Piperacillin/Tazobactam
General
- Type: Anti-Pseudomonal Penicillin
- Dosage Forms: 2.25gm vial, 3.375gm vial, 4.5gm vial, 40.5gm bulk bottle (Powder for reconstitution)
- Common Trade Names: Zosyn
Adult Dosing
General
- 3.375 g IV q6 hours
- Alt: 4.5 g q6-8 hours
- Max: 18 g/day
Extended Interval Dosing
- 3.375 g IV infused over 4 hours q8 hours
Pediatric Dosing[3]
A Piperacillin/Taxobactam 3.375g vial contains 3g piperacillin and 0.375g tazobactam (8:1 ratio)
General
- <2 months
- 100mg piperacillin/kg/dose IV q6 hours
- 2-9 months
- 80mg piperacillin/kg/dose IV q8 hours
- >9 months
- 100mg piperacillin/kg/dose q8 hours
- Max: 16 g/day
Indications by Disease
| Disease | Dose | Context |
|---|---|---|
| Acute cystitis | 3.375 gm IV q6hr | Inpatient |
| Ascending cholangitis | 4.5g IV q8hrs | |
| Diabetic foot infection | 4.5g IV q8hrs | Inpatient DFI |
| Diverticulitis | 3.375g IV q6h x 7-10 days | Complicated/Inpatient |
| Ludwig's angina | 4.5g (80mg/kg) IV q6 hours | Immunocompromised |
| Mammalian bites | 4.5g IV (80mg/kg) q8hrs | Severe mammalian bite infection |
| Mastoiditis | 100mg/kg/dose piperacillin IV q6h (max 4g piperacillin/dose) | Chronic/Severe |
| Neutropenic fever | 4.5g IV q6hrs | Inpatient monotherapy |
| Orbital cellulitis | 4.5 g IV q6h | Inpatient |
| Osteomyelitis | 3.375gm | Animal bites |
| Osteomyelitis | 3.375gm | Human bite |
| Osteomyelitis | 3.375g IV q6h | DM/Vascular insufficiency |
| Osteomyelitis | 3.375g IV q6h | Elderly/Hematogenous |
| Peritonitis | 4.5g (80mg/kg) IV q8hrs | Allergy/Prior exposure |
| Peritonsillar abscess | 4.5 gm IV TID | Inpatient |
| Pneumonia (main) | 4.5g q6h | ICU, Risk of Pseudomonas |
| Pneumonia (main) | 4.5g q6h | VAP, High Risk |
| Pneumonia (main) | 4.5g q6h | HAP, High Risk |
| Pyelonephritis | 3.375 gm IV q6hr | Adult Inpatient |
Pediatric Dosing
Indications by Disease
| Disease | Dose | Context |
|---|---|---|
| Ludwig's angina | 80-100mg/kg IV q6-8hrs (max 4.5g) | Pediatric Immunocompromised |
| Mammalian bites | 80mg/kg IV q8hrs (max 4.5g) | Pediatric Severe |
| Mastoiditis | 100mg/kg IV q6hrs (max 4.5g/dose) | Pediatric Chronic/Severe |
| Neutropenic fever | 80-100mg/kg IV q6-8hrs (max 4.5g) | Pediatric Inpatient |
| Orbital cellulitis | 100mg/kg IV q8hrs (max 4.5g) | Pediatric Inpatient |
| Peritonitis | 80-100mg/kg IV q6-8hrs (max 4.5g) | Pediatric |
Special Populations
- Pregnancy risk: B
- Lactation: excreted in breastmilk, risk likely minimal
- Renal Dosing
- Hepatic Dosing - no change
Contraindications
- Allergy to class/drug
- Caution
- Non-anaphylactic hypersensitivity to beta-lactams
- Asthma, cystic fibrosis
- Recent antibiotic-associated colitis
- Seizure disorder
- Renal impairement
- Sodium restriction
- Hypokalemia
- Bleeding risk
Adverse Reactions
Serious
- Anaphylaxis
- Serum sickness-like reaction
- DRESS syndrome
- Acute generalized exanthematous pustulosis
- Erythema multiforme, SJS, TEN
- Interstitial nephritis
- Superinfection
- C. difficile associated diarrhea
- Hemolytic anemia, leukopenia, neutropenia, pancytopenia, agranulocytosis, thrombocytopenia
- Bleeding
- Hypokalemia
- Seizure
Common
- Diarrhea, constipation, nausea/vomiting, dyspepsia
- Headache
- Insomnia
- Rash, pruritus
- Fever
- Agitation
- Electrolyte abnormality
- LFT elevation
Pharmacology
- Half-life:
- Pipercillin: 30-90 min
- Tazobactam: 0.7-1.2h
- Metabolism:
- Pipercillin: Liver minimally
- Tazobactam: Liver
- Excretion:
- Pipercillin: Urine 68%
- Tazobactam: Urine primarily
- Mechanism of Action:
- Pipercillin: Inhibits cell wall mucopeptide synthesis
- Tazobactam: Inhibits beta-lactamases
Antibiotic Sensitivities[6]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia
See Also
References
- ↑ Shea KM, Cheatham SC, Smith DW, Wack MF, Sowinski KM, Kays MB. Comparative pharmacodynamics of intermittent and prolonged infusions of piperacillin/tazobactamusing Monte Carlo simulations and steady-state pharmacokinetic data from hospitalized patients. Ann Pharmacother. 2009;43(11):1747-54.
- ↑ Kaufman SE, Donnell RW, Hickey WS. Rationale and evidence for extended infusion of piperacillin-tazobactam. Am J Health Syst Pharm. 2011 Aug 15;68(16):1521-6.
- ↑ Red Book, 2012
- ↑ GlobalRPH. Piperacillin/Tazobactam - Zosyn® - Renal Dosing. http://www.globalrph.com/piperacillin-tazobactam_renal.htm
- ↑ Epocrates. Zosyn - Entire Monograph. https://online.epocrates.com/u/10a1657/Zosyn
- ↑ Sanford Guide to Antimicrobial Therapy 2014