Please check your internet connection and try again.
# Piperacillin/Tazobactam
## Overview
Piperacillin is a broad-spectrum 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
* Moderate to severe bacterial infections, including those caused by susceptible aerobic and anaerobic Gram-positive and Gram-negative bacteria.
## Adult Dosing
Standard dose is 3.375 grams every 6 hours or 4.5 grams every 8 hours.
* **3.375 g (3 g piperacillin/0.375 g tazobactam) IV every 6 hours**
* **4.5 g (4 g piperacillin/0.5 g tazobactam) IV every 6 or 8 hours**
The frequency and duration depend on the severity of illness and the pathogen(s) involved. Local antibiograms and institutional protocols should guide therapy.
## Pediatric Dosing
Dosing varies by indication and age/weight. For complicated intra-abdominal infections in pediatric patients 2 months and older:
* **300 mg piperacillin / 3.75 mg tazobactam per kg/day IV divided every 6 hours.**
* Maximum dose: 100 mg piperacillin / 1.25 mg tazobactam per kg per dose, not to exceed the adult dose of 4.5 g per dose.
## Dose Adjustments
* **Renal Impairment:**
* CrCl ≥ 40 mL/min: No dose adjustment.
* CrCl 20-39 mL/min: 2.25 g (2 g piperacillin/0.25 g tazobactam) every 6 hours or 3.375 g (3 g piperacillin/0.375 g tazobactam) every 8 hours.
* CrCl < 20 mL/min: 2.25 g (2 g piperacillin/0.25 g tazobactam) every 8 hours.
* Consider intermittent hemodialysis: Administer dose after dialysis.
* **Hepatic Impairment:** No specific dose adjustments are recommended, but caution is advised.
## Contraindications
* Hypersensitivity to piperacillin, tazobactam, other penicillin derivatives, or any component of the formulation.
* 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, fever, elevated liver enzymes.
Serious: hypersensitivity reactions (including anaphylaxis), C. difficile-associated diarrhea, seizures, neutropenia, thrombocytopenia.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam plasma concentrations.
* **Neuromuscular blocking agents:** May prolong the neuromuscular blockade.
* **Methotrexate:** Piperacillin may reduce methotrexate levels. Monitor methotrexate levels.
* **Warfarin:** May alter the anticoagulant response. Monitor INR closely.
* **Aminoglycosides:** Concurrent use may lead to inactivation of piperacillin in vitro. If used together, administer separately.
## Monitoring
* Renal function (especially in patients with known renal impairment or those receiving nephrotoxic agents).
* Liver function tests.
* Hematologic parameters (e.g., CBC with differential, platelet count) with prolonged therapy.
* Signs and symptoms of C. difficile infection.
* Signs and symptoms of hypersensitivity reactions.
## Clinical Pearls
* Piperacillin/tazobactam is active against *Pseudomonas aeruginosa*.
* Reconstituted solutions are stable for 24 hours at room temperature or 48 hours refrigerated. Further dilution in infusion fluid yields a solution stable for 24 hours at room temperature or 7 days refrigerated.
* The risk of seizure activity may be increased in patients with renal impairment, particularly those receiving higher doses.
***
*Disclaimer: This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making treatment decisions.*
