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# Piperacillin/Tazobactam (Zosyn)
## Overview
Piperacillin/tazobactam is an extended-spectrum penicillin antibiotic combined with a beta-lactamase inhibitor.
## Primary Indications
Treatment of moderate to severe infections caused by susceptible organisms, including:
* Complicated intra-abdominal infections
* Complicated skin and skin structure infections
* Community-acquired pneumonia
* Nosocomial pneumonia
## Adult Dosing
* **Standard:** 3.375 g (3 g piperacillin / 0.375 g tazobactam) every 6 hours.
* **Severe/Nosocomial Infections:** 4.5 g (4 g piperacillin / 0.5 g tazobactam) every 6 or 8 hours.
* **Duration:** Varies based on infection severity and patient response, typically 7-14 days.
* **Maximum dose:** 18 g per day (4.5 g every 6 hours).
## Pediatric Dosing
* **2 months and older:** 80 mg piperacillin/10 mg tazobactam per kg per dose every 6 hours.
* Maximum dose: 3.375 g per dose (equivalent to adult standard dose).
* Note: This dose is for general use; specific indications may have different recommendations. Dosing should not exceed the maximum adult dose.
## Dose Adjustments
* **Renal Impairment (CrCl < 20 mL/min):** Reduce dose frequency. Consult specific guidelines or product labeling for precise recommendations (e.g., administer standard dose every 8-12 hours for CrCl 20-50 mL/min, and every 12 hours for CrCl < 20 mL/min).
* **Hepatic Impairment:** No dose adjustment is typically required.
## Contraindications
* Known severe hypersensitivity to piperacillin, tazobactam, other penicillin antibiotics, or beta-lactams.
## Adverse Effects
* **Common:** Diarrhea, rash, nausea, vomiting, headache, insomnia, fever, injection site reactions.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures (especially with high doses or renal impairment), interstitial nephritis, hematologic effects (neutropenia, thrombocytopenia).
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam serum concentrations.
* **Neuromuscular blocking agents (e.g., vecuronium):** Piperacillin may prolong the neuromuscular blockade.
* **Warfarin:** May decrease the efficacy of warfarin; increased INR monitoring is recommended.
* **Methotrexate:** May decrease methotrexate clearance; increased methotrexate toxicity is possible.
## Monitoring
* Renal function (creatinine, BUN)
* Liver function tests
* Complete blood count (CBC), especially with prolonged therapy
* Electrolytes
* Signs and symptoms of infection
* Signs of hypersensitivity reactions
* Stool for *C. difficile* if diarrhea develops
## Clinical Pearls
* Piperacillin/tazobactam is often used empirically for serious bacterial infections, including those with potential for pseudomonal or resistant bacterial coverage.
* Reconstituted solution stability varies; follow manufacturer's instructions.
* Infusion time is typically 30 minutes; prolonged or continuous infusions may be considered in some settings to achieve higher drug concentrations, particularly for critically ill patients or those with difficult-to-treat organisms. Specific protocols should be followed.
* Dosing for specific indications (e.g., febrile neutropenia) may differ and should be guided by institutional protocols and current guidelines.
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**Disclaimer:** This information is intended for healthcare professionals. Always verify current prescribing information and consult with a pharmacist or physician before making clinical decisions.
