Piperacillin%2525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520tazobactam%2525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520%2525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252528zosyn%2525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252529

# 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, including *Pseudomonas aeruginosa*. ## Primary Indications * Complicated intra-abdominal infections * Complicated skin and skin structure infections * Community-acquired pneumonia * Hospital-acquired pneumonia (including ventilator-associated pneumonia) * Febrile neutropenia (in combination with an aminoglycoside) ## Adult Dosing * **Standard Dose:** 3.375 grams (piperacillin 3 g / tazobactam 0.375 g) every 6 hours intravenously (IV). * **Higher Doses:** 4.5 grams (piperacillin 4 g / tazobactam 0.5 g) every 6 or 8 hours IV may be used for severe infections or those caused by less susceptible organisms. Dosing frequency may be extended to every 8 hours in some institutions for critically ill patients. * **Maximum Daily Dose:** Doses up to 18 g (piperacillin 16 g / tazobactam 2 g) per day have been used in specific situations, but this requires careful consideration and institutional guidelines. ## Pediatric Dosing * **Neonates and Infants (0 to < 2 months):** Dosing is complex and based on gestational and postnatal age. It is typically based on piperacillin component: 75 mg/kg/day divided every 12 or 8 hours IV. Consult specialized pediatric guidelines or pharmacy. * **Children (2 months to < 12 years):** * **Less than 40 kg:** 100 mg piperacillin/kg/day divided every 6 hours IV. For serious infections, doses up to 300 mg piperacillin/kg/day divided every 8 hours have been used. * **Greater than or equal to 40 kg:** Use adult dosing. * **Children (> 12 years):** Use adult dosing. ## Dose Adjustments * **Renal Impairment:** * CrCl > 40 mL/min: No dose adjustment necessary. * CrCl 20-40 mL/min: Administer usual dose every 8 hours. * CrCl < 20 mL/min: Administer usual dose every 12 hours. * Hemodialysis: Administer usual dose every 12 hours and supplement with an additional dose of 2.25 g (piperacillin 2 g / tazobactam 0.25 g) after each dialysis session. * **Hepatic Impairment:** No specific dosage adjustments are routinely recommended, but caution may be warranted in severe hepatic impairment. ## Contraindications * Hypersensitivity to piperacillin, tazobactam, other penicillins, or beta-lactams. * History of immediate or severe allergic reaction to these agents. ## Adverse Effects * **Common:** Diarrhea, nausea, vomiting, rash, headache, insomnia, constipation, abdominal pain, elevated