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# Piperacillin-Tazobactam
## Overview
Piperacillin-tazobactam is a combination penicillin-class antibiotic with a beta-lactamase inhibitor. It is active against many Gram-positive and Gram-negative bacteria, including *Pseudomonas aeruginosa*.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin structure infections
* Community-acquired pneumonia
* Nosocomial pneumonia
* Bacterial infections in febrile neutropenic patients
## Adult Dosing
Standard adult dosing is typically **3.375 grams IV every 6 hours** or **4.5 grams IV every 8 hours**. Dosing frequency and duration depend on the indication, severity of infection, and patient response. Higher doses may be used for severe infections or *Pseudomonas* infections, but specific maximums are often guided by local protocols and clinical judgment.
## Pediatric Dosing
Dosing in pediatric patients depends on age, weight, and indication. Common pediatric dosing is based on piperacillin content:
* **Neonates and infants younger than 2 months:** Dosing is highly variable and should be guided by specific protocols, often based on gestational and chronological age.
* **Children 2 months and older:** Dosing typically ranges from **100 mg piperacillin/12.5 mg tazobactam/kg/day to 300 mg piperacillin/37.5 mg tazobactam/kg/day divided into 3 or 4 doses IV**. The maximum single dose should not exceed 3.375 grams.
## Dose Adjustments
* **Renal Impairment:** Dose adjustment is required in patients with moderate to severe renal impairment (CrCl < 40 mL/min). Consult specific guidelines for adjusted dosing intervals.
* **Hepatic Impairment:** No dose adjustment is generally needed for hepatic impairment alone.
## Contraindications
* Known severe hypersensitivity to piperacillin, tazobactam, other beta-lactam antibiotics, or any component of the formulation.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, headache, insomnia.
* **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures (especially with high doses or renal impairment), neutropenia, thrombocytopenia, hepatitis.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin serum levels.
* **Neuromuscular blocking agents:** May prolong neuromuscular blockade.
* **Warfarin:** May decrease the effect of warfarin; monitor INR.
* **Methotrexate:** May increase methotrexate levels; monitor methotrexate levels.
## Monitoring
* Renal function
* Liver function tests
* Complete blood count (CBC) with differential and platelets
* Signs and symptoms of infection
* Signs of hypersensitivity reactions
* Stool for *C. difficile* if diarrhea develops
## Clinical Pearls
* Piperacillin-tazobactam has broad-spectrum activity, including against *Pseudomonas aeruginosa*.
* Discontinue immediately if hypersensitivity or *C. difficile*-associated diarrhea occurs.
* Reconstituted solutions should be used within the time specified by the manufacturer.
* Dosing in renal impairment requires careful attention to the CrCl and recommended dosing intervals.
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***Disclaimer:** This information is intended for educational purposes only and does not constitute medical advice. Always consult the most current prescribing information and professional resources for definitive patient care decisions.*
