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# 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
* Nosocomial pneumonia
* Febrile neutropenia (empiric therapy)
## Adult Dosing
* **Standard:** 3.375 grams (3 g piperacillin / 0.375 g tazobactam) intravenously every 6 hours.
* **Severe/Nosocomial Infections:** 4.5 grams (4 g piperacillin / 0.5 g tazobactam) intravenously every 6 or 8 hours.
* **Duration:** Typically 7-14 days, depending on infection severity and clinical response.
## Pediatric Dosing
* **Children < 6 months:** Dosing is not established.
* **Children ≥ 6 months:** 100 mg piperacillin/12.5 mg tazobactam per kg per dose intravenously every 8 hours.
* **Maximum per dose:** 4.5 grams.
* **Febrile Neutropenia (empiric):** 100 mg piperacillin/12.5 mg tazobactam per kg per dose intravenously every 6 hours.
* **Maximum per dose:** 4.5 grams.
* **Note:** Dosing can be weight-based (mg/kg) or absolute (g) depending on institutional protocols.
## Dose Adjustments
* **Renal Impairment (CrCl ≤ 40 mL/min):** Reduce dose or extend interval. Dosing per institutional guidelines is recommended.
* **Hepatic Impairment:** No dose adjustment necessary.
## Contraindications
* Hypersensitivity to piperacillin, tazobactam, other penicillins, or beta-lactamase inhibitors.
* History of immediate and severe allergic reaction to penicillin or cephalosporins.
## Adverse Effects
* Diarrhea (most common)
* Nausea, vomiting
* Rash, pruritus
* Headache
* Insomnia
* Fever, injection site reactions
* Increased AST/ALT, bilirubin
* Electrolyte disturbances (e.g., hypokalemia)
* Anaphylaxis, severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis) are rare but serious.
* *Clostridioides difficile*-associated diarrhea.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam serum concentrations.
* **Aminoglycosides:** Potential for synergistic activity but also antagonism in certain situations. Concurrent use requires careful monitoring.
* **Neuromuscular blocking agents:** Piperacillin may prolong the action of vecuronium.
* **Warfarin:** May decrease the effect of warfarin; monitor INR closely.
* **Methotrexate:** Piperacillin may decrease methotrexate clearance; monitor methotrexate levels.
## Monitoring
* Renal function (BUN, Cr)
* Liver function (AST, ALT, bilirubin)
* Electrolytes (especially potassium)
* Signs and symptoms of infection
* Allergic reactions
* *Clostridioides difficile* infection
## Clinical Pearls
* Administer by continuous or intermittent infusion over 30 minutes.
* Higher doses (4.5 g) are often used for nosocomial pneumonia and severe intra-abdominal infections.
* Dosing in critically ill patients and those with significant renal dysfunction requires careful consideration and often adjusment based on pharmacokinetic principles and institutional protocols.
* Ensure adequate hydration to minimize the risk of crystalluria.
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**Disclaimer:** This information is intended for educational purposes and should not replace a review of the current prescribing information, institutional guidelines, or consultation with a qualified healthcare professional. Always verify drug information with the most recent product labeling and local protocols.
