Piperacillin Tazobactam

Aka: Piperacillin Tazobactam, Zosyn

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II. Indications

  1. Complicated Intraabdominal Infections (e.g. Appendicitis, peritonitis, Diverticulitis with abscess)
  2. Complicated genitourinary infections (e.g. Postpartum Endometritis, Pelvic Inflammatory Disease)
  3. Nosocomial Pneumonia
  4. Sepsis

III. Mechanism

  1. Fourth generation, Extended Spectrum Penicillin (acylamino-Penicillin)
  2. Added activity to Natural Penicillins
    1. High affinity for Penicillin binding Proteins
    2. Greater penetration through Gram Negative membrane
    3. Activity against Pseudomonas
    4. Beta lactamase resistance with Tazobactam
  3. Activity Spectrum
    1. Similar to Natural Penicillins and Aminopenicillins
    2. Expanded Gram Negative coverage
      1. Escherichia coli
      2. Morganella
      3. Proteus
      4. Providencia
      5. Salmonella
      6. Shigella
      7. Pseudomonas

IV. Dosing

  1. Adult (or child weight >40 kg)
    1. Give 3.375 to 4.5 g IV every 6 hours
  2. Child (weight <40 kg)
    1. Dosing is based on Piperacillin component
    2. Age 2 to 6 months
      1. Give 80 mg/kg IV every 8 hours OR
      2. Give 150 to 300 mg/kg/day IV divided every 6 to 8 hours
    3. Age >6 months
      1. Give 100 mg/kg IV every 8 hours OR
      2. Give 300 to 400 mg/kg/day IV divided every 6 to 8 hours
  3. Renal Dosing (Adults)
    1. eGFR 20 to 40 ml/min
      1. Give 2.25 g IV every 6 hours
    2. eGFR <20 ml/min
      1. Give 2.25 g IV every 12 hours AND
      2. Give 0.75 g IV after each Hemodialysis run

V. Adverse Effects

  1. Platelet Dysfunction
  2. Renal Failure
    1. Higher risk in Critical Illness
    2. Increased risk when combined with Vancomycin

VI. Safety

  1. Pregnancy Category B
  2. Unknown safety in Lactation

VII. Drug Interactions

  1. Nondepolarizing Neuromuscular Blocking Agent
    1. Prolonged Neuromuscular Blockade
  2. Methotrexate
    1. Decreased renal excretion (higher Methotrexate levels, toxicity risk)

VIII. Resources

  1. Piperacillin Tazobactam (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=19e89f8b-316b-4dd2-9724-bfe0faeba408

IX. References

  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  2. Miller (2002) J Midwifery Womens Health 47(6):426-34 +PMID: 12484664 [PubMed]
  3. Bush (2016) Cold Spring Harb Perspect Med 6(8):a025247 +PMID: 27329032 [PubMed]

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