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# Piperacillin/Tazobactam
## Overview
Piperacillin is a broad-spectrum penicillinase-resistant penicillin antibiotic. Tazobactam is a beta-lactamase inhibitor that protects piperacillin from degradation by many bacterial beta-lactamases, thereby extending its spectrum of activity.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin-structure infections
* Community-acquired pneumonia
* Nosocomial pneumonia
* Bacterial infections in febrile neutropenic patients
## Adult Dosing
* **Standard Dose:** 3.375 grams (3 grams piperacillin/0.375 grams tazobactam) every 6 hours or 4.5 grams (4 grams piperacillin/0.5 grams tazobactam) every 8 hours.
* **Severe Infections/Nosocomial Pneumonia:** 4.5 grams (4 grams piperacillin/0.5 grams tazobactam) every 6 or 8 hours. Dosing frequency and duration depend on the severity of infection and clinical response.
* **Febrile Neutropenia:** 4.5 grams (4 grams piperacillin/0.5 grams tazobactam) every 6 or 8 hours.
## Pediatric Dosing
* **Intra-abdominal Infections (3 months to 12 years):** 90 mg piperacillin/11.25 mg tazobactam per kg of body weight every 8 hours.
* **Nosocomial Pneumonia (3 months to 12 years):** 90 mg piperacillin/11.25 mg tazobactam per kg of body weight every 8 hours.
* **Febrile Neutropenia (3 months to 12 years):** 90 mg piperacillin/11.25 mg tazobactam per kg of body weight every 8 hours.
* **Maximum Dose:** Generally does not exceed the adult dose of 4.5 grams every 8 hours.
* **Note:** For children older than 12 years, use the adult dose.
## Dose Adjustments
* **Renal Impairment:**
* CrCl > 40 mL/min: No adjustment needed.
* CrCl 20-40 mL/min: Administer the usual dose every 8 hours.
* CrCl < 20 mL/min: Administer the usual dose every 12 hours.
* For intermittent hemodialysis: Administer the usual dose every 12 hours. An additional dose should be given after each dialysis session.
## Contraindications
* Hypersensitivity to piperacillin, tazobactam, other penicillins, or beta-lactams.
* History of a severe allergic reaction (e.g., anaphylaxis) to a beta-lactam antibiotic.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, headache, insomnia, constipation, abdominal pain.
* **Serious:** Clostridioides difficile-associated diarrhea, anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, seizures, neutropenia, thrombocytopenia, hepatic dysfunction.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin plasma concentrations.
* **Aminoglycosides:** Concurrent use may be synergistic but also associated with increased nephrotoxicity.
* **Vecuronium:** Piperacillin may prolong the neuromuscular blockade of vecuronium.
* **Warfarin:** May decrease the effect of warfarin.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs and symptoms of C. difficile-associated diarrhea.
* Renal function, liver function tests, and complete blood count may be warranted, especially with prolonged therapy or in patients with renal impairment.
## Clinical Pearls
* Piperacillin/tazobactam has a broad spectrum of activity, including many gram-positive, gram-negative (including Pseudomonas aeruginosa), and anaerobic bacteria.
* It is often used as empiric therapy for serious infections, particularly in hospitalized patients.
* The reconstituted solution is typically administered as an intravenous infusion over 30 minutes.
* Dosing in critically ill patients or those with significant fluid shifts may require individualized adjustment based on pharmacokinetic principles.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information or product literature for complete details and to verify information before administration. Local protocols may dictate specific dosing strategies.*
