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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
* Complicated skin and skin structure infections
* Community-acquired pneumonia
* Hospital-acquired pneumonia (including ventilator-associated pneumonia)
* Febrile neutropenia
## Adult Dosing
* **Standard Dose:** 3.375 g (3 g piperacillin/0.375 g tazobactam) intravenously every 6 hours.
* **High Dose:** 4.5 g (4 g piperacillin/0.5 g tazobactam) intravenously every 6 or 8 hours. Higher doses may be used for severe infections or those caused by less susceptible organisms.
* **Duration:** Typically 7 to 14 days, depending on the infection and clinical response.
* **Administration:** Administer over 30 minutes. For doses greater than 2.25 g, infuse over at least 30 minutes. Rapid infusion may increase the risk of seizures.
## Pediatric Dosing
* **Patients 2 months and older:** Dosing is based on piperacillin component.
* **Complicated Intra-abdominal Infections:** 100 mg piperacillin/12.5 mg tazobactam per kg per dose intravenously every 8 hours.
* **Hospital-Acquired Pneumonia:** 100 mg piperacillin/12.5 mg tazobactam per kg per dose intravenously every 8 hours.
* **Febrile Neutropenia:** 75 mg piperacillin/9.375 mg tazobactam per kg per dose intravenously every 6 hours.
* **Maximum Dose:** Do not exceed the maximum adult dose.
* **Note:** Dosing for children less than 2 months old is not well established and should be based on institutional guidelines and clinical judgment. Dosing requires careful calculation and consideration of renal function.
## Dose Adjustments
* **Renal Impairment:**
* CrCl 20-40 mL/min: Reduce dose frequency to every 8 hours.
* CrCl <20 mL/min: Reduce dose frequency to every 12 hours.
* Hemodialysis: Administer after dialysis and provide an additional dose. Dose frequency every 12 hours.
* **Hepatic Impairment:** No specific dose adjustment recommended, but use with caution.
## Contraindications
* Known severe hypersensitivity to piperacillin, tazobactam, other penicillins, or beta-lactams.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, headache, insomnia, constipation, fever, injection site reactions.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures (especially with rapid infusion or in renal impairment), neutropenia, thrombocytopenia, prolonged activated partial thromboplastin time (aPTT) and prothrombin time (PT).
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam serum concentrations.
* **Neuromuscular Blocking Agents:** Piperacillin may prolong the action of rocuronium and vecuronium.
* **Warfarin:** May decrease the effect of warfarin. Monitor INR closely.
## Monitoring
* Renal function (CrCl)
* Liver function tests
* Complete blood count (CBC) with differential, especially with prolonged therapy
* Electrolytes
* Signs and symptoms of infection and hypersensitivity reactions
* INR if co-administered with warfarin
## Clinical Pearls
* Piperacillin/tazobactam has broad-spectrum activity, making it a common choice for empiric therapy of serious bacterial infections.
* The beta-lactamase inhibitor tazobactam extends the spectrum of piperacillin to include many beta-lactamase producing organisms.
* Ensure adequate hydration when administering, especially in patients with impaired renal function, to minimize seizure risk.
* Reconstituted solutions are stable for 24 hours at room temperature or 48 hours refrigerated.
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*This information is intended for healthcare professionals and does not substitute for current prescribing information or professional medical advice. Always consult the official drug monograph and institutional protocols for complete and up-to-date guidance.*
