Please check your internet connection and try again.
## Piperacillin/Tazobactam (Zosyn)
### Overview
Piperacillin/tazobactam is a combination antibiotic consisting of piperacillin, a broad-spectrum penicillin antibiotic, and tazobactam, 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 (including ventilator-associated pneumonia)
* Empirical treatment of febrile neutropenia
### Adult Dosing
* **Complicated Intra-abdominal Infections, Complicated Skin and Skin Structure Infections, Community-Acquired Pneumonia:** Typically 3.375 grams every 6 hours or 4.5 grams every 8 hours. Duration is usually 7-14 days.
* **Hospital-Acquired Pneumonia, Febrile Neutropenia:** Typically 4.5 grams every 6 hours. Duration varies based on indication and clinical response.
* Maximum dose: 18 grams per day (4.5 grams every 6 hours).
### Pediatric Dosing
Dosing is weight-based and depends on the indication and severity of infection. Specific dosing varies by age and clinical scenario. Consult institutional guidelines or specialized pediatric resources.
### Dose Adjustments
* **Renal Impairment:**
* CrCl ≥ 40 mL/min: No dose adjustment needed.
* CrCl 20-39 mL/min: Reduce dose frequency to every 8 hours.
* CrCl < 20 mL/min: Reduce dose frequency to every 12 hours.
* Hemodialysis: Administer a supplemental dose of 2.25 grams after each dialysis session.
* **Hepatic Impairment:** No dose adjustment is typically required.
### Contraindications
* Known history of severe allergic reaction to piperacillin, tazobactam, other penicillins, or beta-lactamase inhibitors.
### Adverse Effects
* Common: Diarrhea, nausea, vomiting, rash, headache, insomnia.
* Serious: *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures (especially with high doses or renal impairment), neutropenia, thrombocytopenia, elevated liver enzymes.
### Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam serum concentrations.
* **Neuromuscular blocking agents:** May prolong neuromuscular blockade.
* **Warfarin:** May decrease the efficacy of warfarin, requiring closer INR monitoring.
* **Methotrexate:** May decrease methotrexate clearance and increase toxicity.
### Monitoring
* Renal function (CrCl) for dose adjustments.
* Signs and symptoms of hypersensitivity reactions.
* Signs and symptoms of *C. difficile*-associated diarrhea.
* Complete blood count (CBC) for potential hematologic changes.
* Liver function tests.
* Therapeutic drug monitoring is generally not routinely required but may be considered in specific situations.
### Clinical Pearls
* Piperacillin/tazobactam is often used empirically for serious infections, including those with suspected Gram-negative or anaerobic involvement.
* Reconstituted solutions should be used within recommended stability periods.
* The risk of seizures increases with impaired renal function and high doses.
---
*This information is intended for healthcare professionals. Always consult the current prescribing information and institutional guidelines for complete details and to verify drug dosages and indications.*
