Please check your internet connection and try again.
# Piperacillin/Tazobactam
## Overview
Piperacillin/tazobactam is a combination penicillin-class antibacterial and a beta-lactamase inhibitor. It is active against a broad spectrum of Gram-positive and Gram-negative bacteria, including many Gram-negative aerobes, anaerobes, and Gram-positive aerobes.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin-structure infections
* Community-acquired pneumonia
* Nosocomial pneumonia
## Adult Dosing
The typical adult dose is **3.375 g every 6 hours** or **4.5 g every 8 hours** for 30 minutes as an intravenous infusion. The ratio of piperacillin to tazobactam is 8:1. The maximum daily dose of tazobactam should not exceed 4 g.
## Pediatric Dosing
Dosing varies by indication and patient weight.
* For complicated intra-abdominal infections in patients 2 months and older: **100 mg piperacillin/12.5 mg tazobactam per kg body weight every 8 hours** as a 30-minute infusion. Maximum dose is 3.375 g per dose.
* For other infections, refer to specific institutional guidelines or package insert as dosing can be complex.
## Dose Adjustments
* **Renal Impairment:** Dose reduction is required in patients with creatinine clearance less than 40 mL/min.
* CrCl 20-40 mL/min: Administer usual dose every 8 hours.
* CrCl < 20 mL/min: Administer usual dose every 12 hours.
* Hemodialysis: Administer usual dose every 12 hours and supplement with an additional 1.125 g dose after each dialysis.
* **Hepatic Impairment:** No dose adjustment is typically necessary.
## Contraindications
* Known severe hypersensitivity to piperacillin, tazobactam, other penicillins, or beta-lactamase inhibitors.
* History of allergy to cephalosporins or carbapenems may indicate cross-reactivity.
## Adverse Effects
Common adverse effects include diarrhea, nausea, vomiting, rash, headache, insomnia, and pruritus. Serious adverse effects may include hypersensitivity reactions (including anaphylaxis), Clostridioides difficile-associated diarrhea, seizures, and hematologic abnormalities.
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam serum concentrations.
* **Vecuronium:** May prolong the neuromuscular blockade of vecuronium.
* **Warfarin:** Piperacillin may decrease INR; monitor INR closely.
* **Methotrexate:** Piperacillin may decrease methotrexate levels; monitor methotrexate levels.
## Monitoring
* Renal function (creatinine, BUN)
* Liver function tests
* Complete blood count (CBC) with differential
* Signs and symptoms of infection
* Signs of hypersensitivity reactions
* INR if patient is on warfarin
* Methotrexate levels if co-administered
## Clinical Pearls
* The combination is often reserved for more serious infections due to its broad spectrum and potential for resistance development.
* Ensure adequate hydration and monitor for signs of electrolyte imbalance, especially with prolonged infusions or in patients with compromised renal function.
* Tazobactam is a beta-lactamase inhibitor and does not have antibacterial activity on its own; it protects piperacillin from degradation by many beta-lactamases.
* Dosing adjustments for renal impairment are crucial to avoid toxicity.
---
***Disclaimer:** This information is intended for healthcare professionals. Always consult the current official prescribing information and local institutional protocols for the most up-to-date and comprehensive guidance before making any clinical decisions.*
