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# 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: 3.375 g (3 g piperacillin/0.375 g tazobactam) or 4.5 g (4 g piperacillin/0.5 g tazobactam) intravenously (IV) every 6 to 8 hours.
Duration of therapy is typically 7 to 14 days, depending on the indication and clinical response.
## Pediatric Dosing
Dosing in pediatric patients varies significantly by age, weight, and indication.
* **Patients ≥ 12 years of age:** Similar to adult dosing (3.375 g or 4.5 g IV every 6-8 hours).
* **Patients < 12 years of age:** Generally dosed based on piperacillin weight-based recommendations, often between 80-100 mg piperacillin/kg/dose IV every 6-8 hours. **Exact dosing requires consultation of specific pediatric guidelines or institutional protocols.**
* **Neonates and Infants < 2 months:** Dosing is highly individualized based on gestational and postnatal age, weight, and renal function. **Consult specialized pediatric infectious disease resources or institutional protocols.**
## Dose Adjustments
**Renal Impairment:**
* CrCl > 40 mL/min: No adjustment needed.
* CrCl 20-40 mL/min: Administer usual dose every 8 hours.
* CrCl < 20 mL/min: Administer usual dose every 12 hours.
* For intermittent hemodialysis patients, administer usual dose 3 times daily and supplement with one additional dose after each dialysis session.
**Hepatic Impairment:** No dose adjustment is typically required.
## Contraindications
* Known serious hypersensitivity to piperacillin, tazobactam, any other piperacillin/tazobactam component, or beta-lactams.
## Adverse Effects
* Diarrhea, nausea, vomiting, rash, pruritus, urticaria, fever, eosinophilia.
* More serious: Anaphylaxis, Clostridioides difficile-associated diarrhea, seizure, interstitial nephritis, hematologic changes (neutropenia, thrombocytopenia).
* Electrolyte disturbances (hypernatremia may occur due to high sodium content in the formulation).
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin and tazobactam serum concentrations.
* **Neuromuscular blocking agents (e.g., vecuronium):** Piperacillin may prolong the action of vecuronium.
* **Warfarin:** Monitor INR closely; some reports suggest piperacillin-tazobactam may decrease warfarin's effect.
* **Methotrexate:** Piperacillin-tazobactam may decrease methotrexate clearance; monitor methotrexate levels.
## Monitoring
* Renal function (creatinine, BUN).
* Electrolytes, especially sodium and potassium.
* Liver function tests.
* Complete blood count (CBC), particularly in prolonged therapy, for hematologic abnormalities.
* Signs and symptoms of infection.
* Signs and symptoms of hypersensitivity reactions.
* Clostridioides difficile-associated diarrhea.
## Clinical Pearls
* Piperacillin-tazobactam is a high-sodium-content formulation. Use with caution in patients requiring sodium restriction.
* Reconstituted solutions should be infused over at least 30 minutes to minimize risk of infusion-related reactions.
* The 4.5 g formulation contains 1 g of sodium.
* The 3.375 g formulation contains 0.75 g of sodium.
* Ensure adequate hydration to prevent crystalluria.
***
*Please verify current prescribing information and institutional protocols before use. This information is not a substitute for professional medical advice.*
