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# Piperacillin-Tazobactam
## Overview
Piperacillin-tazobactam is a combination of an extended-spectrum penicillin antibiotic (piperacillin) and a beta-lactamase inhibitor (tazobactam). It has broad-spectrum 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
* Nosocomial pneumonia
* Empirical treatment for febrile neutropenia
## Adult Dosing
Standard dose is 3.375 grams every 6 hours or 4.5 grams every 8 hours IV. Dosing frequency and duration depend on the indication and severity of infection. Higher doses may be used for severe infections or specific pathogens.
## Pediatric Dosing
For patients 2 months of age and older:
* **Complicated Intra-abdominal Infections:** 100 mg piperacillin/12.5 mg tazobactam per kg per dose IV every 8 hours.
* **Nosocomial Pneumonia:** 100 mg piperacillin/12.5 mg tazobactam per kg per dose IV every 6 hours.
* **Complicated Skin and Skin-Structure Infections:** 75 mg piperacillin/9.375 mg tazobactam per kg per dose IV every 8 hours.
Maximum dose is typically 4.5 grams every 6 hours for adults. Pediatric dosing is capped at adult maximums.
## Dose Adjustments
* **Renal Impairment (CrCl < 20 mL/min):** Reduce dose by 33% and extend interval to every 8 hours (for standard 3.375g dose) or use 2.25g every 8 hours (for standard 4.5g dose).
* **Hemodialysis:** Dose every 8 hours with an additional dose of 0.75g after each dialysis session.
* **Hepatic Impairment:** No dose adjustment recommended.
## Contraindications
* Known serious hypersensitivity to piperacillin, tazobactam, other penicillins, or beta-lactam antibiotics.
## Adverse Effects
* Diarrhea, nausea, vomiting, rash, headache, insomnia, pruritus, elevated liver enzymes.
* Serious reactions include hypersensitivity reactions (anaphylaxis), Clostridioides difficile-associated diarrhea, seizures (rare, especially with high doses or renal impairment), and interstitial nephritis.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin-tazobactam serum concentrations.
* **Neuromuscular Blocking Agents:** May prolong neuromuscular blockade.
* **Warfarin:** May decrease the effect of warfarin; increased INR monitoring may be required.
* **Methotrexate:** May decrease methotrexate clearance; monitor methotrexate levels.
## Monitoring
* Renal function (creatinine, BUN)
* Liver function tests
* Signs and symptoms of infection resolution
* Electrolytes
* Signs of hypersensitivity reactions
* INR if patient is on warfarin
## Clinical Pearls
* Dosing should be guided by local antibiograms and infection-specific guidelines.
* Duration of therapy varies (e.g., typically 7 days for complicated intra-abdominal infections).
* Reconstituted solutions are stable for limited periods at room temperature or refrigerated; consult manufacturer's instructions.
* Monitor for signs of C. difficile-associated diarrhea.
* Consider dose reduction in patients with severe renal impairment.
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*This information is for educational purposes only and does not substitute for professional medical advice. Always consult the current prescribing information and a qualified healthcare provider for diagnosis and treatment decisions.*
