Tazobactum%252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520piperacillin

# Piperacillin-Tazobactam ## Overview Piperacillin-tazobactam is a combination penicillin-class antibiotic and 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 (including diabetic foot infections) * Community-acquired pneumonia * Hospital-acquired pneumonia (including ventilator-associated pneumonia) * Febrile neutropenia (empiric treatment) * Bacterial infections caused by piperacillin-susceptible, beta-lactamase-producing *Pseudomonas aeruginosa* ## Adult Dosing * **Standard Dose:** 3.375 g every 6 hours or 4.5 g every 8 hours intravenously (IV). * Each 3.375 g dose contains 3 g piperacillin and 0.375 g tazobactam. * Each 4.5 g dose contains 4 g piperacillin and 0.5 g tazobactam. * **Duration of Therapy:** Typically 7-14 days, depending on infection severity and clinical response. * **Maximum Daily Dose:** Generally not to exceed 18 g/day (based on 4.5 g every 6 hours), but typically limited by frequency and total daily piperacillin (e.g., 16 g/day or 18 g/day). ## Pediatric Dosing Dosing in children depends on age, weight, and indication. Dosing below is generally for children 2 months and older. * **3.375 g every 6 hours (3 g piperacillin / 0.375 g tazobactam):** * For children weighing < 40 kg: 100 mg piperacillin / 12.5 mg tazobactam per kg per dose, administered IV every 6 hours. Do not exceed the adult dose of 3.375 g per dose. * **4.5 g every 8 hours (4 g piperacillin / 0.5 g tazobactam):** * For children weighing ≥ 40 kg: Administered as the adult dose, 4.5 g IV every 8 hours. * For children weighing < 40 kg: 112.5 mg piperacillin / 14.06 mg tazobactam per kg per dose, administered IV every 8 hours. Do not exceed the adult dose of 4.5 g per dose. **Note:** Specific pediatric dosing for indications like febrile neutropenia may vary and often follows institutional protocols. ## Dose Adjustments * **Renal Impairment (CrCl < 20 mL/min):** Reduce dose by one-third to one-half. If CrCl is 20-40 mL/min, consider reducing dose frequency to every 8 hours. Dose and frequency adjustments are complex and should be guided by renal function and institutional guidelines. Hemodialysis removes the drug; administer dose after dialysis and supplement as needed. ## Contraindications * Hypersensitivity to piperacillin, tazobactam, other penicillinase-resistant penicillins, 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, constipation, abdominal pain, fever, elevated liver enzymes (AST, ALT). * **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (including anaphylaxis), seizures, neutropenia, thrombocytopenia, interstitial nephritis, hemolytic anemia. ## Key Drug Interactions * **Probenecid:** May increase serum concentrations of piperacillin and tazobactam. * **Neuromuscular blocking agents (e.g., vecuronium):** Penicillins may prolong the blockade. * **Warfarin:** May decrease the efficacy of warfarin, increasing the risk of bleeding. Monitor INR closely. * **Methotrexate:** May decrease the clearance and increase the toxicity of methotrexate. ## Monitoring * Renal function (creatinine, BUN) for dose adjustments. * Liver function tests (AST, ALT) periodically. * Complete blood count (CBC) to monitor for hematologic changes (neutropenia, thrombocytopenia). * Signs and symptoms of *C. difficile* infection. * Signs and symptoms of hypersensitivity reactions. * Clinical signs of infection (fever, WBC count, localization of infection). ## Clinical Pearls * Piperacillin-tazobactam is typically reconstituted and further diluted for IV infusion over 30 minutes. * The broad spectrum is useful for empiric therapy in critically ill patients or those with suspected resistant organisms. * Be aware of the potential for cross-reactivity in patients with penicillin allergies, though the risk is generally lower than with broader-spectrum cephalosporins. * Dosing frequency is critical and must be adjusted for renal impairment. *** **Disclaimer:** This information is intended for clinical use and is not exhaustive. Always consult the most current prescribing information and relevant clinical guidelines for complete details before administering this medication.