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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.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin structure infections
* Community-acquired pneumonia
* Nosocomial pneumonia
* Bacterial infections including those caused by piperacillin-resistant *Pseudomonas aeruginosa*.
## Adult Dosing
Common dosages are 3.375 grams or 4.5 grams every 6 or 8 hours intravenously. Specific dosing frequency and duration depend on the type and severity of infection. Maximum daily dose is generally 18 grams.
## Pediatric Dosing
Dosing in pediatric patients varies by age and weight. For patients 2 months and older, recommended doses are typically based on piperacillin component:
* **2 months to < 4 months:** 90 mg piperacillin/12.5 mg tazobactam per kg administered every 8 hours intravenously.
* **4 months and older:** 90 mg piperacillin/12.5 mg tazobactam per kg administered every 6 hours intravenously, or 120 mg piperacillin/15 mg tazobactam per kg administered every 8 hours intravenously.
* **Maximum dose:** Generally capped based on adult maximums. Renal and hepatic adjustments should be considered.
## Dose Adjustments
* **Renal Impairment:** Dosing requires adjustment based on calculated creatinine clearance (CrCl). For CrCl < 20 mL/min, doses are typically reduced by 25% to 50% and administered less frequently. For CrCl 20-50 mL/min, doses are typically reduced by 25%.
* **Hepatic Impairment:** No specific dose adjustment is recommended, but caution is advised due to potential for accumulation.
## Contraindications
* History of hypersensitivity to piperacillin, tazobactam, other penicillin antibiotics, or beta-lactamases.
## Adverse Effects
Common adverse effects include diarrhea, nausea, vomiting, rash, headache, insomnia, and elevated liver enzymes. Serious adverse effects can include *Clostridioides difficile*-associated diarrhea, anaphylaxis, seizures, and hematologic abnormalities.
## Key Drug Interactions
* **Probenecid:** May increase piperacillin-tazobactam serum concentrations.
* **Neuromuscular blocking agents:** Piperacillin may prolong the neuromuscular blockade.
* **Warfarin:** May decrease INR. Monitor INR closely.
* **Methotrexate:** May decrease methotrexate clearance. Monitor methotrexate levels.
## Monitoring
* Renal function (CrCl)
* Liver function tests
* Signs and symptoms of infection
* Electrolytes
* Hematologic parameters (e.g., platelet count, PT/INR if on warfarin)
* Signs of *Clostridioides difficile*-associated diarrhea
## Clinical Pearls
* Piperacillin-tazobactam is a potent antibiotic with broad-spectrum activity, including against *Pseudomonas aeruginosa*.
* Ensure adequate hydration during infusion to minimize risk of neurotoxicity.
* Interrupt administration and institute appropriate therapy if allergic reactions or *C. difficile* diarrhea occurs.
* Reconstituted solutions should be used within a specific timeframe, often 24 hours when refrigerated, but consult manufacturer labeling.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before making clinical decisions.*
