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# Piperacillin/Tazobactam (Zosyn)
## Overview
Piperacillin/tazobactam is a penicillin-class antibacterial and a beta-lactamase inhibitor. It is active against a broad spectrum of gram-positive, gram-negative, and anaerobic bacteria.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin structure infections (including diabetic foot infections)
* Community-acquired pneumonia
* Nosocomial pneumonia
* Febrile neutropenia (as part of combination therapy)
## Adult Dosing
* **Standard Dose:** 3.375 grams (3 grams piperacillin/0.375 grams tazobactam) intravenously every 6 hours.
* **Higher Dose:** 4.5 grams (4 grams piperacillin/0.5 grams tazobactam) intravenously every 6 or 8 hours for more severe infections or those caused by less susceptible organisms.
* **Maximum Dose:** Generally not to exceed 4.5 grams every 6 hours. Dosing depends on indication and severity.
## Pediatric Dosing
* **Neonates and Infants (< 3 months):** Dosing is complex and based on gestational and postnatal age. Consult specific pediatric guidelines.
* **Children (≥ 3 months to 12 years):**
* **Dosage:** Typically 100 mg piperacillin/12.5 mg tazobactam per kg per dose intravenously every 8 hours.
* **Maximum Dose:** Do not exceed the adult dose of 3.375 grams or 4.5 grams per dose depending on the regimen.
* **Note:** For cystic fibrosis patients, higher doses (e.g., 100 mg/kg/dose every 6 hours) may be used.
## Dose Adjustments
* **Renal Impairment:**
* CrCl ≥ 40 mL/min: No adjustment needed.
* CrCl 20-39 mL/min: Administer every 8 hours (if on q6h dosing) or every 12 hours (if on q8h dosing).
* CrCl < 20 mL/min: Administer every 12 hours (if on q6h dosing) or every 24 hours (if on q8h dosing).
* Hemodialysis: Administer usual dose every 8 hours with an additional dose after each dialysis session.
* **Hepatic Impairment:** No dose adjustment is generally required.
## Contraindications
* Known serious allergy to piperacillin, other penicillins, cephalosporins, beta-lactamase inhibitors, or any component of the product.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, headache, insomnia, fever, constipation.
* **Serious:**
* Hypersensitivity reactions (including anaphylaxis)
* Clostridioides difficile-associated diarrhea (CDAD)
* Seizures (especially at high doses or with renal impairment)
* Neutropenia, leukopenia, thrombocytopenia, eosinophilia
* Hepatotoxicity
* Superinfection
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam plasma concentrations.
* **Neuromuscular blocking agents (e.g., vecuronium):** Piperacillin may prolong the blockade.
* **Warfarin:** May decrease INR. Monitor INR closely.
* **Methotrexate:** May decrease methotrexate clearance. Monitor methotrexate levels.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs of C. difficile-associated diarrhea.
* Assess renal and hepatic function periodically, especially in patients with impaired function or those receiving high doses.
* Monitor complete blood counts for hematologic changes.
## Clinical Pearls
* Reconstituted solution should be used within 24 hours when stored at room temperature or within 48 hours when refrigerated.
* For IV infusion only. Infuse over at least 30 minutes.
* Dosing for febrile neutropenia should be guided by institutional protocols and may include combination therapy with an aminoglycoside.
* Adjust dose based on renal function and the prescribed dosing interval.
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*This information is intended for healthcare professionals and does not substitute for professional medical advice. Always consult the official prescribing information and relevant clinical guidelines for complete and up-to-date details before prescribing or administering any medication.*
