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# Piperacillin-Tazobactam
## Overview
Piperacillin-tazobactam is a combination penicillin-type antibiotic (piperacillin) and a beta-lactamase inhibitor (tazobactam). It is active against a broad spectrum of 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 (piperacillin 3g/tazobactam 0.375g) intravenously every 6 hours.
Higher dose for severe infections or nosocomial pneumonia: 4.5 grams (piperacillin 4g/tazobactam 0.5g) intravenously every 6 hours.
Maximum daily dose: 18 grams (piperacillin 16g/tazobactam 2g).
Duration of therapy varies based on indication and clinical response.
## Pediatric Dosing
Dosing is weight-based and depends on the indication and severity of infection. Local protocols should be consulted.
* **Intra-abdominal infections:** 80 mg piperacillin/10 mg tazobactam per kg per dose intravenously every 8 hours for children 2 months to 12 years.
* **Febrile neutropenia:** 100 mg piperacillin/12.5 mg tazobactam per kg per dose intravenously every 6 hours for children 2 months to 12 years.
* **For children > 12 years:** Dosing is the same as adults.
## Dose Adjustments
* **Renal Impairment:** Adjust dose based on creatinine clearance (CrCl).
* CrCl 20-40 mL/min: Administer usual dose every 8 hours.
* CrCl < 20 mL/min: Administer usual dose every 12 hours.
* Hemodialysis: Administer usual dose every 8 hours and an additional dose after each dialysis session.
* **Hepatic Impairment:** No dose adjustment is typically required.
## Contraindications
* Known history of severe allergic reaction to piperacillin, tazobactam, other penicillins, or beta-lactamase inhibitors.
## Adverse Effects
* Diarrhea (most common)
* Rash
* Nausea, vomiting
* Headache
* Insomnia
* Fever
* Eosinophilia
* Increased serum creatinine
* Clostridioides difficile-associated diarrhea
* Hypersensitivity reactions, including anaphylaxis
* Seizures (rare, associated with high doses or renal impairment)
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin-tazobactam serum concentrations.
* **Neuromuscular blocking agents (e.g., vecuronium):** Piperacillin may prolong the neuromuscular blockade.
* **Warfarin:** May decrease the effect of warfarin. Monitor INR closely.
* **Methotrexate:** Piperacillin may decrease methotrexate clearance. Monitor methotrexate levels.
## Monitoring
* Renal function (creatinine, CrCl)
* Liver function tests
* Complete blood count (CBC), especially for prolonged therapy
* Signs and symptoms of infection
* Clostridioides difficile-associated diarrhea
* Signs of hypersensitivity reactions
## Clinical Pearls
* Reconstituted solutions are stable for 24 hours at room temperature or 48 hours when refrigerated.
* Administer over at least 30 minutes to minimize infusion-related reactions.
* Tazobactam protects piperacillin from degradation by beta-lactamase enzymes, extending its spectrum of activity.
* The choice of dose and duration should be guided by the specific pathogen, site and severity of infection, and clinical response.
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*This information is for educational purposes only and does not substitute for professional medical advice. Always consult the most current prescribing information and clinical guidelines before making any treatment decisions.*
