Please check your internet connection and try again.
# Piperacillin/Tazobactam (Zosyn)
## Overview
Piperacillin/tazobactam is a combination penicillin-class antibacterial agent and 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
* Community-acquired pneumonia
* Nosocomial pneumonia
## Adult Dosing
The typical dose is 3.375 g (piperacillin 3 g/tazobactam 0.375 g) or 4.5 g (piperacillin 4 g/tazobactam 0.5 g) administered intravenously every 6 to 8 hours. Dosing frequency and duration depend on the severity of infection and clinical response.
* **Complicated intra-abdominal infections and complicated skin and skin-structure infections:** 3.375 g IV every 6 hours or 4.5 g IV every 8 hours.
* **Community-acquired pneumonia:** 3.375 g IV every 6 hours.
* **Nosocomial pneumonia:** 4.5 g IV every 6 hours.
* **Maximum dose:** Not explicitly defined but generally guided by the highest recommended dose for severe infections (e.g., 4.5 g every 6 hours).
## Pediatric Dosing
Dosing is typically weight-based and dependent on the indication. Consult specific pediatric guidelines or institutional protocols.
* **Neonates and infants up to 12 months:** Dosing varies significantly by gestational and postnatal age. Specific protocols are essential.
* **Children 12 months and older:** Dosing is often based on piperacillin dose of 75-100 mg/kg/day divided into 4 doses (corresponding tazobactam dose is 9.375-12.5 mg/kg/day). The maximum piperacillin dose is typically 4 g per dose.
## Dose Adjustments
* **Renal Impairment:**
* CrCl > 40 mL/min: No dose adjustment needed.
* CrCl 20-40 mL/min: 2.25 g (piperacillin 2 g/tazobactam 0.25 g) IV every 8 hours for 3.375 g q6h regimens, or 3.375 g IV every 8 hours for 4.5 g q8h regimens.
* CrCl < 20 mL/min: 2.25 g IV every 8 hours for 3.375 g q6h regimens, or 3.375 g IV every 12 hours for 4.5 g q8h regimens.
* For hemodialysis patients, administer the dose for CrCl < 20 mL/min and supplement with an additional 0.75 g dose after each dialysis session.
## Contraindications
* Hypersensitivity to piperacillin, tazobactam, any other piperacillin/tazobactam component, or other beta-lactam antibiotics.
* History of cholestatic jaundice or hepatic dysfunction associated with piperacillin/tazobactam therapy.
## Adverse Effects
Common adverse effects include diarrhea, nausea, vomiting, headache, rash, insomnia, constipation, and rash.
Serious adverse effects include hypersensitivity reactions (including anaphylaxis), Clostridioides difficile-associated diarrhea, seizures, and hematologic abnormalities (e.g., neutropenia, thrombocytopenia).
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam plasma concentrations.
* **Vecuronium:** Piperacillin may prolong the neuromuscular blockade of vecuronium.
* **Warfarin:** May decrease the anticoagulant effect of warfarin. Monitor INR closely.
* **Methotrexate:** Piperacillin may decrease methotrexate clearance. Monitor methotrexate levels.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs and symptoms of C. difficile infection.
* Monitor renal and hepatic function, especially with prolonged therapy or in patients with pre-existing impairment.
* Monitor complete blood counts, particularly if used for extended periods, due to potential for neutropenia and thrombocytopenia.
## Clinical Pearls
* Piperacillin/tazobactam has broad-spectrum activity and is often reserved for more severe or complicated infections, including those with suspected or confirmed resistance to less broad-spectrum agents.
* Reconstitution and further dilution are required before IV administration. Infusion over at least 30 minutes is recommended.
* The beta-lactamase inhibitor tazobactam broadens the spectrum of activity to include many beta-lactamase-producing organisms that are resistant to piperacillin alone.
***
*This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and institutional guidelines before administering any medication.*
