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# Piperacillin-Tazobactam
## Overview
Piperacillin-tazobactam is a combination of a penicillin-class antibacterial agent and a beta-lactamase inhibitor. It is active against a broad spectrum of gram-positive and gram-negative bacteria, including many anaerobes.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin-structure infections
* Community-acquired pneumonia
* Nosocomial pneumonia
* Febrile neutropenia (empiric treatment)
## Adult Dosing
The usual adult dose is **3.375 grams** (piperacillin 3 grams / tazobactam 0.375 grams) intravenously every 6 hours or **4.5 grams** (piperacillin 4 grams / tazobactam 0.5 grams) intravenously every 6 or 8 hours.
The maximum daily dose is **18 grams** (piperacillin 16 grams / tazobactam 2 grams).
## Pediatric Dosing
Dosing varies by indication and patient weight. General guidelines:
* **Intra-abdominal infections:** 100 mg piperacillin / 12.5 mg tazobactam per kg per dose IV every 6 hours.
* **Community-acquired pneumonia:** 100 mg piperacillin / 12.5 mg tazobactam per kg per dose IV every 8 hours.
* **Febrile neutropenia:** 100 mg piperacillin / 12.5 mg tazobactam per kg per dose IV every 6 hours.
Maximum pediatric dose is generally **4.5 grams** per dose. Refer to specific institutional guidelines for detailed pediatric dosing.
## Dose Adjustments
* **Renal Impairment:**
* CrCl > 40 mL/min: No dose adjustment needed.
* CrCl 20-40 mL/min: Administer recommended dose every 8 hours.
* CrCl < 20 mL/min: Administer recommended dose every 12 hours.
* Hemodialysis: Administer recommended dose every 8 hours and an additional 1.125 grams (piperacillin 1 gram / tazobactam 0.125 grams) after each dialysis session.
## Contraindications
* Hypersensitivity to piperacillin, tazobactam, other penicillins, or beta-lactams.
* History of cholestatic jaundice or hepatic dysfunction associated with piperacillin-tazobactam.
## Adverse Effects
* Diarrhea
* Nausea
* Vomiting
* Rash
* Pruritus
* Elevated liver enzymes (AST, ALT)
* Headache
* Insomnia
* Hypersensitivity reactions (including anaphylaxis)
* Clostridioides difficile-associated diarrhea
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin-tazobactam serum concentrations.
* **Neuromuscular blocking agents:** May prolong neuromuscular blockade.
* **Warfarin:** May decrease the effect of warfarin; monitor INR closely.
* **Methotrexate:** May decrease methotrexate clearance; monitor methotrexate levels.
## Monitoring
* Renal function (CrCl) for dose adjustments.
* Liver function tests (LFTs).
* Signs and symptoms of hypersensitivity reactions.
* Signs and symptoms of C. difficile infection.
## Clinical Pearls
* Piperacillin-tazobactam is a common choice for empiric therapy for serious infections, especially in hospital-acquired settings.
* The choice of the 4.5 g dose and the 6-hour or 8-hour interval should be based on the severity of infection and local susceptibility patterns.
* Consider the risk of hypersensitivity reactions, especially in patients with a history of penicillin allergy.
* When reconstituting, use the appropriate diluent and ensure complete dissolution.
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*This information is intended for healthcare professionals. Please consult the official prescribing information and institutional guidelines for complete details.*
