• Appendicitis and peritonitis.
• Skin and skin structure infections.
• Gynecologic infections.
• Community-acquired and nosocomial pneumonia.

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).

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, (INCLUDING ANAPHYLAXIS AND SERUM SICKNESS)HYPERSENSITIVITY REACTIONS , superinfection.

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.

(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;

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.

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.

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

• IV (Adults): 3.375 g every 6 hr.

Zosyn

• 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.

• 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.

Therapeutic Classification: anti-infectives

Pharmacologic Classification: extended spectrum penicillins

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.

(piperacillin plasma concentrations)

• 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.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

pi-PER-a-sill-in/tay-zoe-BAK-tam