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# Piperacillin/Tazobactam (Zosyn)
## Overview
Piperacillin/tazobactam is a combination penicillin-class antibacterial 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
* Nosocomial pneumonia
* Febrile neutropenia (empiric treatment)
## Adult Dosing
* **Standard Dose:** 3.375 grams (3g piperacillin/0.375g tazobactam) IV every 6 hours.
* **Higher Dose (Severe Infections):** 4.5 grams (4g piperacillin/0.5g tazobactam) IV every 6 hours or every 8 hours depending on severity and pathogen.
* **Maximum Dose:** Generally not to exceed 4.5 grams every 6 hours. Dosing for febrile neutropenia may vary based on local protocols.
## Pediatric Dosing
Dosing is based on piperacillin component.
* **1 month to 12 years:** 90 mg/kg (piperacillin component) IV every 8 hours. Maximum dose is 4.5 grams per dose.
* **Infants younger than 1 month:** Dosing is complex and often guided by institutional protocols due to immature renal and hepatic function. Generally, doses are lower and given more frequently.
## Dose Adjustments
* **Renal Impairment (CrCl < 20 mL/min):** Reduce dose frequency. For standard 3.375g q6h regimen, consider 2.25g q6h or 3.375g q8h. For 4.5g q6h regimen, consider 4.5g q8h or q12h. Specific adjustments should follow institutional guidelines or a pharmacist consultation.
* **Hepatic Impairment:** No dose adjustment is typically necessary, but caution is advised.
## Contraindications
* Known hypersensitivity to piperacillin, tazobactam, other penicillins, or beta-lactamase inhibitors.
* History of immediate or severe allergic reaction to these agents.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, headache, insomnia, fever, injection site reactions.
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea (CDAD), seizures (especially with high doses or renal impairment), hematologic changes (neutropenia, thrombocytopenia), interstitial nephritis.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin serum concentrations.
* **Neuromuscular Blocking Agents (e.g., vecuronium):** Piperacillin may prolong the neuromuscular blockade.
* **Methotrexate:** Piperacillin may decrease methotrexate levels, potentially reducing efficacy.
## Monitoring
* **Renal function:** Especially in patients with pre-existing renal impairment or those receiving concomitant nephrotoxic agents.
* **Electrolytes:** Particularly sodium, due to high sodium content in the formulation.
* **Hematologic parameters:** Complete blood count (CBC) if prolonged therapy or signs of cytopenias.
* **Signs of hypersensitivity reactions.**
* **Signs of CDAD.**
## Clinical Pearls
* Piperacillin/tazobactam has good activity against *Pseudomonas aeruginosa*.
* The sodium content per 3.375g dose is approximately 2.3 mEq. This can be significant in patients requiring sodium restriction.
* Dosing for specific indications like febrile neutropenia or meningitis can vary significantly by institution and should be confirmed.
Please verify the current prescribing information and institutional guidelines before administration.
