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# Piperacillin/Tazobactam (Zosyn)
## Overview
Piperacillin/tazobactam is an extended-spectrum penicillin antibiotic combined with a beta-lactamase inhibitor.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin structure infections
* Community-acquired pneumonia
* Nosocomial pneumonia
* Febrile neutropenia (empiric treatment)
## Adult Dosing
* **General:** Doses are typically expressed as piperacillin sodium/tazobactam sodium. Common adult regimens include 3.375 g or 4.5 g every 6 or 8 hours.
* **Complicated Intra-abdominal Infections, Complicated Skin and Skin Structure Infections, Community-Acquired Pneumonia:** 3.375 g or 4.5 g every 6 or 8 hours.
* **Nosocomial Pneumonia:** 4.5 g every 6 hours.
* **Febrile Neutropenia:** 4.5 g every 6 hours.
* **Duration of Therapy:** Typically 7 to 14 days, depending on the indication and patient response.
## Pediatric Dosing
Dosing is based on piperacillin component.
* **Children younger than 12 years:**
* **Complicated intra-abdominal infections:** 90-100 mg piperacillin/kg/dose given every 6 hours. Maximum dose: 4.5 g/dose.
* **Nosocomial pneumonia:** 90-100 mg piperacillin/kg/dose given every 6 hours. Maximum dose: 4.5 g/dose.
* **Children 12 years and older:** Administer adult doses.
* **Neonates and infants < 1 year:** Dosing is complex and generally guided by specialist recommendations due to immature renal and hepatic function.
## Dose Adjustments
* **Renal Impairment (CrCl < 40 mL/min):**
* **3.375 g every 6 hours:** Administer 2.25 g every 6 hours.
* **4.5 g every 6 hours:** Administer 3.375 g every 6 hours.
* **4.5 g every 8 hours:** Administer 2.25 g every 8 hours.
* Dosing may need further adjustment with intermittent hemodialysis or continuous renal replacement therapy (CRRT).
* **Hepatic Impairment:** No specific dose adjustment is usually necessary.
## Contraindications
* Known history of hypersensitivity to piperacillin, tazobactam, other penicillin antibiotics, or beta-lactamase inhibitors.
* History of cholestatic jaundice or hepatic dysfunction associated with prior piperacillin/tazobactam use.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, headache, insomnia, constipation, abdominal pain, fever.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures (especially with high doses or renal impairment), interstitial nephritis, hepatic dysfunction, hematologic changes (thrombocytopenia, neutropenia, anemia).
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam serum levels.
* **Neuromuscular Blocking Agents (e.g., vecuronium):** Piperacillin may prolong the neuromuscular blockade.
* **Methotrexate:** Piperacillin may decrease methotrexate serum levels.
* **Warfarin:** May decrease the effect of warfarin. Monitor INR closely.
* **Live Vaccines:** Live bacterial vaccines should not be administered during or for at least 30 days after treatment.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs of *Clostridioides difficile* infection.
* Monitor renal and hepatic function, especially with prolonged therapy or in patients with pre-existing impairment.
* Monitor complete blood count (CBC), particularly in prolonged therapy, for hematologic changes.
* Monitor electrolytes.
## Clinical Pearls
* Piperacillin/tazobactam has broad-spectrum activity including many Gram-positive, Gram-negative (including *Pseudomonas aeruginosa*), and anaerobic bacteria.
* It is a common choice for empiric therapy in serious infections, particularly in hospitalized patients or those with risk factors for resistant organisms.
* Ensure adequate hydration to minimize the risk of crystalluria.
* Dosing for specific indications, especially in critically ill patients or those with complex infections, may vary based on institutional protocols and pathogen susceptibility.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before administering any medication.*
