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# Piperacillin/Tazobactam (Zosyn)
## Overview
Piperacillin/tazobactam is an extended-spectrum penicillin antibiotic combined with a beta-lactamase inhibitor. It is active against many Gram-positive, Gram-negative, and anaerobic bacteria.
## Primary Indications
* Complicated intra-abdominal infections (cIAI)
* Complicated skin and skin structure infections (cSSSI)
* Community-acquired pneumonia (CAP)
* Hospital-acquired pneumonia (HAP), including ventilator-associated pneumonia (VAP)
## Adult Dosing
* **Standard Dose:** 3.375 grams IV every 6 hours or 4.5 grams IV every 8 hours.
* **Higher Doses (e.g., for severe infections or resistant organisms):** May receive 4.5 grams IV every 6 hours.
* **Duration:** Typically 7-14 days, depending on infection severity and clinical response.
## Pediatric Dosing
Dosing is based on piperacillin component and patient weight. Renal function is a critical factor.
* **Patients 3 months and older:**
* **Complicated Intra-abdominal Infections:** 100 mg piperacillin/12.5 mg tazobactam per kg per dose IV every 8 hours.
* **Complicated Skin and Skin Structure Infections:** 75 mg piperacillin/9.375 mg tazobactam per kg per dose IV every 6 hours.
* **Maximum dose per dose:** Typically does not exceed 4.5 grams of piperacillin/0.5625 grams of tazobactam per dose.
* **Note:** Specific dosing may vary based on indication and local protocol. Always consult pediatric guidelines.
## Dose Adjustments
* **Renal Impairment (CrCl < 40 mL/min):**
* CrCl 20-40 mL/min: 2.25 grams IV every 6 hours or 3.375 grams IV every 8 hours.
* CrCl < 20 mL/min: 2.25 grams IV every 8 hours or 3.375 grams IV every 12 hours.
* Hemodialysis: 2.25 grams IV every 8 hours, with an additional 0.75 grams dose after each dialysis session.
* **Hepatic Impairment:** No dose adjustment typically required, but monitor closely.
## Contraindications
* Known hypersensitivity to piperacillin, tazobactam, other penicillins, or cephalosporins.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, headache, insomnia, constipation.
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (including anaphylaxis), seizures (especially with high doses or renal impairment), neutropenia, thrombocytopenia, elevated liver enzymes.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam plasma concentrations.
* **Neuromuscular blocking agents:** Piperacillin may prolong the action of vecuronium.
* **Warfarin:** Monitor INR closely; may decrease warfarin's anticoagulant effect.
* **Methotrexate:** May decrease methotrexate clearance.
## Monitoring
* Renal function (baseline and periodically).
* Liver function tests.
* Complete blood count (CBC) with differential, especially during prolonged therapy.
* Signs and symptoms of infection.
* For *Clostridioides difficile*-associated diarrhea.
## Clinical Pearls
* Reconstituted solutions should be refrigerated and used within 24 hours.
* Intermittent IV infusion is typically over 30 minutes. Extended infusion (e.g., 4 hours) may be considered for critically ill patients to achieve higher drug concentrations.
* Consider the need for additional antibiotics if the patient is not improving, especially if resistant organisms are suspected.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the current prescribing information and institutional guidelines before administering any medication.
