Please check your internet connection and try again.
# Piperacillin-Tazobactam
## Overview
Piperacillin-tazobactam is an extended-spectrum penicillin combined with a beta-lactamase inhibitor. It has broad-spectrum bactericidal 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)
* Febrile neutropenia (empiric treatment)
## Adult Dosing
Common adult dosages are 3.375 grams (3g piperacillin/0.375g tazobactam) or 4.5 grams (4g piperacillin/0.5g tazobactam) administered intravenously every 6 to 8 hours. Duration of therapy depends on the indication and patient response, typically ranging from 7 to 14 days. Specific dosing frequency and duration may vary based on local protocols and institutional guidelines.
## Pediatric Dosing
For pediatric patients (greater than or equal to 2 months of age):
* **Weight-based dosing:** 90 mg piperacillin component per kg per dose, given every 8 hours.
* **Maximum dose:** 4.5 grams per dose.
* **Weight-based dosing (with consideration for severe infections or patients requiring higher doses):** 112.5 mg piperacillin component per kg per dose, given every 6 hours.
* **Maximum dose:** 4.5 grams per dose.
Dosing for neonates and infants younger than 2 months is not established. Refer to institutional guidelines for precise dosing and duration.
## Dose Adjustments
**Renal Impairment:**
* CrCl > 40 mL/min: No dose adjustment needed.
* CrCl 20-40 mL/min: Reduce dose frequency to every 8 hours.
* CrCl < 20 mL/min: Reduce dose frequency to every 12 hours.
* Hemodialysis: Administer dose every 12 hours and administer an additional 0.75 grams after each dialysis session.
**Hepatic Impairment:** No dose adjustment is typically required, but caution is advised.
## Contraindications
* Hypersensitivity to piperacillin, tazobactam, other penicillin derivatives, or any component of the formulation.
* History of a severe allergic reaction (e.g., anaphylaxis) to a beta-lactam antibiotic.
## Adverse Effects
Common: Diarrhea, rash, nausea, vomiting, headache, insomnia, abdominal pain, fever.
Serious:
* Hypersensitivity reactions (including anaphylaxis)
* Clostridioides difficile-associated diarrhea (CDAD)
* Seizures (especially with high doses or renal impairment)
* Hepatotoxicity
* Hematologic changes (e.g., neutropenia, thrombocytopenia, eosinophilia)
## Key Drug Interactions
* **Probenecid:** May increase and prolong serum concentrations of piperacillin.
* **Neuromuscular blocking agents (e.g., vecuronium):** Piperacillin may prolong the effect of vecuronium.
* **Warfarin:** May decrease the effect of warfarin, leading to increased INR. Monitor INR closely.
* **Methotrexate:** May decrease serum methotrexate levels. Monitor methotrexate levels.
## Monitoring
* Renal function (creatinine, BUN) for dose adjustment.
* Liver function tests (AST, ALT, bilirubin) if clinically indicated.
* Signs and symptoms of hypersensitivity reactions.
* Signs and symptoms of CDAD.
* Complete blood count (CBC) for hematologic changes, especially with prolonged therapy.
* Prothrombin time/INR if the patient is also on warfarin.
## Clinical Pearls
* Piperacillin-tazobactam is administered via intravenous infusion. Reconstitute and dilute according to manufacturer instructions.
* The duration of infusion is typically 30 minutes for doses up to 4.5 grams.
* If treating suspected or confirmed MRSA, piperacillin-tazobactam alone may not be sufficient and combination therapy might be required.
* Monitor for signs of superinfection, including fungal infections.
***
*This information is intended for healthcare professionals. Always consult the current prescribing information and relevant guidelines for complete details. Dosing recommendations may vary based on local protocols and patient-specific factors.*
