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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, gram-negative, and anaerobic bacteria.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin-structure infections
* Community-acquired pneumonia
* Nosocomial pneumonia
* Febrile neutropenia (empiric treatment)
## Adult Dosing
* **Standard Dose:** 3.375 grams every 6 hours or 4.5 grams every 6 or 8 hours intravenously (IV). The ratio of piperacillin to tazobactam is typically 8:1.
* **Dosage depends on the specific indication and severity of infection.** Consult local guidelines or formulary for specific dosing recommendations.
* **Maximum daily dose:** Typically 18 grams (15.75 grams of piperacillin) per day.
## Pediatric Dosing
* **Children < 12 years:** Dosing is based on piperacillin component and typically ranges from 80-100 mg/kg/dose of piperacillin, given every 6-8 hours IV. Maximum single doses should not exceed the adult maximum.
* **Children ≥ 12 years:** Generally dosed as adults.
* **Dosage adjustments are necessary for renal impairment.**
* **Tazobactam component is usually 1/8th the piperacillin dose.**
* **Consult pediatric infectious disease resources or institutional guidelines for precise dosing.**
## Dose Adjustments
* **Renal Impairment:**
* CrCl > 50 mL/min: No adjustment needed.
* CrCl 20-50 mL/min: 2.25 grams or 3.375 grams every 8 hours.
* CrCl < 20 mL/min: 2.25 grams every 8 hours or 3.375 grams every 12 hours.
* **For hemodialysis patients:** Administer dose after hemodialysis and supplement dose based on CrCl.
* **Hepatic Impairment:** No specific dose adjustment is recommended.
## Contraindications
* Hypersensitivity to piperacillin, tazobactam, other penicillinase-resistant penicillins, or any component of the formulation.
* History of a cholestatic jaundice or hepatic dysfunction associated with piperacillin/tazobactam therapy.
## Adverse Effects
* **Common:** Diarrhea, rash, nausea, vomiting, headache, insomnia, constipation, fever.
* **Serious:** Clostridioides difficile-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures (particularly with high doses or renal impairment), interstitial nephritis, hematologic effects (e.g., leukopenia, neutropenia, thrombocytopenia, eosinophilia).
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam plasma concentrations.
* **Neuromuscular blocking agents (e.g., vecuronium):** Piperacillin may prolong the neuromuscular blockade.
* **Warfarin:** May decrease the efficacy of warfarin. Monitor INR closely.
* **Methotrexate:** Piperacillin may decrease methotrexate levels. Monitor methotrexate levels.
## Monitoring
* Renal function (especially with concomitant nephrotoxic agents).
* Liver function tests.
* Electrolytes.
* Hematologic parameters (CBC with differential).
* Signs and symptoms of C. difficile infection.
* Signs and symptoms of hypersensitivity reactions.
## Clinical Pearls
* Piperacillin/tazobactam is a broad-spectrum agent often used empirically for serious infections, particularly in hospital settings.
* Administer IV infusion over at least 30 minutes to reduce the risk of infusion-related reactions.
* Be aware of the potential for cross-reactivity in patients with penicillin allergies.
* The addition of tazobactam extends the spectrum of activity to include many beta-lactamase-producing organisms.
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*Disclaimer: This information is intended for clinical professionals. Always verify current prescribing information and consult with a pharmacist or physician before making any treatment decisions.*
