Please check your internet connection and try again.
# Piperacillin/Tazobactam (Zosyn)
## Overview
Piperacillin/tazobactam is a combination antibiotic consisting of piperacillin, a broad-spectrum penicillinase-susceptible penicillin, and tazobactam, a beta-lactamase inhibitor. It is active against many Gram-positive, Gram-negative, and anaerobic bacteria.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin-structure infections
* Community-acquired pneumonia
* Nosocomial pneumonia
* Empirical treatment of febrile neutropenia
## Adult Dosing
* **Standard Dose:** 3.375 grams (3 grams piperacillin/0.375 grams tazobactam) intravenously every 6 hours.
* **Higher Dose (for more severe infections or suspected resistant organisms):** 4.5 grams (4 grams piperacillin/0.5 grams tazobactam) intravenously every 6 or 8 hours.
* **Maximum Daily Dose:** Generally does not exceed 18 grams per day (e.g., 4.5 grams every 6 hours). Dosing depends on the severity and type of infection.
## Pediatric Dosing
* **Children 2 months and older:** Dosing is based on piperacillin content.
* **General Infections:** 90 mg piperacillin/11.25 mg tazobactam per kg per dose intravenously every 8 hours.
* **Nosocomial Pneumonia and Febrile Neutropenia:** 112.5 mg piperacillin/14.1 mg tazobactam per kg per dose intravenously every 6 hours.
* **Maximum Dose:** 4.5 grams per dose. Dosing must not exceed the adult maximum dose.
## Dose Adjustments
* **Renal Impairment (CrCl > 40 mL/min):** No dose adjustment necessary.
* **Renal Impairment (CrCl 20-40 mL/min):** Reduce dose by 25% or increase interval to every 8 hours.
* **Renal Impairment (CrCl < 20 mL/min):** Reduce dose by 50% or increase interval to every 8 hours.
* **Hemodialysis:** Administer dose after hemodialysis and increase frequency to every 8 hours. An additional 0.75 g dose should be given after each dialysis.
* **Hepatic Impairment:** No specific guidelines, but caution advised.
## Contraindications
* Hypersensitivity to piperacillin, tazobactam, other penicillins, cephalosporins, or beta-lactams.
* History of cholestatic jaundice or hepatic dysfunction associated with piperacillin/tazobactam.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, pruritus, eosinophilia, elevated AST/ALT, increased BUN/creatinine, headache, insomnia.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures, neutropenia, thrombocytopenia, interstitial nephritis, liver toxicity.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam serum levels.
* **Neuromuscular Blocking Agents (e.g., vecuronium):** Piperacillin may prolong the action of vecuronium.
* **Warfarin:** May decrease the effect of warfarin. Monitor INR closely.
* **Methotrexate:** Piperacillin may reduce methotrexate clearance. Monitor methotrexate levels.
## Monitoring
* Renal function (BUN, creatinine).
* Liver function tests (AST, ALT).
* Complete blood count (CBC), particularly for signs of neutropenia or thrombocytopenia.
* Electrolytes.
* Signs and symptoms of infection.
* Signs and symptoms of hypersensitivity reactions or *C. difficile* infection.
## Clinical Pearls
* Piperacillin/tazobactam is reconstituted and further diluted for intravenous infusion, typically over 30 minutes.
* The duration of therapy should be guided by the patient's clinical response, the severity of the infection, and the infecting organism.
* Consider the potential for cross-reactivity in patients with penicillin allergies.
* The addition of tazobactam extends the spectrum of activity to include many beta-lactamase producing organisms.
***
*Disclaimer: This information is intended for healthcare professionals and should not replace professional medical advice. Always consult the most current prescribing information and relevant guidelines for definitive drug management.*
