Tazobactum%25252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520piperacillin

# Piperacillin/Tazobactam ## Overview Piperacillin/tazobactam is a combination antibiotic consisting of piperacillin, a broad-spectrum penicillin antibiotic, and tazobactam, a beta-lactamase inhibitor. Tazobactam protects piperacillin from degradation by many bacterial beta-lactamases, thereby extending its spectrum of activity against beta-lactamase-producing bacteria. ## Primary Indications * Complicated intra-abdominal infections * Complicated skin and skin structure infections * Community-acquired pneumonia * Hospital-acquired pneumonia * Febrile neutropenia (empiric treatment) ## Adult Dosing Standard doses are typically given every 6 or 8 hours. The tazobactam component is always 1/8th the dose of piperacillin. * **Complicated Intra-abdominal Infections, Complicated Skin and Skin Structure Infections, Community-Acquired Pneumonia, Hospital-Acquired Pneumonia:** * 3.375 grams every 6 hours (piperacillin 3 g / tazobactam 0.375 g) intravenously. * 4.5 grams every 6 or 8 hours (piperacillin 4 g / tazobactam 0.5 g) intravenously. The 8-hour interval is typically used for less severe infections or as de-escalation. * **Febrile Neutropenia (Empiric):** * 4.5 grams every 6 or 8 hours (piperacillin 4 g / tazobactam 0.5 g) intravenously. Duration of therapy varies based on indication and clinical response, generally 7-14 days. ## Pediatric Dosing Dosing is based on piperacillin component. * **Children 2 months and older:** * **Complicated Intra-abdominal Infections:** 100 mg piperacillin component/kg/dose IV every 8 hours, not to exceed 4 g/dose. Total daily dose not to exceed 400 mg piperacillin component/kg/day, up to 16 g/day. * **Complicated Skin and Skin Structure Infections:** 75 mg piperacillin component/kg/dose IV every 8 hours, not to exceed 4 g/dose. Total daily dose not to exceed 300 mg piperacillin component/kg/day, up to 12 g/day. * **Febrile Neutropenia (Empiric):** 100 mg piperacillin component/kg/dose IV every 8 hours, not to exceed 4 g/dose. Total daily dose not to exceed 400 mg piperacillin component/kg/day, up to 16 g/day. ## Dose Adjustments * **Renal Impairment (CrCl < 20 mL/min):** Reduce dose frequency. For the 4.5 g dose given every 6 hours, administer every 8-12 hours. For the 3.375 g dose given every 6 hours, administer every 8-12 hours. May require further adjustments based on specific protocol. * **Hemodialysis:** Patients on hemodialysis should receive a supplemental dose of piperacillin/tazobactam (e.g., 2.25 g or 4.5 g depending on dose regimen) after each dialysis session. ## Contraindications * Documented hypersensitivity to piperacillin, tazobactam, other penicillin antibiotics, or any component of the formulation. ## Adverse Effects * Diarrhea (most common) * Rash, pruritus * Nausea, vomiting * Headache * Insomnia * Superinfection (e.g., *Clostridioides difficile*-associated diarrhea) * Hypersensitivity reactions (including anaphylaxis) * Seizures (more common with rapid infusion or renal impairment) * Hematologic effects (e.g., eosinophilia, neutropenia, thrombocytopenia) * Hepatotoxicity ## Key Drug Interactions * **Probenecid:** Increases piperacillin/tazobactam serum concentrations. * **Vecuronium:** Piperacillin may prolong the neuromuscular blockade of vecuronium. * **Warfarin:** May decrease the effect of warfarin. Monitor INR closely. * **Methotrexate:** Piperacillin may decrease methotrexate clearance. Monitor methotrexate levels. * **Bacteriostatic antibiotics:** May antagonize the action of beta-lactam antibiotics. ## Monitoring * Signs and symptoms of infection (fever, WBC count, inflammatory markers) * Renal function (serum creatinine, BUN) * Liver function tests (AST, ALT, bilirubin) * Hematologic parameters (CBC, platelet count) * Signs of hypersensitivity reactions * Signs of *Clostridioides difficile*-associated diarrhea ## Clinical Pearls * Administer intravenously over at least 30 minutes. Rapid infusion may increase risk of seizures. * Reconstituted solutions are generally stable for 24 hours at room temperature or 48 hours if refrigerated. Discard after the longest recommended stability period. * Ensure adequate hydration and monitor renal function, especially in elderly patients or those with pre-existing renal disease, due to potential for high peak concentrations leading to seizures. * When reconstituting, follow specific instructions for the product used, as different concentrations may be available. * Empirical therapy for febrile neutropenia should generally be initiated as soon as possible. *** **Disclaimer:** This information is intended for clinical pharmacists and healthcare professionals. It is essential to consult the most current prescribing information and institutional guidelines for definitive patient care decisions. Dosing may vary based on local protocols and specific patient factors.