Please check your internet connection and try again.
# Piperacillin-Tazobactam
## Overview
Piperacillin-tazobactam is an extended-spectrum penicillin antibiotic combined with a beta-lactamase inhibitor. It is bactericidal and effective against a wide range of Gram-positive, Gram-negative, and anaerobic bacteria.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin structure infections (including diabetic foot infections)
* Community-acquired pneumonia
* Hospital-acquired pneumonia (including ventilator-associated pneumonia)
* Nosocomial infections caused by piperacillin-resistant, beta-lactamase producing Gram-negative organisms (in combination with an aminoglycoside for suspected Pseudomonas infections)
## Adult Dosing
* **Standard dose:** 3.375 grams (3g piperacillin/0.375g tazobactam) every 6 hours intravenously (IV).
* **Higher dose for severe infections orPseudomonas:** 4.5 grams (4g piperacillin/0.5g tazobactam) every 6 or 8 hours IV.
* **Maximum dose:** Generally not to exceed 18 grams per day (e.g., 4.5g every 4 hours is not typical due to tazobactam stability). Specific maximums may vary based on indication and institutional guidelines.
## Pediatric Dosing
Dosing in pediatric patients depends on age, weight, and severity of infection. Recommendations vary:
* **Infants and children < 2 months:** Not well studied; use with caution and consider consultation.
* **Children ≥ 2 months:**
* **Complicated intra-abdominal infections:** 100 mg piperacillin/12.5 mg tazobactam per kg per dose every 8 hours IV.
* **Hospital-acquired pneumonia:** 100 mg piperacillin/12.5 mg tazobactam per kg per dose every 8 hours IV.
* **Higher doses (up to 300 mg piperacillin/3.75 mg tazobactam/kg/day) may be used for severe infections or specific pathogens like *Pseudomonas aeruginosa*, administered every 6 or 8 hours.**
* **Maximum dose:** Generally limited by maximum adult doses and specific patient weight considerations. Consult pediatric infectious disease or pharmacy for specific guidance.
## Dose Adjustments
* **Renal Impairment (CrCl < 20 mL/min):** Reduce dose frequency. Consult prescribing information or pharmacy for specific recommendations (e.g., 2.25g every 8 hours or 3.375g every 12 hours for standard dose).
* **Hemodialysis:** Administer dose after dialysis and supplement with an additional dose.
* **Hepatic Impairment:** No specific dose adjustment is usually recommended, but monitor liver function tests.
## Contraindications
* Hypersensitivity to piperacillin, tazobactam, other penicillin antibiotics, or any component of the formulation.
* History of immediate or severe allergic reaction to beta-lactams.
## Adverse Effects
* **Common:** Diarrhea, rash, nausea, vomiting, constipation, headache, insomnia, phlebitis/thrombophlebitis at the infusion site, elevated liver enzymes (AST, ALT).
* **Serious:** *Clostridioides difficile*-associated diarrhea (CDAD), hypersensitivity reactions (anaphylaxis), seizures (especially with high doses or renal impairment), neutropenia, thrombocytopenia, interstitial nephritis, hepatotoxicity.
## Key Drug Interactions
* **Aminoglycosides:** Potential for synergistic or additive antibacterial activity, but also increased risk of nephrotoxicity.
* **Probenecid:** May increase and prolong serum concentrations of piperacillin.
* **Neuromuscular Blocking Agents:** Piperacillin may prolong the action of vecuronium.
* **Warfarin:** May decrease the effect of warfarin. Monitor INR closely.
* **Live Vaccines:** Live vaccines may be less effective if administered during or shortly after piperacillin-tazobactam therapy.
## Monitoring
* Renal function (BUN, creatinine)
* Liver function tests (AST, ALT)
* Complete blood count (CBC) with differential and platelets
* Signs and symptoms of infection
* Signs and symptoms of hypersensitivity reactions
* Stool for *C. difficile* if diarrhea develops
## Clinical Pearls
* Administer IV infusions over at least 30 minutes to minimize infusion-related reactions and ensure stability.
* Not effective against MRSA or ESBL-producing *Klebsiella pneumoniae* and *E. coli* unless susceptibility is confirmed.
* Tazobactam extends the spectrum of piperacillin to include many beta-lactamase-producing bacteria.
* Reconstituted solution stability is limited; follow manufacturer's instructions.
***
*This information is intended for clinical pharmacy professionals and should not replace a thorough review of the current prescribing information and institutional protocols.*
