Please check your internet connection and try again.
# Piperacillin/Tazobactam
## 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
* Febrile neutropenia (empiric treatment)
* Nosocomial pneumonia
## Adult Dosing
* **Standard Dose:** 3.375 grams (piperacillin 3 g / tazobactam 0.375 g) IV every 6 hours.
* **Higher Dose (for severe infections/nosocomial pneumonia):** 4.5 grams (piperacillin 4 g / tazobactam 0.5 g) IV every 6 or 8 hours.
* **Duration:** Typically 7-10 days, dependent on infection severity and clinical response.
## Pediatric Dosing
* **Children < 12 years:** Dosing is based on piperacillin component, typically 80-100 mg/kg/dose piperacillin (as part of the 8:1 ratio combination) IV every 6-8 hours. Weight-based dosing should not exceed adult doses.
* **Children ≥ 12 years:** Use adult dosing.
* **Febrile Neutropenia in Children:** 100 mg/kg/dose piperacillin (as part of the 8:1 ratio combination) IV every 8 hours, not to exceed 4.5 g per dose. Duration typically 7 days or until resolution of neutropenia and fever.
## Dose Adjustments
* **Renal Impairment (CrCl < 20 mL/min):** Administer standard 3.375 g dose every 8 hours. For the 4.5 g dose, administer every 12 hours. Intermittent hemodialysis: administer 2.25 g every 8 hours, with a supplemental dose of 0.75 g after each dialysis session.
* **Hepatic Impairment:** No specific dose adjustment recommended, but caution is advised.
## Contraindications
* Known history of severe allergic reaction to piperacillin, tazobactam, other penicillin antibiotics, or beta-lactamase inhibitors.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, headache, insomnia.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures (rare, particularly with renal impairment and high doses), neutropenia, thrombocytopenia, eosinophilia, elevated liver enzymes.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam serum levels.
* **Aminoglycosides:** Concurrent use may lead to inactivation of piperacillin; separate administration or avoid if possible, especially in severe infections.
* **Neuromuscular blocking agents (e.g., vecuronium):** Piperacillin may prolong the neuromuscular blockade.
* **Warfarin:** May decrease the effect of warfarin. Monitor INR closely.
## Monitoring
* Renal function (baseline and periodically).
* Liver function tests.
* Complete blood count (including platelets) for prolonged therapy.
* Signs and symptoms of hypersensitivity reactions.
* Signs and symptoms of *C. difficile*-associated diarrhea.
## Clinical Pearls
* The reconstituted solution is stable for 24 hours at room temperature and 7 days when refrigerated.
* Administer IV infusions over at least 30 minutes.
* Discontinue if hypersensitivity reaction or *C. difficile*-associated diarrhea occurs.
* Consider potential for cross-reactivity in patients with penicillin allergy.
***
*Please verify this information with the most current prescribing information and institutional protocols before administration.*
