Please check your internet connection and try again.
# Piperacillin-Tazobactam
## Overview
Piperacillin-tazobactam is a combination antibiotic consisting of a broad-spectrum penicillin antibiotic (piperacillin) and a beta-lactamase inhibitor (tazobactam). It is active against many 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
* Nosocomial pneumonia
* Febrile neutropenia (in combination with an aminoglycoside)
* Bacterial meningitis (less commonly used due to availability of other agents with better CNS penetration)
## Adult Dosing
The usual dose is 3.375 grams (3g piperacillin/0.375g tazobactam) or 4.5 grams (4g piperacillin/0.5g tazobactam) administered intravenously every 6 or 8 hours.
* **Complicated intra-abdominal infections, complicated skin and skin-structure infections, community-acquired pneumonia, nosocomial pneumonia:** Typically 3.375 grams IV every 6 hours or 4.5 grams IV every 8 hours.
* **Febrile neutropenia:** Typically 4.5 grams IV every 6 hours (often in combination with an aminoglycoside, dose determined by pathogen and site of infection).
* **Duration of therapy:** Varies based on indication, severity of illness, and clinical response. Generally 7-14 days for complicated infections. For febrile neutropenia, therapy may be de-escalated or discontinued once neutropenia resolves and the patient is afebrile for 48 hours.
## Pediatric Dosing
Dosing is based on the piperacillin component and the patient's age and weight.
* **Patients ≥ 12 years old:** 3.375 grams or 4.5 grams IV every 6 or 8 hours.
* **Patients 2 months to 12 years old:** Dosing varies. Common regimens include 100 mg piperacillin/12.5 mg tazobactam per kg per dose IV every 8 hours, or 75 mg piperacillin/9.375 mg tazobactam per kg per dose IV every 6 hours. Maximum dose for pediatric patients should not exceed the adult dose.
* **Neonates and infants < 2 months:** Data is limited, and dosing should be guided by institutional protocols or specialized literature.
## Dose Adjustments
* **Renal Impairment:**
* CrCl > 40 mL/min: No dose adjustment needed.
* CrCl 20-40 mL/min: 2.25 grams (2g piperacillin/0.25g tazobactam) IV every 6 hours or 3.375 grams (3g piperacillin/0.375g tazobactam) IV every 8 hours.
* CrCl < 20 mL/min: 2.25 grams IV every 8 hours.
* For patients on intermittent hemodialysis, administer a dose after each dialysis session.
* **Hepatic Impairment:** No specific dose adjustments are typically recommended, but caution is advised.
## Contraindications
* Known history of hypersensitivity to piperacillin, tazobactam, other penicillins, or beta-lactam antibiotics.
* History of cholestatic jaundice or hepatic dysfunction associated with piperacillin-tazobactam.
## Adverse Effects
Common: Diarrhea, nausea, vomiting, rash, headache, insomnia, fever, phlebitis.
Serious: *Clostridioides difficile*-associated diarrhea, hypersensitivity reactions (including anaphylaxis), seizures (especially with high doses or renal impairment), neutropenia, thrombocytopenia, eosinophilia, elevated liver enzymes, acute kidney injury.
## Key Drug Interactions
* **Aminoglycosides:** Potential for synergistic activity but also increased risk of nephrotoxicity and ototoxicity. Monitor levels and renal function.
* **Probenecid:** May increase and prolong serum concentrations of piperacillin and tazobactam.
* **Neuromuscular blocking agents:** Penicillins may potentiate neuromuscular blockade.
* **Warfarin:** May decrease the efficacy of warfarin. Monitor INR closely.
* **Methotrexate:** Penicillins may decrease the renal excretion of methotrexate. Monitor methotrexate levels.
## Monitoring
* Renal function (BUN, creatinine)
* Liver function tests (AST, ALT, bilirubin)
* Complete blood count (CBC) including platelets, especially with prolonged therapy.
* Signs and symptoms of hypersensitivity reactions.
* Signs and symptoms of *Clostridioides difficile*-associated diarrhea.
## Clinical Pearls
* Piperacillin-tazobactam is a broad-spectrum agent often used for empiric treatment of severe infections, particularly in hospitalized patients.
* The ratio of piperacillin to tazobactam is critical for efficacy.
* Ensure adequate hydration and monitor for signs of fluid overload, especially in patients with heart failure or renal impairment.
* Dosing and duration of therapy should be guided by clinical response, pathogen susceptibility, and site of infection.
* For patients with CrCl < 20 mL/min, consider a change in dosing interval to every 8 hours.
***
*This information is intended for clinical pharmacists and should not be used as a substitute for professional medical advice. Always verify current prescribing information with the official drug labeling and institutional protocols.*
