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# Piperacillin-Tazobactam
## Overview
Piperacillin-tazobactam is a combination antibiotic consisting of piperacillin, a broad-spectrum penicillin antibiotic, and tazobactam, a beta-lactamase inhibitor. It is administered intravenously.
## 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 3 grams / tazobactam 0.375 grams) intravenously every 6 hours.
Alternative dose: 4.5 grams (piperacillin 4 grams / tazobactam 0.5 grams) intravenously every 6 or 8 hours.
Maximum dose: Generally not to exceed 18 grams per day (e.g., 4.5 grams every 6 hours).
Dosing frequency and duration depend on the severity and type of infection, as well as patient response.
## Pediatric Dosing
For children 0 to 12 years of age: Dosing is based on piperacillin weight-based dose.
* **Complicated intra-abdominal infections:** 100 mg piperacillin / 12.5 mg tazobactam per kg per dose administered intravenously every 6 hours.
* **Severe infections:** 200 mg piperacillin / 25 mg tazobactam per kg per dose administered intravenously every 6 hours.
* **Febrile neutropenia:** 100 mg piperacillin / 12.5 mg tazobactam per kg per dose administered intravenously every 6 hours.
Maximum dose in pediatrics: 4.5 grams per dose.
For children 12 years of age and older: Use adult dosing.
## Dose Adjustments
* **Renal Impairment:**
* CrCl ≥ 50 mL/min: No adjustment needed.
* CrCl 20-49 mL/min: 2.25 grams every 6 hours.
* CrCl < 20 mL/min: 2.25 grams every 8 hours.
* Hemodialysis: 2.25 grams every 8 hours, with an additional 0.75 gram dose after each hemodialysis session.
## Contraindications
* Known serious allergic reaction to penicillin or beta-lactamase inhibitors.
## Adverse Effects
Common: Diarrhea, rash, nausea, vomiting, headache, insomnia, constipation, abdominal pain, phlebitis/infusion site reactions.
Serious: *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures, hepatotoxicity, neutropenia, thrombocytopenia, interstitial nephritis.
## 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:** Piperacillin may decrease the effect of warfarin. Monitor INR closely.
* **Methotrexate:** Piperacillin may decrease methotrexate clearance. Monitor methotrexate levels.
## Monitoring
* Signs and symptoms of infection.
* Renal function (especially with dose adjustments).
* Liver function tests.
* Hematologic parameters (CBC with differential, platelets).
* Electrolytes.
* Signs of hypersensitivity reactions.
* Signs of *C. difficile* infection.
## Clinical Pearls
* Reconstitute and dilute according to manufacturer instructions.
* Administer as a slow intravenous infusion over at least 30 minutes.
* Consider the spectrum of activity and local resistance patterns when choosing antibiotic therapy.
* In patients with cystic fibrosis, higher doses of piperacillin may be necessary.
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**Disclaimer:** This information is intended for healthcare professionals. Please refer to the most current prescribing information and consult with other reliable resources for definitive guidance. Clinical decisions should be based on individual patient factors and local guidelines.
