Please check your internet connection and try again.
# Piperacillin-Tazobactam
## Overview
Piperacillin-tazobactam is a combination antibiotic consisting of piperacillin, a broad-spectrum penicillinase-susceptible penicillin, and tazobactam, a beta-lactamase inhibitor.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin structure infections
* Community-acquired pneumonia
* Nosocomial pneumonia
* Febrile neutropenia (as part of combination therapy)
## Adult Dosing
Standard dose is **3.375 grams intravenously every 6 hours** or **4.5 grams intravenously every 8 hours**.
* For severe or life-threatening infections, doses of **4.5 grams intravenously every 6 hours** may be used.
* Maximum daily dose is generally **18 grams**.
* Dosing frequency and duration depend on the severity of infection and clinical response.
## Pediatric Dosing
* **3 months and older:** Dosing is based on piperacillin weight-based recommendations.
* Complicated intra-abdominal infections: **100 mg piperacillin component/12.5 mg tazobactam component per kg of body weight intravenously every 8 hours**.
* Complicated skin and skin structure infections, Community-acquired pneumonia, Febrile neutropenia: **75 mg piperacillin/9.375 mg tazobactam per kg per dose intravenously every 6 hours**.
* Maximum dose: Generally **4.5 grams per dose**.
* Dosing should not exceed the maximum adult dose.
* For neonates and infants younger than 3 months, specific dosing recommendations are less established and should be guided by clinical judgment and local protocols.
## Dose Adjustments
* **Renal Impairment:**
* CrCl > 40 mL/min: No adjustment needed.
* CrCl 20-40 mL/min: Reduce dose by 25% (e.g., 3.375 g every 8 hours).
* CrCl < 20 mL/min: Reduce dose by 50% (e.g., 2.25 g every 8 hours or 3.375 g every 12 hours).
* Hemodialysis: Administer dose and supplement with 0.75 g after each dialysis session.
* **Hepatic Impairment:** No specific dose adjustments are usually recommended, but caution is advised.
## Contraindications
* Known serious allergic reaction (e.g., anaphylaxis) to piperacillin, other penicillins, cephalosporins, or beta-lactamase inhibitors.
## Adverse Effects
* **Common:** Diarrhea, rash, nausea, vomiting, headache, insomnia, eosinophilia, increased AST/ALT.
* **Serious:** Hypersensitivity reactions (including anaphylaxis), Clostridioides difficile-associated diarrhea, seizures (particularly with high doses or renal impairment), interstitial nephritis, hematologic effects (neutropenia, thrombocytopenia), liver dysfunction.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin-tazobactam serum levels.
* **Neuromuscular blocking agents:** Piperacillin may prolong the action of vecuronium.
* **Warfarin:** May decrease the efficacy of warfarin; monitor INR closely.
* **Methotrexate:** May decrease methotrexate clearance, leading to toxicity.
## Monitoring
* Renal function (especially in patients with pre-existing renal disease or receiving concomitant nephrotoxic agents).
* Liver function tests.
* Complete blood count, particularly with prolonged therapy.
* Signs and symptoms of hypersensitivity reactions.
* Signs and symptoms of Clostridioides difficile infection.
## Clinical Pearls
* Piperacillin-tazobactam covers a wide range of gram-positive, gram-negative, and anaerobic bacteria, including many beta-lactamase producing strains.
* The duration of therapy should be guided by the clinical response, and generally should not exceed the recommended duration for specific indications.
* Dosing for specific patient populations (e.g., critically ill, obese) may require individualized adjustments.
* For febrile neutropenia, piperacillin-tazobactam is typically used in combination with an aminoglycoside.
* Reconstituted solutions are generally stable for 24 hours at room temperature or 48 hours under refrigeration.
***
*This information is intended for healthcare professionals and does not replace the need to consult the official prescribing information or local institutional protocols. Always verify current dosing, indications, and safety information before use.*
