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# Piperacillin/Tazobactam
## Overview
Piperacillin/tazobactam is a combination antibiotic consisting of piperacillin, a broad-spectrum penicillin antibiotic, and tazobactam, 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 adult dosing is typically 3.375 grams (piperacillin 3 grams/tazobactam 0.375 grams) or 4.5 grams (piperacillin 4 grams/tazobactam 0.5 grams) administered intravenously every 6 or 8 hours. Dosing frequency and duration depend on the severity and type of infection, renal function, and clinical response. Dosing for specific indications like febrile neutropenia may vary based on institutional protocols.
## Pediatric Dosing
Dosing in pediatric patients is weight-based and depends on age and indication.
* **Infants and children (< 12 years):** Typically dosed based on piperacillin component: 80 mg/kg to 100 mg/kg per dose, administered every 6 to 8 hours. A maximum dose of 4 grams of piperacillin per dose should not be exceeded.
* **Adolescents (≥ 12 years):** Can be dosed as per adult recommendations.
* **Neonates:** Dosing is complex and often guided by specific protocols due to immature renal and hepatic function.
## Dose Adjustments
Dose reduction and/or increased dosing interval is required in patients with renal impairment.
* **CrCl 20-40 mL/min:** Reduce dose by 25% or increase interval to 8 hours.
* **CrCl < 20 mL/min:** Reduce dose by 50% or increase interval to 12 hours.
* **Hemodialysis:** Administer dose every 8 hours and supplement with an additional 1.125 grams after each dialysis session.
## Contraindications
* Known serious hypersensitivity to piperacillin, tazobactam, other beta-lactam antibiotics, or any component of the formulation.
## Adverse Effects
Common adverse effects include diarrhea, nausea, vomiting, rash, headache, insomnia, and phlebitis at the injection site. Serious adverse effects may include *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures, and hematologic abnormalities.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam serum concentrations.
* **Neuromuscular blocking agents:** Piperacillin may reduce the efficacy of oral contraceptives.
* **Methotrexate:** Piperacillin may decrease methotrexate levels.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for *Clostridioides difficile*-associated diarrhea.
* Monitor renal and hepatic function.
* Monitor complete blood count, including platelet count, especially in patients with prolonged treatment.
## Clinical Pearls
* Piperacillin/tazobactam has a broad spectrum of activity and is often used for moderate to severe infections, including those caused by resistant organisms.
* Reconstituted solutions are typically stable for 24 hours at room temperature and 7 days if refrigerated.
* The ratio of piperacillin to tazobactam is fixed (8:1).
* Tazobactam is a potent inhibitor of many beta-lactamases, broadening the spectrum of piperacillin.
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*This information is intended for healthcare professionals and should not replace clinical judgment or consultation of the official prescribing information. Always verify the most current drug information before making prescribing decisions.*
