Please check your internet connection and try again.
# Piperacillin/Tazobactam
## Overview
Piperacillin/tazobactam is a combination antibiotic consisting of an extended-spectrum penicillin (piperacillin) and a beta-lactamase inhibitor (tazobactam). It is bactericidal and effective against a broad range of Gram-positive and Gram-negative bacteria, including many anaerobes.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin structure infections
* Community-acquired pneumonia
* Hospital-acquired pneumonia
* Nosocomial pneumonia
* Bacterial infections in febrile neutropenic patients (in combination with an aminoglycoside)
## Adult Dosing
Standard doses are:
* **3.375 grams (3 g piperacillin/0.375 g tazobactam) every 6 hours** intravenously.
* **4.5 grams (4 g piperacillin/0.5 g tazobactam) every 6 or 8 hours** intravenously.
The frequency and dose depend on the severity and type of infection. Maximum daily dose of piperacillin is typically 18 g. Specific dosing for certain indications like febrile neutropenia may involve combination therapy. Consult local guidelines for specific duration of therapy.
## Pediatric Dosing
Dosing is weight-based and depends on the indication and patient age.
* **3.375 grams (3 g piperacillin/0.375 g tazobactam) every 6 hours** intravenously for children 12 years and older.
* For neonates and children younger than 12 years:
* **90-100 mg piperacillin/11.25-12.5 mg tazobactam per kg per dose** administered intravenously every 6 or 8 hours.
* Maximum single dose should not exceed the adult dose of 4.5 grams.
* A higher dose of **150 mg piperacillin/18.75 mg tazobactam per kg per day** divided into 3 or 4 doses may be used for more severe infections, particularly in children with febrile neutropenia.
## Dose Adjustments
* **Renal Impairment:**
* If CrCl > 40 mL/min: No dose adjustment needed.
* If CrCl 20-40 mL/min: Administer usual dose every 8 hours.
* If CrCl < 20 mL/min: Administer usual dose every 12 hours.
* Hemodialysis: Administer usual dose every 8 hours, and administer an additional 1.125 grams after each hemodialysis session.
## Contraindications
* Hypersensitivity to piperacillin, tazobactam, other penicillins, or cephalosporins.
* History of immediate and severe allergic reaction to beta-lactam antibiotics.
## Adverse Effects
Common: Diarrhea, rash, nausea, vomiting, headache, insomnia.
Serious: Clostridioides difficile-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures (especially with high doses or renal impairment), neutropenia, thrombocytopenia, elevated liver enzymes.
## Key Drug Interactions
* **Probenecid:** May increase and prolong serum concentrations of piperacillin and tazobactam.
* **Neuromuscular blocking agents (e.g., vecuronium):** Piperacillin may prolong the neuromuscular blockade.
* **Warfarin:** May decrease warfarin's anticoagulant effect. Monitor INR closely.
* **Methotrexate:** Piperacillin may decrease methotrexate clearance. Monitor methotrexate levels.
## Monitoring
* Renal function (CrCl) for dose adjustment.
* Liver function tests.
* Hematologic parameters (CBC with differential and platelet count).
* Signs and symptoms of hypersensitivity reactions.
* Signs and symptoms of C. difficile infection.
## Clinical Pearls
* Piperacillin/tazobactam provides broad-spectrum coverage, including many resistant organisms like Pseudomonas aeruginosa.
* Tazobactam inhibits many beta-lactamases, extending the spectrum of piperacillin.
* Administer by slow intravenous infusion over at least 30 minutes.
* Do not add piperacillin/tazobactam to lipid-containing solutions.
* Reconstituted solution stability varies; consult manufacturer package insert for details.
***
**Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant guidelines for complete details and to ensure patient-specific care.
