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# Piperacillin-Tazobactam
## Overview
Piperacillin-tazobactam is a combination antibiotic consisting of an extended-spectrum penicillin (piperacillin) and a beta-lactamase inhibitor (tazobactam). It is active against a broad range of Gram-positive, Gram-negative, and anaerobic bacteria.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin-structure infections
* Community-acquired pneumonia
* Nosocomial pneumonia
## Adult Dosing
Standard dose: 3.375 g every 6 hours or 4.5 g every 6 or 8 hours intravenously.
Dosing frequency and duration depend on the indication, severity of infection, and pathogen susceptibility.
## Pediatric Dosing
* **3 months and older:**
* Complicated intra-abdominal infections: 100 mg piperacillin component/12.5 mg tazobactam component per kg per dose every 6 hours.
* Complicated skin and skin-structure infections: 75 mg piperacillin component/9.375 mg tazobactam component per kg per dose every 6 hours.
* **Maximum doses:** Do not exceed the adult maximum dose of 4.5 g per dose. Dosing should be adjusted for renal impairment.
## Dose Adjustments
* **Renal Impairment (CrCl < 20 mL/min):**
* 3.375 g every 8 hours.
* 4.5 g every 8 or 12 hours.
* **Hemodialysis:** Administer dose after dialysis and supplement with 1.125 g to 2.25 g, depending on the regimen.
## Contraindications
* Hypersensitivity to piperacillin, tazobactam, other penicillins, or beta-lactams.
## Adverse Effects
Common: Diarrhea, nausea, vomiting, rash, headache, insomnia, constipation, fever.
Serious: *Clostridioides difficile*-associated diarrhea, anaphylaxis, seizures (especially at higher doses or with renal impairment), Stevens-Johnson syndrome, toxic epidermal necrolysis, interstitial nephritis, hemolytic anemia.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin-tazobactam plasma concentrations.
* **Neuromuscular blocking agents:** May prolong neuromuscular blockade.
* **Warfarin:** May decrease INR.
* **Methotrexate:** May decrease methotrexate levels.
## Monitoring
* Renal function (especially with CrCl < 40 mL/min)
* Liver function
* Signs of hypersensitivity reactions
* Signs of *C. difficile*-associated diarrhea
* Prothrombin time/INR (if on warfarin)
## Clinical Pearls
* Tazobactam broadens the spectrum of piperacillin by inhibiting many beta-lactamases.
* Maximum dose of 4.5 g every 6 hours is often used for severe infections, especially in critical care settings.
* Reconstituted solution should be used within a specific timeframe (refer to manufacturer's instructions).
* Monitor for electrolyte abnormalities, especially hypernatremia, due to the sodium content of the formulation.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols for complete details.
