Please check your internet connection and try again.
# Piperacillin-Tazobactam
## Overview
Piperacillin-tazobactam is a combination antibiotic consisting of an extended-spectrum penicillin (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 (including diabetic foot infections)
* Community-acquired pneumonia
* Nosocomial pneumonia
* Febrile neutropenia (empiric treatment)
## Adult Dosing
Standard dose: 3.375 grams IV every 6 hours or 4.5 grams IV every 8 hours.
Dosing and frequency may vary based on indication and severity of infection. For severe infections or those caused by less susceptible organisms, higher doses or more frequent administration may be necessary, up to 4.5 grams IV every 6 hours.
## Pediatric Dosing
Dosing is typically based on piperacillin component.
* **Patients 2 months and older:**
* 3.375 grams IV every 6 hours
* 4.5 grams IV every 6 hours (for severe infections)
* Or 90-100 mg piperacillin/12.5 mg tazobactam per kg per dose IV every 6 hours, up to 4.5 grams per dose.
Dosing may need adjustment for renal impairment.
## Dose Adjustments
* **Renal Impairment (CrCl > 20 mL/min):** Administer usual dose every 8 hours.
* **Renal Impairment (CrCl ≤ 20 mL/min):** Administer usual dose every 12 hours.
* **Hemodialysis:** Administer usual dose every 8 hours. Administer an additional 2.25 g dose after each dialysis session.
* **Peritoneal Dialysis:** Administer usual dose every 8 hours. Monitor for potential neurotoxicity.
Dose adjustments for hepatic impairment are not typically required.
## Contraindications
* Known serious allergy to piperacillin, tazobactam, or other beta-lactam antibiotics (e.g., penicillins, cephalosporins, carbapenems).
* History of cholestatic jaundice or hepatic dysfunction associated with piperacillin-tazobactam.
## Adverse Effects
Common: Diarrhea, nausea, vomiting, rash, headache, injection site reactions, elevated liver enzymes.
Serious: *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures (especially with high doses or renal impairment), neutropenia, thrombocytopenia, interstitial nephritis.
## Key Drug Interactions
* **Probenecid:** May increase and prolong serum concentrations of piperacillin-tazobactam.
* **Neuromuscular blocking agents:** Piperacillin may prolong the action of vecuronium.
* **Warfarin:** May decrease the effect of warfarin; monitor INR closely.
* **Methotrexate:** Piperacillin may decrease methotrexate clearance; monitor methotrexate levels.
* **Bacteriostatic agents:** May antagonize the bactericidal effect of piperacillin-tazobactam.
## Monitoring
* Renal function (BUN, Cr)
* Liver function (AST, ALT, bilirubin)
* Complete blood count (CBC) with differential
* Signs and symptoms of infection
* Signs and symptoms of hypersensitivity reactions
* Electrolytes
## Clinical Pearls
* Reconstituted solutions should be used within 24 hours if refrigerated or within 12 hours at room temperature.
* Administer IV infusions over at least 30 minutes to reduce the risk of hypersensitivity reactions.
* Tazobactam broadens the spectrum of activity by inhibiting many beta-lactamases, making piperacillin effective against beta-lactamase producing organisms.
* Discontinue if a hypersensitivity reaction occurs.
***
*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional guidelines for complete details.*
