piperacillin/tazobactam

Contraindicated in:

Hypersensitivity to penicillins, beta-lactams, cephalosporins, or tazobactam (cross-sensitivity may occur).

Use Cautiously in:

Renal impairment (↑ risk of seizures) (dosage ↓ or increased interval recommended if CCr <40 mL/min);
Seizure disorders
Sodium restriction;
Critically ill patients (↑ risk of renal failure; use alternative antibiotic, if possible);
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Children <2 mo (safety and effectiveness not established).

Adv. Reactions/Side Effects

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Derm: rash (↑ in patients with cystic fibrosis), ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS, DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, urticaria

GI: diarrhea, CLOSTRIDIOIDES DIFFICILE-ASSOCIATED DIARRHEA (CDAD), constipation, drug-induced hepatitis, nausea, vomiting

GU: interstitial nephritis, renal failure

Hemat: bleeding, leukopenia, neutropenia, thrombocytopenia

Local: pain, phlebitis at IV site

Neuro: confusion, dizziness, headache, insomnia, lethargy, SEIZURES (HIGHER DOSES)

Misc: fever (↑ in cystic fibrosis patients), hemophagocytic lymphohistiocytosis, HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS AND SERUM SICKNESS), superinfection

Interactions

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Drug-drug:

Probenecid↓ renal excretion and ↑ blood levels.
May alter excretion of lithium.
Potassium-losing diuretics, corticosteroids, or amphotericin B may ↑ risk of hypokalemia.
↑risk of hepatotoxicity with other hepatotoxic agents.
May ↓ levels/effects of aminoglycosides in patients with renal impairment.
May ↑ levels and risk of toxicity from methotrexate.
↑risk of acute kidney injury when concomitantly administered with vancomycin.
May prolong the neuromuscular blockade associated with vecuronium.

Availability

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(Generic available)

Powder for injection: 2.25 g (2 g piperacillin/0.25 g tazobactam)/vial; 3.375 g (3 g piperacillin/0.375 g tazobactam)/vial; 4.5 g (4 g piperacillin/0.5 g tazobactam)/vial; 13.5 g (12 g piperacillin/1.5 g tazobactam)/vial; 40.5 g (36 g piperacillin/4.5 g tazobactam)/vial
Premixed infusion: 2.25 g (2 g piperacillin/0.25 g tazobactam) in 50 mL; 3.375 g (3 g piperacillin/0.375 g tazobactam) in 50 mL; 4.5 g (4 g piperacillin/0.5 g tazobactam) in 100 mL

Route/Dosage

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Contains 2.84 mEq (65 mg) sodium/g of piperacillin; adult doses below expressed as combined piperacillin/tazobactam content

Appendicitis/Peritonitis

IV (Adults and Children ≥2 mo and >40 kg): 3.375 g every 6 hr.
IV (Children ≥9 mo and ≤40 kg and normal renal function): 112.5 mg (100 mg piperacillin/12.5 mg tazobactam)/kg every 8 hr.
IV (Infants 2–9 mo and ≤40 kg and normal renal function): 90 mg (80 mg piperacillin/10 mg tazobactam)/kg every 8 hr.

Renal Impairment

IV (Adults ): CCr 20–40 mL/min: 2.25 g every 6 hr; CCr <20 mL/min: 2.25 g every 8 hr; Hemodialysis: 2.25 g every 12 hr + 0.75 g following hemodialysis on hemodialysis days; Continuous ambulatory peritoneal dialysis: 2.25 g every 12 hr.

Nosocomial Pneumonia

IV (Adults and Children ≥2 mo and >40 kg): 4.5 g every 6 hr.
IV (Children ≥9 mo and ≤40 kg and normal renal function): 112.5 mg (100 mg piperacillin/12.5 mg tazobactam)/kg every 6 hr.
IV (Infants 2–9 mo and ≤40 kg and normal renal function): 90 mg (80 mg piperacillin/10 mg tazobactam)/kg every 6 hr.

Renal Impairment

IV (Adults ): CCr 20–40 mL/min: 3.375 g every 6 hr; CCr <20 mL/min: 2.25 g every 6 hr; Hemodialysis: 2.25 g every 8 hr + 0.75 g following hemodialysis on hemodialysis days; Continuous ambulatory peritoneal dialysis: 2.25 g every 8 hr.

Skin and Skin Structure Infections, Gynecologic Infections, and Community-Acquired Pneumonia

IV (Adults ): 3.375 g every 6 hr.

Renal Impairment

IV (Adults ): CCr 20–40 mL/min: 2.25 g every 6 hr; CCr <20 mL/min: 2.25 g every 8 hr; Hemodialysis: 2.25 g every 12 hr + 0.75 g following hemodialysis on hemodialysis days; Continuous ambulatory peritoneal dialysis: 2.25 g every 12 hr.

US Brand Names

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Action

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Piperacillin

Binds to bacterial cell wall membrane, causing cell death. Spectrum is extended compared with other penicillins.

Tazobactam

Inhibits beta-lactamase, an enzyme that can destroy penicillins.

Therapeutic effects:

Death of susceptible bacteria.

Spectrum:

Active against piperacillin-resistant, beta-lactamase–producing:
- Bacteroides fragilis,
- E. coli,
- Acinetobacter baumanii,
- Klebsiella pneumoniae,
- Pseudomonas aeruginosa,
- Staphylococcus aureus,
- Haemophilus influenzae.

Classifications

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Therapeutic Classification: anti-infectives

Pharmacologic Classification: extended spectrum penicillins

Pharmacokinetics

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Absorption: IV administration results in complete bioavailability.

Distribution: Widely distributed. Enters CSF well only when meninges are inflamed.

Metabolism/Excretion: Piperacillin (68%) and tazobactam (80%) are mostly excreted unchanged by the kidneys.

Half-Life: Adults: 0.7–1.2 hr; Children (6 mo–12 yr): 0.7–0.9 hr; Infants (2–5 mo): 1.4 hr.

Time/Action Profile

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(piperacillin plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	end of infusion	4–6 hr

Patient/Family Teaching

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Explain purpose of piperacillin/tazobactam to patient.
Advise patient to report rash and signs of superinfection (black furry overgrowth on tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy.
Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several wk after discontinuation of medication.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

section name header

Indications ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Availability ⬆ ⬇

Route/Dosage ⬆ ⬇

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Classifications ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Pronunciation ⬆

Indications

Contraind./Precautions

Adv. Reactions/Side Effects

Interactions

Availability

Route/Dosage

US Brand Names

Action

Classifications

Pharmacokinetics

Time/Action Profile

Patient/Family Teaching

Pronunciation