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# Piperacillin/Tazobactam
## Overview
Piperacillin/tazobactam is a combination of an extended-spectrum penicillin-class antibacterial agent and a beta-lactamase inhibitor. It is active against many Gram-positive, Gram-negative, and anaerobic bacteria.
## Primary Indications
Treatment of moderate to severe infections including:
* Complicated intra-abdominal infections
* Complicated skin and skin-structure infections
* Community-acquired pneumonia
* Hospital-acquired pneumonia
* Febrile neutropenia
## Adult Dosing
* **Standard Dose:** 3.375 grams (3g piperacillin/0.375g tazobactam) every 6 hours intravenously (IV).
* **Higher Dose (for specific indications like HAP or febrile neutropenia):** 4.5 grams (4g piperacillin/0.5g tazobactam) every 6 or 8 hours IV.
* **Dosing frequency and duration** are dependent on the severity of infection, pathogen susceptibility, and clinical response. May be given as a 30-minute infusion.
## Pediatric Dosing
* **Neonates and infants < 2 months:** Dosing is highly variable and should be based on weight, gestational age, and renal function, often guided by specialist recommendations.
* **Children 2 months to < 12 years:**
* **Complicated intra-abdominal infections:** 100 mg piperacillin/12.5 mg tazobactam per kg per dose every 8 hours IV.
* **Hospital-acquired pneumonia:** 100 mg piperacillin/12.5 mg tazobactam per kg per dose every 8 hours IV.
* **Febrile neutropenia:** 300 mg piperacillin/37.5 mg tazobactam per kg per dose every 6 hours IV.
* **Maximum pediatric dose:** Generally does not exceed the adult maximum dose (e.g., 4.5 grams per dose).
* **Infusion:** Typically infused over 30 minutes.
## Dose Adjustments
* **Renal Impairment (CrCl < 20 mL/min):** Reduce frequency. For standard dosing (3.375g q6h), consider 2.25g every 8 hours. For higher dosing (4.5g q6h), consider 2.25g every 8 hours or 3.375g every 12 hours. Consult product information for specific recommendations based on the dose and frequency.
* **Hemodialysis:** Administer dose after dialysis and supplement with an additional dose if indicated.
## Contraindications
* Known hypersensitivity to piperacillin, tazobactam, other penicillins, or beta-lactams.
* History of cholestatic jaundice or hepatic dysfunction associated with piperacillin/tazobactam therapy.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, headache, insomnia, elevated liver enzymes.
* **Serious:** Hypersensitivity reactions (including anaphylaxis), *Clostridioides difficile*-associated diarrhea, seizures, neutropenia, thrombocytopenia, interstitial nephritis, renal failure.
## Key Drug Interactions
* **Probenecid:** May increase and prolong serum concentrations of piperacillin/tazobactam.
* **Neuromuscular blocking agents (e.g., vecuronium):** May prolong neuromuscular blockade.
* **Warfarin:** May decrease the efficacy of warfarin. Monitor INR closely.
* **Methotrexate:** May decrease methotrexate clearance. Monitor methotrexate levels.
## Monitoring
* Renal and hepatic function.
* Electrolytes.
* Complete blood count, including differential and platelets.
* Signs and symptoms of infection.
* Signs of hypersensitivity or *C. difficile* infection.
## Clinical Pearls
* The beta-lactamase inhibitor tazobactam broadens the spectrum of piperacillin to include many beta-lactamase producing bacteria.
* Discontinue if allergic reaction occurs.
* Adequate hydration is important during infusion.
* Consider the potential for cross-reactivity in patients with penicillin allergy.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols for definitive guidance.*
