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# Piperacillin-Tazobactam
## Overview
Piperacillin-tazobactam is a combination penicillin-class antibiotic and beta-lactamase inhibitor. It is bactericidal and has a broad spectrum of activity against many Gram-positive, Gram-negative, and anaerobic bacteria.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin-structure infections
* Community-acquired pneumonia
* Hospital-acquired pneumonia, including ventilator-associated pneumonia
## Adult Dosing
Standard adult dosing is 3.375 grams every 6 hours or 4.5 grams every 6 or 8 hours intravenously. The duration of therapy depends on the infection severity and clinical response, typically 7 to 14 days. Specific dosing for complex infections may vary based on local institutional protocols.
## Pediatric Dosing
For children 0 to 12 months, dosing is typically 80 mg piperacillin component per kg per dose every 6 hours.
For children 1 to 12 years, dosing is typically 80 to 100 mg piperacillin component per kg per dose every 6 hours.
Maximum pediatric dose is 4.5 grams every 6 hours.
Dosing for neonates (up to 1 month) is based on gestational and postnatal age and should follow specific guidelines.
## Dose Adjustments
* **Renal Impairment:**
* CrCl > 40 mL/min: No dose adjustment needed.
* CrCl 20-40 mL/min: 2.25 grams every 6 hours (for 3.375 g formulation) or 3.375 grams every 8 hours (for 4.5 g formulation).
* CrCl < 20 mL/min: 2.25 grams every 8 hours (for 3.375 g formulation) or 3.375 grams every 12 hours (for 4.5 g formulation).
* Hemodialysis: Administer dose after dialysis and adjust as above.
## Contraindications
* Known history of severe allergic reaction (e.g., anaphylaxis) to piperacillin, tazobactam, or other beta-lactam antibiotics.
## Adverse Effects
* Diarrhea (most common)
* Rash, pruritus
* Nausea, vomiting
* Headache
* Insomnia
* Hypersensitivity reactions, including anaphylaxis
* Clostridioides difficile-associated diarrhea
* Hematologic abnormalities (e.g., eosinophilia, leukopenia, thrombocytopenia)
* Elevated liver enzymes
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin-tazobactam serum concentrations.
* **Neuromuscular blocking agents:** May prolong neuromuscular blockade.
* **Warfarin:** May decrease INR. Monitor INR closely.
* **Methotrexate:** May decrease methotrexate levels. Monitor methotrexate levels.
## Monitoring
* Signs and symptoms of infection.
* Renal function (serum creatinine, CrCl).
* Liver function tests.
* Complete blood count, especially in prolonged therapy.
* Signs of hypersensitivity reactions.
## Clinical Pearls
* Piperacillin-tazobactam has broad-spectrum activity, including against Pseudomonas aeruginosa.
* Administer intravenously, typically over 30 minutes.
* Reconstituted solutions are stable for limited periods at room temperature or refrigerated; consult manufacturer information.
* Risk of C. difficile-associated diarrhea.
* Potential for false-positive urine glucose tests with Benedict's or Fehling's solution.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the current official prescribing information and relevant clinical guidelines for complete and up-to-date details before making any treatment decisions.
