Adult Dosing
Treatment of moderate to severe infections caused by piperacillin-resistant, beta-lactamase-producing bacteria
- 3.375 g (3.0 g piperacillin/0.375 g tazobactam) IV infusion over 30 minutes q6 hrs x 7-10 days
Nosocomial Pneumonia
- 4.5 g (4.0 g piperacillin/0.5 g tazobactam) IV infusion over 30 minutes q6 hrs x 7-14 days; administer aminoglycosides concomitantly in patients from whom Pseudomonas aeruginosa is isolated
Note:
- If administering aminoglycosides along with piperacillin/tazobactam, separate administration of these drugs by 30-60 minutes
Pediatric Dosing
Treatment of appendicitis or peritonitis caused by piperacillin-resistant, beta-lactamase-producing bacteria
Pediatric patients (mg/kg dosing based on piperacillin amount)
- 2-9 mo: 240 mg/kg/day IV divided q8 hrs
9 mo and <40 kg: 300 mg/kg/day IV divided q8 hrs- Children >40 kg: Administer adult dosing
Note:
- Safety and efficacy in pediatric patients <2 months of age have not been established
Cellulitis [Non-FDA Approved]
- Infant <6 mo: 150-300 mg/kg/24 hr IV divided q6-8hr
- Infant >6 mo and child: 300-400 mg/kg/24 hr IV divided q6-8hr
Renal Dose Adjustment (Based on CrCl)
All Indications
- >40 mL/min: 3.375 g IV q6 hrs
- 20-40 mL/min: 2.25 g IV q6 hrs
- <20 mL/min: 2.25 g IV q8 hrs
- Hemodialysis: 2.25 g IV q12 hrs; supplement 0.75 g after each dialysis on hemodialysis days
- CAPD: 2.25 grams IV q12 hrs
Nosocomial Pneumonia
- >40 mL/min: 4.5 g IV q6 hrs
- 20-40 mL/min: 3.375 g IV q6 hrs
- <20 mL/min: 2.25 g IV q6 hrs
- Hemodialysis: 2.25 g IV q8 hrs; supplement 0.75 g after each dialysis on hemodialysis days
- CAPD: 2.25 grams IV q8 hrs
Hepatic Dose Adjustment
- Hepatic impairment: No dose adjustments
See Supplemental Patient Information
- Serious, and sometimes fatal, hypersensitivity (anaphylactic) reactions including shock have been reported in patients receiving penicillin therapy; such reactions are more likely to occur in individuals with a history of penicillin hypersensitivity or a history of sensitivity to multiple allergens. Discontinue therapy if such reaction occurs
- Prior to initiating therapy, obtain a detailed history concerning previous hypersensitivity reactions to penicillins, cephalosporins, or other allergens
- Treatment with epinephrine and other emergency measures may be required to manage serious acute hypersensitivity reactions
- Clostridium difficile associated diarrhea (CDAD), which may range in severity from mild diarrhea to fatal colitis, may occur during or after antibiotic treatment. In case of suspected or confirmed C. difficile infection, discontinue ongoing antibiotic therapy and initiate fluid and electrolyte management, protein supplementation, appropriate antibiotic treatment, and surgical evaluation as indicated
- Bleeding manifestations, sometimes associated with abnormalities of coagulation tests, have been reported in certain patients receiving beta-lactam antibiotics; patients with renal failure are more prone to such reactions. If bleeding manifestations occur, discontinue therapy and institute appropriate therapy
- Higher doses may result in neuromuscular excitability or convulsions
- Prolonged use may result in fungal or bacterial superinfections; initiate appropriate measures if this occurs
- Patients receiving higher than recommended doses intravenously may experience neuromuscular excitability or convulsions
- Monitor electrolyte levels periodically in patients with low potassium reserves and those receiving cytotoxic therapy or diuretics to avoid the risk of hypokalemia
- Piperacillin/tazobactam is not compatible with tobramycin for simultaneous coadministration via Y-site infusion. Compatibility with other aminoglycosides has not been established
- Leukopenia and neutropenia may occur during prolonged therapy
- Piperacillin may cause an increased incidence of fever and rash in cystic fibrosis patients
- Avoid use of piperacillin/tazobactam in the absence of confirmed or strongly suspected bacterial infection or a prophylactic indication to prevent drug-resistance
Cautions: Use cautiously in
- Hypersensitivity to multiple allergens
- Risk of bleeding
- Penicillin-sensitive patients
- Seizure disorder
- Restricted salt intake
- Hypokalemia
- Elderly patients
- Renal impairment
- Cystic fibrosis patients
Supplemental Patient Information
- Advise patients to avoid skipping doses or abrupt discontinuation of therapy as it may reduce effectiveness of treatment and increase the likelihood that bacteria will develop resistance
- Instruct patients to promptly consult their physician, if they experience watery and bloody stools even as late as 2 or more months after having taken the last dose of the antibiotic
Pregnancy Category:B
Breastfeeding: Limited information indicates that maternal doses of piperacillin produce low levels in milk that are not expected to cause adverse effects in breastfed infants. Piperacillin and tazobactam are compatible with breastfeeding. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 22 July 2010). Manufacturer advises caution while administering to nursing mothers.
US Trade Name(s)
US Availability
piperacillin/tazobactam (generic)
- PWDR for INJ:
- 2.25 g [2 g/0.25 g] vials
- 3.375 g [3 g/0.375 g] vials
- 4.5 g [4 g/0.5 g] vials
- 40.5 g [36 g/4.5 g] pharmacy bulk vials
Zosyn (piperacillin/tazobactam)
- PWDR for INJ:
- 2.25 g [2 g/0.25 g] vials
- 3.375 g [3 g/0.375 g] vials
- 4.5 g [4 g/0.5 g] vials
- 40.5 g [36 g/4.5 g] pharmacy bulk vials
- 2.25 g [2 g/0.25 g] plastic containers
- 3.375 g [3 g/0.375 g] plastic containers
- 4.5 g [4 g/0.5 g] plastic containers
Canadian Trade Name(s)
Canadian Availability
piperacillin/tazobactam (generic)
- PWDR for INJ:
- 2.25 g [2 g/0.25 g] vials
- 3.375 g [3 g/0.375 g] vials
- 4.5 g [4 g/0.5 g] vials
- 13.5 g [12 g/1.5 g] vials
Tazocin (piperacillin/tazobactam)
- PWDR for INJ:
- 2.25 g [2 g/0.25 g] vials
- 3.375 g [3 g/0.375 g] vials
- 4.5 g [4 g/0.5 g] vials
UK Trade Name(s)
UK Availability
piperacillin/tazobactam (generic)
- PWDR for INJ:
- 2.25 g [2 g/0.25 g] vials
- 4.5 g [4 g/0.5 g] vials
Tazocin (piperacillin/tazobactam)
- PWDR for INJ:
- 2.25 g [2 g/0.25 g] vials
- 4.5 g [4 g/0.5 g] vials
Australian Trade Name(s)
Australian Availability
piperacillin/tazobactam (generic)
PiperTaz, Tazocin EF (piperacillin/tazobactam)
Pricing data from www.DrugStore.com in U.S.A.
- Zosyn 4-0.5 GM SOLR [Vial] (WYETH PHARMACEUTICAL)
1 gm = $252.28
3 gm = $734.91 - Zosyn 3-0.375 GM SOLR [Vial] (WYETH PHARMACEUTICAL)
1 gm = $28.99
3 gm = $79.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.