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# Piperacillin-Tazobactam (Zosyn)
## Overview
Piperacillin-tazobactam is a combination antibiotic consisting of piperacillin, a broad-spectrum penicillin derivative, and tazobactam, a beta-lactamase inhibitor.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin structure infections
* Community-acquired pneumonia
* Nosocomial pneumonia
* *Pseudomonas aeruginosa*-containing infections
## Adult Dosing
* **Standard dose:** 3.375 grams (3g piperacillin/0.375g tazobactam) intravenously every 6 hours.
* **For severe or nosocomial infections, or *Pseudomonas* infections:** 4.5 grams (4g piperacillin/0.5g tazobactam) intravenously every 6 or 8 hours. Higher doses of 4.5 grams every 6 hours may be used for critically ill patients with severe infections or documented *Pseudomonas* infections.
* **Duration:** Typically 7 to 14 days, depending on infection severity and clinical response.
## Pediatric Dosing
* **Patients 2 months and older:** Dosing is based on piperacillin component.
* **Mild to moderate infections:** 90 to 100 mg piperacillin/kg/day divided every 6 to 8 hours. Maximum dose should not exceed 4.5 grams per dose.
* **Severe infections:** 100 to 150 mg piperacillin/kg/day divided every 6 to 8 hours. Maximum dose should not exceed 4.5 grams per dose.
* Dosing for children weighing more than 50 kg should be the same as adult doses.
* **For critically ill patients with severe infections or documented *Pseudomonas* infections:** Higher doses (e.g., 4.5 grams every 6 hours) may be considered, but specific pediatric dosing for these scenarios often relies on institutional protocols and expert consultation.
## Dose Adjustments
* **Renal Impairment (CrCl < 20 mL/min):** Reduce dose by 25-50% and/or increase interval to every 8 hours. Consult prescribing information for specific adjustments based on dose and frequency.
* **Hepatic Impairment:** No specific dose adjustment is usually recommended, but caution is advised.
## Contraindications
* Known serious allergy to piperacillin, tazobactam, other penicillins, or cephalosporins.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, headache, insomnia, constipation.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis, interstitial nephritis, seizures (especially at higher doses or in renal impairment), neutropenia, thrombocytopenia, Coombs' test positivity.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin-tazobactam serum levels.
* **Neuromuscular blocking agents:** May prolong neuromuscular blockade.
* **Warfarin:** May decrease the effect of warfarin. Monitor INR closely.
* **Methotrexate:** May decrease methotrexate clearance. Monitor methotrexate levels.
## Monitoring
* Renal function (baseline and periodically).
* Liver function tests (baseline and periodically).
* Complete blood count (including platelets) for prolonged therapy.
* Signs and symptoms of infection and superinfection.
* Electrolytes, especially in patients with renal impairment or receiving other nephrotoxic agents.
## Clinical Pearls
* Piperacillin-tazobactam has broad-spectrum activity including many Gram-positive, Gram-negative (including *Pseudomonas aeruginosa*), and anaerobic bacteria.
* Dose and frequency are often guided by institutional antibiograms and clinical severity.
* Intermittent infusions are standard; extended infusion protocols (e.g., over 4 hours) may be used to optimize efficacy, particularly in critically ill patients, but require specific institutional guidelines.
* Reconstituted solution is stable for 24 hours at room temperature or 48 hours refrigerated.
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**Disclaimer:** This information is intended for healthcare professionals. Always verify current prescribing information and consult with relevant resources before making clinical decisions. Dosing may vary based on patient-specific factors and local protocols.
