache
* Insomnia
* Fever
* Increased liver enzymes (AST, ALT)
* Hypokalemia
* Pseudomembranous colitis (C. difficile associated diarrhea)
* Anaphylaxis and other hypersensitivity reactions
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam serum concentrations.
* **Neuromuscular blocking agents (e.g., vecuronium):** Piperacillin may prolong the neuromuscular blockade.
* **Warfarin:** May decrease INR. Monitor INR closely.
* **Methotrexate:** Piperacillin may decrease methotrexate clearance. Monitor methotrexate levels.
## Monitoring
* Renal function
* Liver function tests
* Electrolytes (especially potassium)
* Signs and symptoms of infection
* Signs and symptoms of hypersensitivity reactions
* Clostridium difficile infection
## Clinical Pearls
* Ensure adequate hydration to reduce risk of neurotoxicity.
* Monitor for signs of hypersensitivity reactions, especially in patients with a history of penicillin allergy.
* Consider C. difficile testing if diarrhea develops.
* Dosing for specific pathogens or critical illness may require higher doses or more frequent administration.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional guidelines before administering any medication.*
