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# Piperacillin/Tazobactam
## Overview
Piperacillin/tazobactam is an extended-spectrum penicillin antibiotic combined with a beta-lactamase inhibitor. It is active against many Gram-positive, Gram-negative, and anaerobic bacteria.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin structure infections
* Community-acquired pneumonia
* Hospital-acquired pneumonia
* Febrile neutropenia (empiric treatment)
## Adult Dosing
* **Complicated intra-abdominal infections, complicated skin and skin structure infections, community-acquired pneumonia, hospital-acquired pneumonia:** Typically 3.375 grams (3 grams piperacillin/0.375 grams tazobactam) intravenously every 6 hours or 4.5 grams intravenously every 8 hours. Duration of treatment varies based on indication and clinical response.
* **Febrile neutropenia:** Typically 4.5 grams intravenously every 8 hours.
## Pediatric Dosing
Dosing in pediatric patients varies significantly by age, weight, and indication. General guidelines include:
* **Children < 12 years:** Typically 100 mg piperacillin/12.5 mg tazobactam per kg per dose intravenously every 6 hours or 75 mg piperacillin/9.375 mg tazobactam per kg per dose intravenously every 8 hours. Dosing should not exceed adult doses.
* **Neonates and infants:** Dosing is highly individualized and based on gestational and chronological age, weight, and renal function. Consult specialized pediatric guidelines.
## Dose Adjustments
* **Renal Impairment (CrCl < 20 mL/min):** Reduce dose frequency. For example, doses typically given every 6 hours may be given every 8 hours, and doses typically given every 8 hours may be given every 12 hours. Alternatively, adjust the dose amount itself. Specific adjustments depend on the dose regimen.
* **Hemodialysis:** Patients on hemodialysis should receive a supplemental dose after each dialysis session.
## Contraindications
* Known severe hypersensitivity to piperacillin, tazobactam, other penicillin antibiotics, or beta-lactamase inhibitors.
## Adverse Effects
Common adverse effects include diarrhea, nausea, vomiting, rash, headache, and insomnia. Serious adverse effects can include Clostridioides difficile-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures (especially with high doses or renal impairment), and hematologic changes.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam plasma concentrations.
* **Neuromuscular blocking agents (e.g., vecuronium):** Piperacillin may prolong the neuromuscular blockade.
* **Methotrexate:** Piperacillin may decrease methotrexate concentrations.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for diarrhea and assess for Clostridioides difficile infection.
* Monitor renal function, especially in patients with pre-existing renal impairment or those receiving other nephrotoxic agents.
* Monitor for neurological adverse effects, particularly with high doses or renal impairment.
* Monitor complete blood count, especially with prolonged therapy, for potential hematologic changes.
## Clinical Pearls
* Piperacillin/tazobactam is a broad-spectrum agent often used for serious infections, including those caused by resistant organisms.
* Reconstituted solutions should be used within specified timeframes to maintain potency.
* The addition of tazobactam extends the spectrum of activity against many beta-lactamase-producing bacteria.
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*Please verify current prescribing information and institutional protocols for the most up-to-date and specific dosing and safety guidance.*
