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# Tazobactam/Piperacillin
## Overview
Tazobactam/piperacillin is a combination of a beta-lactamase inhibitor (tazobactam) and an extended-spectrum penicillin antibiotic (piperacillin). It is bactericidal and active against a broad spectrum of gram-positive and gram-negative bacteria, including anaerobes.
## Primary Indications
* Complicated intra-abdominal infections
* Complicated skin and skin-structure infections
* Community-acquired pneumonia
* Nosocomial pneumonia
## Adult Dosing
The typical dose is 3.375 g (3 g piperacillin/0.375 g tazobactam) or 4.5 g (4 g piperacillin/0.5 g tazobactam) intravenously (IV) every 6 or 8 hours. Duration of treatment is typically 7 to 14 days.
## Pediatric Dosing
Dosing varies by indication and age/weight.
* **For intra-abdominal infections:**
* Children 2 months to <12 years weighing <40 kg: 90 mg piperacillin component/11.25 mg tazobactam component per kg per dose IV every 8 hours.
* Children 2 months to <12 years weighing ≥40 kg: 3.375 g IV every 6 hours.
* Children ≥12 years: Same as adult dosing.
* **For other indications:** Consult specific pediatric guidelines or product information as dosing is less standardized.
## Dose Adjustments
* **Renal Impairment:**
* CrCl >40 mL/min: No dose adjustment needed.
* CrCl 20-40 mL/min: 2.25 g IV every 6 hours or 3.375 g IV every 8 hours.
* CrCl <20 mL/min: 2.25 g IV every 8 hours.
* Hemodialysis: 2.25 g IV every 8 hours, with an additional 0.75 g dose after each dialysis session.
## Contraindications
* Known serious hypersensitivity to piperacillin, tazobactam, or any component of the formulation.
* Known serious hypersensitivity to other beta-lactam antibiotics, carbapenems, or cephalosporins.
## Adverse Effects
* Diarrhea (most common)
* Rash, pruritus
* Nausea, vomiting
* Headache
* Insomnia
* Fever
* Eosinophilia
* Thrombocytopenia
* Increased serum creatinine and BUN
* Hepatitis
* Seizures (rare, particularly with high doses or renal impairment)
* Anaphylaxis (rare but serious)
## Key Drug Interactions
* **Probenecid:** May increase and prolong piperacillin/tazobactam plasma concentrations.
* **Neuromuscular blocking agents (e.g., vecuronium):** Piperacillin may prolong the neuromuscular blockade.
* **Warfarin:** May decrease the effect of warfarin. Monitor INR closely.
* **Methotrexate:** Piperacillin/tazobactam may decrease methotrexate clearance. Monitor methotrexate levels.
## Monitoring
* Signs and symptoms of infection (fever, WBC count, cultures).
* Renal function (serum creatinine, BUN).
* Liver function tests (LFTs).
* Electrolytes.
* Signs of hypersensitivity or infusion-related reactions.
* INR if patient is on warfarin.
* Methotrexate levels if co-administered.
## Clinical Pearls
* Administer IV infusion over at least 30 minutes.
* Reconstituted solutions should be used within 24 hours when refrigerated or within 12 hours at room temperature.
* Tazobactam/piperacillin is associated with a higher risk of Clostridioides difficile-associated diarrhea.
* The dose of tazobactam is related to the piperacillin dose (e.g., 3.375 g contains 0.375 g tazobactam).
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*Disclaimer: This information is intended for clinical pharmacy use and does not replace a thorough review of the current prescribing information, relevant clinical guidelines, or individual patient factors. Always verify current drug information with official sources before use.*
