Tazobactum%252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520piperacillin

# Piperacillin-Tazobactam ## Overview Piperacillin-tazobactam is a combination penicillin-class antibacterial and a beta-lactamase inhibitor. 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 * Hospital-acquired pneumonia * Febrile neutropenia (in combination with an aminoglycoside) ## Adult Dosing The typical dose is 3.375 grams (3g piperacillin/0.375g tazobactam) or 4.5 grams (4g piperacillin/0.5g tazobactam) intravenously every 6 or 8 hours. * **Complicated Intra-abdominal Infections:** 3.375g IV every 6 hours or 4.5g IV every 8 hours. Duration typically 5-14 days. * **Complicated Skin and Skin-Structure Infections:** 3.375g IV every 6 hours or 4.5g IV every 8 hours. Duration typically 7-10 days. * **Community-Acquired Pneumonia:** 3.375g IV every 6 hours or 4.5g IV every 8 hours. Duration typically 7 days. * **Hospital-Acquired Pneumonia:** 4.5g IV every 6 hours. Duration typically 7-14 days. * **Febrile Neutropenia:** 4.5g IV every 6 hours in combination with an aminoglycoside. Duration typically 7 days. ## Pediatric Dosing Dosing is based on piperacillin component. * **Neonates and Infants < 2 months:** Dosing is highly variable and depends on gestational and chronological age. Consult specific pediatric guidelines or product information. * **Patients 2 months and older:** * **Complicated Intra-abdominal Infections:** 90-100 mg piperacillin/kg/dose (e.g., 80mg piperacillin/10mg tazobactam per kg) IV every 8 hours. Doses up to 100 mg piperacillin/kg/dose (4g/0.5g product) every 6 hours have been used in severe infections. Maximum daily dose of piperacillin is 16g. * **Complicated Skin and Skin-Structure Infections:** 90-100 mg piperacillin/kg/dose IV every 8 hours. * **Hospital-Acquired Pneumonia:** 90-100 mg piperacillin/kg/dose IV every 6 or 8 hours. ## Dose Adjustments * **Renal Impairment:** * CrCl 20-80 mL/min: Reduce frequency to every 8 hours (for 6-hour interval regimens) or every 12 hours (for 8-hour interval regimens). * CrCl < 20 mL/min: Reduce frequency to every 12 hours (for 6-hour interval regimens) or every 12-24 hours (for 8-hour interval regimens). * **Hemodialysis:** Administer a dose after each dialysis session. ## Contraindications * Known serious hypersensitivity to penicillin, cephalosporins, or beta-lactamase inhibitors. ## Adverse Effects * Diarrhea, nausea, vomiting, rash, pruritus, headache, insomnia, fever, phlebitis, eosinophilia, leukopenia, neutropenia, thrombocytopenia. * *Clostridioides difficile*-associated diarrhea. * Seizures (rare, especially with high doses or renal impairment). * Anaphylaxis. ## Key Drug Interactions * **Probenecid:** May increase and prolong piperacillin serum concentrations. * **Neuromuscular Blocking Agents (e.g., vecuronium):** Piperacillin may prolong the neuromuscular blockade. * **Warfarin:** May decrease the anticoagulant effect of warfarin. Monitor INR closely. * **Methotrexate:** Piperacillin may decrease methotrexate clearance. Monitor methotrexate levels. ## Monitoring * Renal function (CrCl). * Electrolytes, particularly with prolonged therapy. * Complete blood count (CBC) for signs of hematologic toxicity (neutropenia, thrombocytopenia). * Signs and symptoms of hypersensitivity reactions. * Signs and symptoms of *C. difficile*-associated diarrhea. * INR if patient is on warfarin. * Methotrexate levels if patient is on methotrexate. ## Clinical Pearls * Reconstitute and dilute according to manufacturer instructions. Infuse over at least 30 minutes. * Dosing depends on the severity of infection and renal function. * If patient develops a rash, monitor for signs of Stevens-Johnson syndrome or toxic epidermal necrolysis. Discontinue if hypersensitivity is suspected. * Consider a beta-lactam/beta-lactamase inhibitor combination for infections with known or suspected piperacillin-resistant, beta-lactamase-producing Enterobacterales. * Tazobactam is primarily active against *beta-lactamases* produced by many gram-negative and anaerobic organisms. Piperacillin covers many gram-positive organisms. *** *Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before making any treatment decisions. Dosing and recommendations may vary.*