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# Piperacillin/Tazobactam
## Overview
Piperacillin/tazobactam is a combination antibiotic consisting of a broad-spectrum penicillin (piperacillin) and a beta-lactamase inhibitor (tazobactam).
## Primary Indications
Piperacillin/tazobactam is indicated for the treatment of moderate to severe infections caused by piperacillin-susceptible organisms, including:
* Intra-abdominal infections
* Complicated skin and skin structure infections
* Community-acquired pneumonia
* Nosocomial pneumonia
* Bacterial infections in febrile neutropenic patients
## Adult Dosing
* **Standard Dose:** 3.375 g (3 g piperacillin / 0.375 g tazobactam) intravenously every 6 hours or 4.5 g (4 g piperacillin / 0.5 g tazobactam) intravenously every 6 or 8 hours.
* **Higher Doses:** For severe infections or those caused by less susceptible organisms, higher doses such as 4.5 g every 6 hours may be used.
* **Duration:** Typically 7-14 days, depending on the infection and clinical response.
## Pediatric Dosing
Dosing is typically based on piperacillin:
* **Neonates and Infants:** Generally 80-100 mg/kg (piperacillin component) administered intravenously every 12 or 24 hours, depending on gestational and postnatal age. Specific dosing requires consultation with pediatric infectious disease specialists.
* **Children > 2 months:** 240-300 mg/kg/day (piperacillin component) divided into 3 or 4 doses intravenously. Maximum daily dose is 16 g (piperacillin component).
## Dose Adjustments
* **Renal Impairment:**
* CrCl 20-40 mL/min: Reduce dose frequency to every 8 hours.
* CrCl < 20 mL/min: Reduce dose frequency to every 12 hours.
* Consider further dose reduction or increased frequency if on hemodialysis.
* **Hepatic Impairment:** No specific dose adjustment is recommended.
## Contraindications
* Hypersensitivity to piperacillin, tazobactam, other penicillins, or beta-lactamase inhibitors.
* History of severe allergic reaction (e.g., anaphylaxis) to these agents.
## Adverse Effects
Common adverse effects include diarrhea, nausea, vomiting, rash, headache, and insomnia. Serious adverse effects include hypersensitivity reactions (including anaphylaxis), Clostridioides difficile-associated diarrhea, neutropenia, thrombocytopenia, and renal toxicity.
## Key Drug Interactions
* **Probenecid:** May increase and prolong serum concentrations of piperacillin and tazobactam.
* **Neuromuscular blocking agents (e.g., vecuronium):** Piperacillin may prolong the neuromuscular blockade.
* **Warfarin:** May decrease the effect of warfarin; monitor INR closely.
* **Methotrexate:** Piperacillin may decrease methotrexate clearance; monitor methotrexate levels.
## Monitoring
* Renal function (BUN, creatinine).
* Liver function tests.
* Complete blood counts (especially if prolonged therapy).
* Signs and symptoms of infection.
* Electrolytes, particularly potassium, due to the large sodium load.
## Clinical Pearls
* Reconstitute and dilute according to manufacturer instructions.
* Infuse over at least 30 minutes.
* Consider the potential for cross-reactivity in patients with penicillin allergies.
* The high sodium content (up to 11.25 mmol per 3.375g dose) should be considered in patients requiring sodium restriction.
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*This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and guidelines for definitive treatment decisions.*
