Tazobactum%2525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520piperacillin

# Piperacillin/Tazobactam ## Overview Piperacillin/tazobactam is a combination of a penicillin-class antibacterial agent and a beta-lactamase inhibitor. ## Primary Indications * Complicated intra-abdominal infections * Complicated skin and skin structure infections (including diabetic foot infections) * Community-acquired pneumonia * Nosocomial pneumonia * Nosocomial infections (e.g., hospital-acquired pneumonia, ventilator-associated pneumonia) * Febrile neutropenia (in combination with an aminoglycoside or other appropriate antimicrobial) * Gynecologic infections ## Adult Dosing * **Standard Dose:** 3.375 g (3 g piperacillin / 0.375 g tazobactam) IV every 6 hours. * **Higher Dose (for severe infections or nosocomial pneumonia):** 4.5 g (4 g piperacillin / 0.5 g tazobactam) IV every 6 or 8 hours. * **Maximum Dose:** Generally, do not exceed 18 g per day (e.g., 4.5 g every 4 hours), though this depends on the specific indication and renal function. ## Pediatric Dosing Dosing varies significantly by age, weight, and indication. **Consult institutional guidelines or product monograph for specific pediatric dosing.** * **Intra-abdominal Infections:** * 3 months to < 2 years: 90 mg piperacillin / 11.25 mg tazobactam per kg per dose IV every 8 hours. * ≥ 2 years: 2.5 g (2 g piperacillin / 0.25 g tazobactam) per 100 kg IV every 6 hours. * **Febrile Neutropenia:** Often dosed at 100 mg piperacillin / 12.5 mg tazobactam per kg per dose IV every 8 hours, usually in combination with an aminoglycoside. * **Maximum dose in pediatrics:** Generally 4.5 g per dose. ## Dose Adjustments * **Renal Impairment:** Dose reduction and/or interval extension is required. * CrCl 20-80 mL/min: Administer standard dose every 8 hours. * CrCl < 20 mL/min: Administer standard dose every 12 hours. * Hemodialysis: Administer standard dose every 12 hours, and give an additional dose after each dialysis session. * **Hepatic Impairment:** No specific dose adjustment is usually required, but caution is advised. ## Contraindications * Known severe hypersensitivity to piperacillin, tazobactam, other beta-lactam antibacterials, or any component of the formulation. ## Adverse Effects * **Common:** Diarrhea, nausea, vomiting, rash, headache, insomnia, constipation, abdominal pain, dyspepsia. * **Serious:** *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures (especially with high doses or renal impairment), hematologic effects (e.g., neutropenia, thrombocytopenia), hepatotoxicity, interstitial nephritis. ## Key Drug Interactions * **Probenecid:** May increase and prolong piperacillin/tazobactam serum concentrations. * **Neuromuscular blocking agents (e.g., vecuronium):** Piperacillin may prolong the neuromuscular blockade. * **Methotrexate:** Piperacillin may decrease methotrexate levels. * **Warfarin:** May decrease warfarin levels, potentially reducing INR. Monitor INR closely. * **Aminoglycosides:** While often used in combination, their co-administration requires careful consideration of potential for antagonism (especially *in vitro* against certain organisms) and additive nephrotoxicity/ototoxicity. ## Monitoring * Renal function (CrCl) for dose adjustments. * Signs and symptoms of hypersensitivity reactions. * Signs and symptoms of *Clostridioides difficile*-associated diarrhea. * Complete blood counts (CBC) periodically, especially with prolonged therapy. * Liver function tests (LFTs) periodically. * Prothrombin time/INR if co-administered with warfarin. * Signs of infection and response to therapy. ## Clinical Pearls * Piperacillin/tazobactam provides broad-spectrum activity, including coverage against *Pseudomonas aeruginosa* and many Gram-positive and anaerobic organisms. * Always reconstitute and dilute according to manufacturer instructions. * Infusion time is typically 30 minutes. Do not administer as an IV bolus. * Use with caution in patients with a history of penicillin allergy, though cross-reactivity with other beta-lactams may occur. * Tazobactam inhibits many beta-lactamases but is not effective against all extended-spectrum beta-lactamases (ESBLs) or carbapenemases. *** **Disclaimer:** This information is for educational purposes only and does not substitute for professional medical advice. Always consult the most current prescribing information and institutional protocols before making clinical decisions.