Please check your internet connection and try again.
# Piperacillin/Tazobactam (Zosyn)
## Overview
Piperacillin/tazobactam is an extended-spectrum penicillin antibiotic combined with a beta-lactamase inhibitor.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin structure infections
* Community-acquired pneumonia
* Hospital-acquired pneumonia (including ventilator-associated pneumonia)
* Febrile neutropenia (empiric treatment)
## Adult Dosing
Standard dose: 3.375 grams (piperacillin 3 grams/tazobactam 0.375 grams) intravenously every 6 hours.
Higher dose: 4.5 grams (piperacillin 4 grams/tazobactam 0.5 grams) intravenously every 6 or 8 hours. Dosing frequency and duration depend on the indication, severity of infection, and patient response.
## Pediatric Dosing
Dosing is typically based on the piperacillin component.
* **Patients ≥ 12 years:** Same as adult dosing.
* **Patients < 12 years:**
* **3 months to 12 years:** 90-100 mg piperacillin/kg/dose intravenously every 6 hours.
* **Less than 12 months:** Dosing is less well-established and may vary. A common range is 50-75 mg piperacillin/kg/dose every 6-8 hours, but this requires careful consideration and may depend on specific institutional protocols.
* **Premature infants and neonates:** Dosing is highly variable and should be guided by specific neonatal guidelines or expert consultation due to immature renal and hepatic function.
## Dose Adjustments
* **Renal Impairment:** Adjust dose based on calculated creatinine clearance (CrCl).
* CrCl ≥ 40 mL/min: No adjustment needed.
* CrCl 20-39 mL/min: Administer usual dose every 8 hours.
* CrCl < 20 mL/min: Administer usual dose every 12 hours.
* Hemodialysis: Administer usual dose every 12 hours and supplement with an additional 1.125 g dose after each dialysis session.
* **Hepatic Impairment:** No specific dose adjustment is generally recommended, but caution is advised.
## Contraindications
* Known severe hypersensitivity to piperacillin, tazobactam, other penicillin antibiotics, or beta-lactams.
## Adverse Effects
Common: Diarrhea, nausea, vomiting, rash, pruritus, headache, insomnia, fever, eosinophilia, elevated AST/ALT.
Serious: *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures (especially with high doses or renal impairment), neutropenia, thrombocytopenia, prolonged bleeding times.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam plasma concentrations.
* **Neuromuscular blocking agents (e.g., vecuronium):** May prolong neuromuscular blockade.
* **Warfarin:** Piperacillin may reduce the effect of warfarin, potentially decreasing INR. Monitor INR closely.
* **Methotrexate:** Piperacillin may decrease methotrexate clearance; monitor methotrexate levels.
## Monitoring
* Renal function (baseline and during therapy, especially with risk factors for nephrotoxicity).
* Liver function tests.
* Electrolytes.
* Complete blood count (especially for prolonged therapy or signs of hematologic changes).
* Signs and symptoms of infection.
* Monitor for diarrhea and *C. difficile* infection.
* Bleeding times and coagulation parameters, particularly in patients with risk factors for bleeding or those on anticoagulants.
## Clinical Pearls
* Piperacillin/tazobactam has broad-spectrum activity, including against *Pseudomonas aeruginosa* and many Gram-positive and Gram-negative anaerobes.
* Administer by slow intravenous infusion over at least 30 minutes to minimize infusion reactions.
* Maximum daily dose in adults is typically 18 g piperacillin/2.25 g tazobactam (4.5 g every 6 hours).
* The pediatric dose of 90-100 mg piperacillin/kg/dose every 6 hours is commonly used for uncomplicated infections. Higher doses may be necessary for more severe infections, and the maximum piperacillin dose should not exceed the adult maximum.
***
*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional guidelines for complete details.*
