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# Piperacillin/Tazobactam (Zosyn)
## Overview
Piperacillin/tazobactam is a combination antibiotic consisting of piperacillin, a broad-spectrum penicillin antibiotic, and tazobactam, a beta-lactamase inhibitor. It is effective 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
* Empirical treatment of febrile neutropenia
* Other serious infections caused by piperacillin-susceptible organisms, including those due to *Pseudomonas aeruginosa*.
## Adult Dosing
* **Standard Dosing:** 3.375 grams (3 g piperacillin/0.375 g tazobactam) intravenously every 6 hours.
* **High-Dose Dosing:** 4.5 grams (4 g piperacillin/0.5 g tazobactam) intravenously every 6 or 8 hours. Higher doses are often used for severe infections, *Pseudomonas aeruginosa* infections, or in critically ill patients.
* **Duration of Therapy:** Typically 7 to 14 days, but guided by clinical response, pathogen, and site of infection. For febrile neutropenia, therapy is usually continued until resolution of neutropenia or for a defined duration (e.g., 7 days).
## Pediatric Dosing
Dosing is based on the piperacillin component and is weight-based. Renal function should be considered. Consult specific institutional guidelines for precise dosing.
* **Neonates (0-1 week):** 75 mg/kg/day piperacillin divided every 12 hours.
* **Neonates (1-4 weeks):** 100 mg/kg/day piperacillin divided every 8 hours.
* **Infants and Children (up to 50 kg):** 90-100 mg/kg/day piperacillin divided every 6 or 8 hours.
* **Children > 50 kg:** May be dosed as per adult recommendations.
## Dose Adjustments
* **Renal Impairment:**
* CrCl ≥ 20 mL/min: No adjustment usually needed with standard dosing.
* CrCl < 20 mL/min: Standard 3.375 g dose every 8 hours. Higher doses may require reduction to 2.25 g every 6 or 8 hours.
* Hemodialysis: 2.25 g every 8 hours, plus an additional 0.75 g dose after each dialysis session.
* **Hepatic Impairment:** Dose adjustments are generally not required, but caution is advised.
## Contraindications
* Hypersensitivity to piperacillin, tazobactam, other penicillins, or beta-lactam antibiotics.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, pruritus, headache, insomnia, fever, eosinophilia.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures, neutropenia, thrombocytopenia, elevated liver enzymes.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam serum concentrations.
* **Neuromuscular blocking agents:** Penicillins may prolong the action of vecuronium.
* **Warfarin:** May decrease the effect of warfarin; monitor INR closely.
* **Aminoglycosides:** Do not mix in the same IV line due to potential inactivation; administer separately.
## Monitoring
* Renal function (serum creatinine, BUN)
* Liver function tests (AST, ALT)
* Complete blood count (CBC)
* Signs and symptoms of infection
* Electrolytes
* Signs of hypersensitivity reactions
## Clinical Pearls
* Piperacillin/tazobactam is often reconstituted with sterile water for injection and then further diluted in a compatible IV fluid (e.g., 0.9% sodium chloride or 5% dextrose) for infusion.
* Infusion time is typically 30 minutes. Longer infusions may be used for higher doses to minimize adverse effects.
* The tazobactam component extends the spectrum of activity of piperacillin to include many beta-lactamase-producing organisms.
* Discontinue if a hypersensitivity reaction occurs.
* Monitor for signs of C. difficile infection.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the official prescribing information and institutional protocols for complete and up-to-date guidance.*
