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# 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 (empiric treatment)
## Adult Dosing
* **Standard Dose:** 3.375 grams (3 g piperacillin/0.375 g tazobactam) intravenously every 6 hours.
* **Severe/Hospital-Acquired Infections:** 4.5 grams (4 g piperacillin/0.5 g tazobactam) intravenously every 6 or 8 hours. Higher frequency (e.g., every 4 hours) or continuous infusions may be used for critically ill patients or *Pseudomonas aeruginosa* infections, based on institutional protocols and susceptibility testing.
* **Maximum Dose:** Generally not to exceed 18 g per day (16 g piperacillin/2 g tazobactam).
## Pediatric Dosing
* **Infants and Children (up to 12 years):**
* Dosing is based on piperacillin component.
* **General Infections:** 90-100 mg piperacillin/11.25-12.5 mg tazobactam per kg per dose intravenously every 6 or 8 hours.
* **Severe Infections/Pseudomonas:** 100-200 mg piperacillin/12.5-25 mg tazobactam per kg per dose intravenously every 6 or 8 hours.
* **Maximum Dose:** Do not exceed adult doses.
* **Adolescents (≥12 years):** Use adult dosing.
## 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.
* An additional dose may be given after each dialysis session. Adjustments are based on institutional protocols and patient response.
## Contraindications
* Known serious allergic reaction (e.g., anaphylaxis) to piperacillin, tazobactam, other penicillins, or cephalosporins.
## Adverse Effects
* **Common:** Diarrhea, rash, nausea, vomiting, headache, insomnia, constipation.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis, seizures (especially with high doses or renal impairment), leukopenia, neutropenia, thrombocytopenia, eosinophilia, elevated liver enzymes.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam plasma concentrations.
* **Neuromuscular blocking agents (e.g., vecuronium):** May prolong the effect of neuromuscular blocking agents.
* **Oral anticoagulants (e.g., warfarin):** May interfere with platelet aggregation and prolong bleeding time. Monitor INR closely.
* **Methotrexate:** Piperacillin may decrease methotrexate clearance. Monitor methotrexate levels.
## Monitoring
* Renal function (baseline and periodically)
* Liver function tests (baseline and periodically)
* Complete blood count (especially with prolonged therapy)
* Signs and symptoms of infection (clinical response)
* Electrolytes, especially in patients with renal impairment or receiving diuretics.
## Clinical Pearls
* Dosing for *Pseudomonas aeruginosa* infections or critically ill patients should be guided by institutional protocols, local resistance patterns, and susceptibility testing. Continuous infusion may improve efficacy and reduce toxicity.
* The reconstituted solution should be infused over at least 30 minutes.
* Monitor for signs of hypersensitivity reactions, especially in patients with a history of penicillin or cephalosporin allergy.
* Use with caution in patients with a history of gastrointestinal disease, particularly colitis.
*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional guidelines before administering medication. Drug information can change, and individual patient factors must be considered.*
