Please check your internet connection and try again.
# 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.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin structure infections
* Community-acquired pneumonia
* Nosocomial pneumonia
* Febrile neutropenia (empiric treatment)
## Adult Dosing
* **Standard Dose:** 3.375 g (3 g piperacillin/0.375 g tazobactam) IV every 6 hours or 4.5 g (4 g piperacillin/0.5 g tazobactam) IV every 6 or 8 hours.
* **Dose for severe infections or infections caused by less susceptible organisms:** May require higher doses, such as 4.5 g IV every 6 hours.
* **Maximum Dose:** Doses higher than 4.5 g every 6 hours are generally not recommended.
## Pediatric Dosing
Dosing varies significantly based on indication, age, weight, and renal function. Consult specific pediatric guidelines. General ranges:
* **Neonates and Infants < 4 months:** Often dosed based on piperacillin component, typically 50-100 mg/kg/day divided every 8-12 hours. This requires careful calculation due to immature renal function.
* **Children > 4 months to 12 years:** Typically 80-100 mg piperacillin/kg/day divided every 6-8 hours. Maximum piperacillin dose per administration is usually 12 g/day or 4 g per dose.
## Dose Adjustments
* **Renal Impairment (CrCl < 40 mL/min):** Dose reduction is required. Consult prescribing information for specific recommendations based on CrCl.
* **Hepatic Impairment:** No dose adjustment is generally recommended, but caution is advised.
## Contraindications
* Hypersensitivity to piperacillin, tazobactam, other penicillins, or beta-lactamase inhibitors.
* History of cholestatic jaundice or hepatic dysfunction associated with prior piperacillin/tazobactam use.
## Adverse Effects
* **Common:** Diarrhea, rash, nausea, vomiting, headache, insomnia, constipation.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures (especially with high doses or renal impairment), interstitial nephritis, hematologic changes (neutropenia, thrombocytopenia).
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam serum concentrations.
* **Neuromuscular Blockers:** Piperacillin may prolong the action of neuromuscular blockers.
* **Warfarin:** May decrease the effect of warfarin; increased monitoring of INR is recommended.
* **Methotrexate:** Piperacillin may decrease methotrexate clearance; monitor methotrexate levels.
## Monitoring
* Monitor for signs of hypersensitivity reactions.
* Assess renal and liver function, complete blood counts (especially with prolonged therapy).
* Monitor for diarrhea, especially *C. difficile*.
* If co-administered with warfarin, monitor INR closely.
## Clinical Pearls
* The reconstitution and dilution for IV infusion are critical for patient safety and drug stability. Follow manufacturer instructions precisely.
* Dosing frequency is often dictated by renal function.
* Piperacillin/tazobactam has activity against *Pseudomonas aeruginosa*.
***
*Please verify this information with the most current prescribing information or other reliable drug compendia before making clinical decisions.*
