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# Piperacillin/Tazobactam (Zosyn)
## Overview
Piperacillin/tazobactam is a combination antibiotic consisting of piperacillin, a broad-spectrum penicillin antibiotic, and tazobactam, 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
## Adult Dosing
* **Standard dose:** 3.375 grams (piperacillin 3 grams/tazobactam 0.375 grams) every 6 hours intravenously (IV).
* **Severe infections/Hospital-acquired pneumonia:** 4.5 grams (piperacillin 4 grams/tazobactam 0.5 grams) every 6 hours or every 8 hours IV. Higher frequency may be used in critically ill patients depending on local protocols and susceptibility.
* **Maximum daily dose:** Generally not to exceed 18 grams (piperacillin 16 grams/tazobactam 2 grams) per day.
## Pediatric Dosing
Dosing in pediatric patients is complex and depends on age, weight, and indication.
* **Children 2 months to <12 years:** Dosing is based on piperacillin weight-based dose (e.g., 90-100 mg piperacillin/kg/dose) administered every 6 or 8 hours, with tazobactam given at a 1:8 ratio (e.g., 11.25-12.5 mg piperacillin/tazobactam/kg/dose).
* **Children 12 years and older:** Dosing is typically the same as adult dosing.
* Refer to specific institutional guidelines or pediatric infectious disease resources for precise dosing.
## Dose Adjustments
* **Renal Impairment (CrCl < 20 mL/min):** Reduce dose frequency. Consult specific guidelines for dose and frequency adjustments.
* **Hepatic Impairment:** No specific dose adjustment is routinely recommended, but caution is advised.
## Contraindications
* Known severe hypersensitivity to piperacillin, tazobactam, other penicillins, or beta-lactams.
## Adverse Effects
* Diarrhea, nausea, vomiting, rash, pruritus, headache, insomnia, fever, eosinophilia, elevated liver enzymes.
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea (CDAD), seizures (especially with high doses or renal impairment), neutropenia, thrombocytopenia.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam serum concentrations.
* **Neuromuscular blocking agents:** Piperacillin may prolong the neuromuscular blockade.
* **Warfarin:** May decrease the effect of warfarin; increased monitoring of INR is recommended.
* **Methotrexate:** Piperacillin may decrease methotrexate clearance, leading to toxicity.
## Monitoring
* Renal function (especially if baseline impairment exists or with concomitant nephrotoxic agents).
* Liver function tests.
* Complete blood count (CBC) for signs of hematologic abnormalities.
* Signs and symptoms of infection for clinical response.
* Signs of hypersensitivity reactions.
* Monitor for diarrhea and potential CDAD.
## Clinical Pearls
* Piperacillin/tazobactam is a broad-spectrum agent; tailor therapy based on culture and sensitivity results when available.
* Ensure adequate hydration to minimize the risk of crystalluria.
* Reconstituted solutions should be used within 24 hours when refrigerated or within 12 hours at room temperature, depending on the diluent and manufacturer's instructions.
* Rapid IV infusion can cause hypersensitivity reactions; infuse over at least 30 minutes.
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*Disclaimer: This information is intended for clinical professionals. Always verify current prescribing information with the official product labeling and institutional protocols before administering any medication.*
