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# Piperacillin/Tazobactam (Zosyn)
## Overview
Piperacillin/tazobactam is a combination of an extended-spectrum penicillin antibiotic and a beta-lactamase inhibitor.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin structure infections
* Hospital-acquired pneumonia (including ventilator-associated pneumonia)
* Febrile neutropenia (empiric treatment)
* Aspiration pneumonia
## Adult Dosing
* **Complicated intra-abdominal infections, complicated skin and skin structure infections, hospital-acquired pneumonia:** 3.375 grams (3g piperacillin / 0.375g tazobactam) or 4.5 grams (4g piperacillin / 0.5g tazobactam) intravenously every 6 or 8 hours.
* **Febrile neutropenia:** 4.5 grams (4g piperacillin / 0.5g tazobactam) intravenously every 6 or 8 hours.
* **Duration:** Typically 7-14 days depending on indication and clinical response.
## Pediatric Dosing
* **Children < 12 years:** Dosing is typically based on piperacillin component and should be determined by local protocol or specialist consultation. Common ranges are 80-100 mg piperacillin/kg/dose IV every 6-8 hours.
* **Children ≥ 12 years:** Dosing is usually the same as adults (3.375g or 4.5g IV every 6 or 8 hours).
## Dose Adjustments
* **Renal Impairment (CrCl < 40 mL/min):** Reduce dose or extend interval. Consult prescribing information or institutional guidelines for specific recommendations.
* For 3.375g every 6 hours: May need 2.25g every 6 hours or 3.375g every 8 hours.
* For 4.5g every 6 hours: May need 3.375g every 6 hours or 4.5g every 8 hours.
* For 4.5g every 8 hours: May need 3.375g every 8 hours.
* **Hepatic Impairment:** No specific dose adjustment is usually recommended, but caution is advised.
## Contraindications
* Known serious hypersensitivity to piperacillin, tazobactam, other penicillins, or beta-lactamase inhibitors.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, headache, insomnia, elevated liver enzymes.
* **Serious:** Hypersensitivity reactions (anaphylaxis), *Clostridioides difficile*-associated diarrhea, seizures (especially with renal impairment and high doses), neutropenia, thrombocytopenia.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam plasma concentrations.
* **Neuromuscular blocking agents (e.g., vecuronium):** Piperacillin may prolong the neuromuscular blockade.
* **Methotrexate:** May decrease methotrexate serum levels.
* **Warfarin:** May increase the anticoagulant effect of warfarin. Monitor INR closely.
## Monitoring
* Renal function
* Liver function tests
* Complete blood count (especially in prolonged therapy)
* Signs and symptoms of hypersensitivity reactions
* Signs and symptoms of *C. difficile*-associated diarrhea
## Clinical Pearls
* Reconstituted solutions are typically stable for 24 hours at room temperature or 48 hours under refrigeration.
* Most commonly reconstituted with sterile water for injection or 0.9% sodium chloride. Check manufacturer recommendations for specific diluents and compatibility.
* Ensure adequate hydration to minimize the risk of crystalluria.
* Tazobactam inhibits beta-lactamases, extending piperacillin's spectrum of activity against many Gram-negative bacteria, including *Pseudomonas aeruginosa*, and some Gram-positive bacteria.
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*This information is intended for healthcare professionals and should be used as a guide. Always consult the official prescribing information and relevant institutional guidelines for complete and up-to-date details.*
