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# Piperacillin/Tazobactam (Zosyn)
## Overview
Piperacillin/tazobactam is a combination penicillin-class antibacterial and 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
* Febrile neutropenia (empiric treatment)
## Adult Dosing
* **General:** 3.375 grams (piperacillin 3g/tazobactam 0.375g) or 4.5 grams (piperacillin 4g/tazobactam 1g) intravenously every 6 or 8 hours.
* **Dosing depends on the severity of infection and institutional protocol.** Maximum dose is typically 4.5 grams every 6 hours.
* **Duration:** Varies by indication, generally 7-14 days.
## Pediatric Dosing
* **Patients 2 months and older:** Dosing is based on piperacillin component.
* **Mild to moderate infections:** 100 mg/kg/day of piperacillin, administered every 6 or 8 hours.
* **Severe infections:** 200-300 mg/kg/day of piperacillin, administered every 6 or 8 hours.
* **Maximum dose:** 4.5 grams per dose or 18 grams/day (piperacillin component).
* **Note:** Tazobactam is dosed at 1/8th the weight-based dose of piperacillin. For example, at 100 mg/kg/day piperacillin, tazobactam is 12.5 mg/kg/day, given as 3.125 mg/kg every 6 hours.
## Dose Adjustments
* **Renal Impairment (CrCl < 40 mL/min):** Reduce dose and/or increase interval. Specific recommendations vary, consult prescribing information or institutional guidelines.
* Example: For a standard 3.375g Q6H regimen, may switch to 2.25g Q6H or 3.375g Q8H. For 4.5g Q6H, may switch to 3.375g Q6H or 4.5g Q8H.
* **Hepatic Impairment:** No dose adjustment necessary, but monitor hepatic function.
## Contraindications
* Known history of severe allergic reaction to piperacillin, tazobactam, other beta-lactam antibacterials, or beta-lactamase inhibitors.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, headache, insomnia, fever.
* **Serious:** Hypersensitivity reactions (including anaphylaxis), Clostridioides difficile-associated diarrhea (CDAD), seizures (especially with high doses or renal impairment), neutropenia, thrombocytopenia, elevated liver enzymes, interstitial nephritis.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam serum concentrations.
* **Neuromuscular Blocking Agents (e.g., vecuronium):** Piperacillin may prolong the neuromuscular blockade.
* **Methotrexate:** Piperacillin may decrease methotrexate levels. Monitor methotrexate levels closely.
## Monitoring
* Renal function (especially with concomitant nephrotoxic agents or existing renal impairment).
* Liver function tests.
* Complete blood count (for neutropenia or thrombocytopenia).
* Signs and symptoms of hypersensitivity reactions.
* Signs and symptoms of CDAD.
## Clinical Pearls
* Piperacillin/tazobactam is a broad-spectrum agent often used for empiric therapy of serious infections, including those suspected to be caused by resistant organisms (e.g., *Pseudomonas aeruginosa*).
* Tazobactam inhibits beta-lactamases, extending the spectrum of piperacillin to include many beta-lactamase producing organisms.
* Reconstitution and administration require specific dilution and infusion times (usually over 30 minutes) to avoid pain and phlebitis.
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*This information is intended for healthcare professionals. Always consult the official prescribing information and institutional protocols for complete and up-to-date guidance.*
