Please check your internet connection and try again.
# 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 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
* Febrile neutropenia
## Adult Dosing
Dosing varies based on indication and severity. Common regimens include:
* **3.375 g IV every 6 hours** for 4-7 days for uncomplicated intra-abdominal infections.
* **4.5 g IV every 6 or 8 hours** for 4-7 days for complicated intra-abdominal infections, complicated skin and skin structure infections, community-acquired pneumonia, and febrile neutropenia.
* **4.5 g IV every 8 hours** for 7 days for nosocomial pneumonia.
* **Maximum daily dose:** Generally considered 18 g per day.
Specific dosing for certain indications (e.g., severe infections, prolonged duration) may be guided by local antibiogram data and clinical judgment.
## Pediatric Dosing
Dosing is based on piperacillin component and patient weight.
* **3 months to 12 years:** Dosing typically ranges from **50 mg piperacillin/6.25 mg tazobactam/kg/dose to 100 mg piperacillin/12.5 mg tazobactam/kg/dose IV every 6 or 8 hours**.
* **Maximum dose:** Should not exceed the adult maximum of 4.5 g per dose.
* **Neonates and infants < 3 months:** Safety and efficacy not established; dosing is highly individualized if used.
## Dose Adjustments
* **Renal Impairment:**
* **CrCl > 20 mL/min:** No dose adjustment typically needed.
* **CrCl ≤ 20 mL/min:** Reduce dose frequency (e.g., to every 8 or 12 hours depending on regimen) or reduce the daily dose. For 3.375 g every 6 hours, consider 2.25 g every 6 hours. For 4.5 g every 6 hours, consider 3.375 g every 6 hours. For 4.5 g every 8 hours, consider 2.25 g every 8 hours.
* **Hemodialysis:** Administer dose after hemodialysis and supplement with 1 g of piperacillin/tazobactam.
## Contraindications
* History of allergic reaction to piperacillin, other penicillin's, or beta-lactamase inhibitors.
* Known hypersensitivity to either component.
## Adverse Effects
* **Common:** Diarrhea, rash, nausea, vomiting, headache, insomnia, constipation, pruritus, fever.
* **Serious:** Hypersensitivity reactions (including anaphylaxis), Clostridioides difficile-associated diarrhea, seizure activity, leukopenia, neutropenia, thrombocytopenia, increased liver enzymes.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin serum concentrations.
* **Neuromuscular blocking agents (e.g., vecuronium):** May prolong neuromuscular blockade.
* **Warfarin:** May decrease INR. Monitor INR closely.
* **Methotrexate:** May decrease methotrexate clearance and increase toxicity.
## Monitoring
* **Renal function:** Especially in patients with pre-existing renal impairment or receiving concomitant nephrotoxic agents.
* **Hepatic function:** Monitor liver function tests.
* **Hematologic parameters:** Complete blood count, including platelet count.
* **Signs of hypersensitivity:** Monitor for rash, pruritus, and signs of anaphylaxis.
* **Signs of C. difficile infection:** Diarrhea.
## Clinical Pearls
* Piperacillin/tazobactam covers *Pseudomonas aeruginosa*.
* Reconstituted solutions have limited stability and should be used within the manufacturer's recommended timeframe.
* Infusion-related reactions, including phlebitis, can occur; consider slower infusion rates or rotating infusion sites.
* The risk of seizures may be increased in patients with renal impairment.
***
**Disclaimer:** This information is intended for healthcare professionals and does not replace the official prescribing information or professional judgment. Always consult the most current product monograph and institutional guidelines before prescribing.
