Tazobactum%2525252525252525252525252525252525252525252525252525252525252520piperacillin

# Piperacillin-Tazobactam ## Overview Piperacillin-tazobactam is a combination penicillin-class antibacterial and a beta-lactamase inhibitor. It is bactericidal and has a broad spectrum of activity against many Gram-positive, Gram-negative (including *Pseudomonas aeruginosa*), and anaerobic bacteria. ## Primary Indications * Complicated intra-abdominal infections * Complicated skin and skin structure infections * Community-acquired pneumonia * Nosocomial pneumonia ## Adult Dosing Standard dose is 3.375 grams every 6 hours or 4.5 grams every 6 or 8 hours intravenously (IV). Dosing frequency and duration depend on the severity and type of infection. Specific dosing for certain indications may vary based on institutional protocols. ## Pediatric Dosing For patients 2 months of age and older: * **Complicated intra-abdominal infections:** 100 mg piperacillin/12.5 mg tazobactam per kg every 8 hours IV. Maximum dose: 3.375 g per dose. * **Complicated skin and skin structure infections:** 75 mg piperacillin/9.375 mg tazobactam per kg every 8 hours IV. Maximum dose: 3.375 g per dose. * Consider higher doses for severe infections or *Pseudomonas* infections, as per institutional guidelines. ## Dose Adjustments * **Renal Impairment:** * CrCl > 40 mL/min: No dose adjustment needed. * CrCl 20-40 mL/min: 2.25 g every 6 hours or 3.375 g every 8 hours IV. * CrCl < 20 mL/min: 2.25 g every 8 hours IV. * In severe renal impairment, consider the maximum dose and frequency recommendations. ## Contraindications * Known serious hypersensitivity to piperacillin, tazobactam, other penicillins, or beta-lactamase inhibitors. * History of cholestatic jaundice/hepatic dysfunction associated with piperacillin-tazobactam. ## Adverse Effects Common: Diarrhea, nausea, vomiting, rash, headache, insomnia, fever, increased liver enzymes. Serious: *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures, neutropenia, thrombocytopenia, hemolytic anemia. ## Key Drug Interactions * **Probenecid:** May increase and prolong piperacillin-tazobactam plasma concentrations. * **Neuromuscular blocking agents (e.g., vecuronium):** Piperacillin may prolong the effect of vecuronium. * **Warfarin:** Piperacillin may decrease warfarin's effect. Monitor INR closely. * **Methotrexate:** Piperacillin may decrease methotrexate clearance. Monitor methotrexate levels. ## Monitoring * Renal function (baseline and during therapy, especially in patients with pre-existing renal impairment). * Liver function tests. * Signs and symptoms of hypersensitivity reactions. * Signs and symptoms of *C. difficile*-associated diarrhea. * Blood counts (especially with prolonged therapy). * INR if co-administered with warfarin. ## Clinical Pearls * Administer IV infusion over at least 30 minutes. * Do not add piperacillin-tazobactam to lipid-containing solutions. * If administered with an aminoglycoside, physically separate the drugs or administer them sequentially to avoid inactivation, unless the specific combination is approved. * Consider de-escalation to a narrower-spectrum agent once culture and sensitivity results are available. *** *Disclaimer: This information is intended for clinical pharmacists and should not replace a comprehensive review of the full prescribing information or professional judgment. Always verify current prescribing information before use.*