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# Piperacillin/tazobactam (Zosyn)
## Overview
Piperacillin/tazobactam is an extended-spectrum penicillin antibiotic combined with a beta-lactamase inhibitor. It provides broad-spectrum coverage 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 g (3 g piperacillin / 0.375 g tazobactam) or 4.5 g (4 g piperacillin / 0.5 g tazobactam) intravenously every 6 hours.
* **Higher Doses (e.g., for severe infections or specific pathogens):** May be dosed up to 4.5 g every 4 hours or continuous infusion. Specific dosing depends on the indication and local protocols.
* **Maximum Daily Dose:** Generally not to exceed 18 g piperacillin component daily.
## Pediatric Dosing
* **Patients 2 months and older:** Dosing is based on the piperacillin component.
* **2 months to < 1 year:** 50 mg piperacillin/6.25 mg tazobactam per kg intravenously every 8 hours.
* **1 to < 2 years:** 75 mg piperacillin/9.375 mg tazobactam per kg intravenously every 8 hours.
* **2 years and older:** 100 mg piperacillin/12.5 mg tazobactam per kg intravenously every 8 hours.
* **Maximum pediatric dose:** Not to exceed the maximum adult dose (typically 4.5 g per dose for intermittent infusions). For continuous infusions, specific pediatric guidelines should be consulted.
* **Neonates and infants < 2 months:** Dosing recommendations are less established and may vary; consult specialized pediatric guidelines.
## Dose Adjustments
* **Renal Impairment (CrCl < 40 mL/min):** Reduce the dose frequency or amount.
* For the 3.375 g dose every 6 hours: Administer every 8 hours.
* For the 4.5 g dose every 6 hours: Administer every 8 hours.
* For higher frequency dosing (e.g., every 4 hours): Reduce frequency to every 6 hours.
* Dosing for CrCl < 20 mL/min may require further reduction or specific protocols. Hemodialysis patients typically receive doses after dialysis.
## Contraindications
* Known history of severe allergic reaction (e.g., anaphylaxis) to piperacillin, tazobactam, or other beta-lactam antibiotics.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, headache, insomnia, fever, injection site reactions.
* **Serious:** Clostridioides difficile-associated diarrhea, hypersensitivity reactions (including anaphylaxis), neutropenia, thrombocytopenia, prolonged bleeding times, seizures (rare, particularly with high doses or renal impairment).
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam serum concentrations.
* **Neuromuscular blocking agents (e.g., vecuronium):** May prolong the duration of neuromuscular blockade.
* **Warfarin:** May decrease INR. Monitor INR closely.
* **Methotrexate:** Piperacillin may reduce methotrexate clearance. Monitor methotrexate levels.
## Monitoring
* Renal function (especially with dose adjustments).
* Signs and symptoms of hypersensitivity reactions.
* Signs and symptoms of C. difficile infection.
* Complete blood counts (especially during prolonged therapy).
* Coagulation parameters (PT/INR) if co-administered with warfarin or if clinical suspicion warrants.
## Clinical Pearls
* Dosing for severe infections, critical illness, or specific pathogens (e.g., Pseudomonas aeruginosa) may require higher doses and/or more frequent administration, often via continuous infusion. Consult institutional guidelines.
* Reconstituted solutions are stable for 24 hours at room temperature or 48 hours refrigerated.
* The beta-lactamase inhibitor tazobactam broadens the spectrum of activity against beta-lactamase-producing organisms.
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*This information is intended for healthcare professionals. Always consult the official prescribing information and institutional protocols for complete and current details before prescribing.*
