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# Piperacillin/Tazobactam
## Overview
Piperacillin/tazobactam is a combination penicillin-class antibacterial and a beta-lactamase inhibitor. It is active against many Gram-positive and Gram-negative aerobic and anaerobic bacteria, including *Pseudomonas aeruginosa*.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin structure infections
* Community-acquired pneumonia
* Nosocomial pneumonia
* Febrile neutropenia (empiric treatment)
## Adult Dosing
The standard dose is 3.375 grams (piperacillin 3 grams / tazobactam 0.375 grams) intravenously every 6 hours or 4.5 grams (piperacillin 4 grams / tazobactam 0.5 grams) intravenously every 6 or 8 hours. Duration of therapy is typically 7 to 14 days depending on the indication and patient response. Higher doses may be used for severe infections or *Pseudomonas* infections, but specific dosing often depends on local antibiogram and institutional protocols.
## Pediatric Dosing
For children 2 months of age and older:
* **Intra-abdominal infections:** 100 mg piperacillin / 12.5 mg tazobactam per kg per dose intravenously every 8 hours.
* **Nosocomial pneumonia:** 100 mg piperacillin / 12.5 mg tazobactam per kg per dose intravenously every 8 hours, OR 75 mg piperacillin / 9.375 mg tazobactam per kg per dose intravenously every 6 hours.
* **Febrile neutropenia:** 75 mg piperacillin / 9.375 mg tazobactam per kg per dose intravenously every 6 hours.
Maximum dose: 4.5 grams per dose.
## Dose Adjustments
**Renal Impairment:**
* CrCl > 20 mL/min: No dose adjustment needed.
* CrCl ≤ 20 mL/min: Administer the usual dose every 8 hours.
* For intermittent hemodialysis: Administer the usual dose every 8 hours, with an additional dose after each dialysis session.
* For continuous venovenous hemofiltration (CVVH): Specific dosing recommendations vary; consult institutional guidelines.
**Hepatic Impairment:** No dose adjustment is recommended.
## Contraindications
Hypersensitivity to piperacillin, tazobactam, other penicillins, or beta-lactamase inhibitors.
## Adverse Effects
Common adverse effects include diarrhea, nausea, vomiting, rash, headache, insomnia, and injection site reactions. Serious adverse effects include hypersensitivity reactions (anaphylaxis), *Clostridioides difficile*-associated diarrhea, seizures, and hematologic abnormalities.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin serum concentrations.
* **Neuromuscular blocking agents:** May prolong the neuromuscular blockade.
* **Warfarin:** May decrease the efficacy of warfarin. Monitor INR closely.
* **Methotrexate:** May decrease methotrexate serum concentrations.
## Monitoring
* Renal function (especially with concomitant nephrotoxic agents).
* Liver function tests.
* Complete blood count, including platelet count.
* Signs and symptoms of infection.
* Signs of hypersensitivity reactions.
* INR if co-administered with warfarin.
## Clinical Pearls
* Piperacillin/tazobactam provides broad-spectrum coverage, including *Pseudomonas aeruginosa*.
* Dosing frequency (every 6 vs. 8 hours) may be adjusted based on severity of infection and renal function.
* Ensure adequate hydration and monitor for signs of seizures, especially in patients with renal impairment.
* Administer over at least 30 minutes to reduce infusion-related reactions.
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*This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and institutional guidelines.*
