Piperacillin/tazobactam (PDF Version)
Beta-lactam/beta-lactamase inhibitor
Staphylococcus aureus (methicillin susceptible), Coagulase negative Staphylococci, Streptococcus pneumoniae (penicillin susceptible), Streptococcus spp., Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitides, Neisseria gonorrhoeae, Enterobacteriaceae, E. coli, Pseudomonas aeruginosa
The beta-lactamase inhibitors are recognized as substrates for the beta-lactamases produced by bacteria. This allows the actual beta-lactams to attack the bacterial cell wall by binding to penicillin binding proteins
Time dependent killer (Time > MIC)
(of the tazobactam)
Dose 200mg: Cmax: 29 mcg/L; Protein binding: 20-23%; Volume of distribution: 0.18-0.33L/kg; Table 5
No new adverse effects are seen as a result of adding beta-lactamase inhibitors to beta-lactam antibiotics. The adverse reactions would remain the same for the parent compound
IV: Complete listing on Table 6
Dosing in adults:
Mild/Moderate: 2.25-3.375g q6h
Severe: 3.375-4.5g q6h
Dosing in pediatrics:
Not indicated in children < 12 years of age
Disease state based dosing:
Renal failure: CrCl > 40mL/min: 3.375g q4-6h
CrCl 20-40mL/min: 2.25g q6h
CrCl < 20mL/min: 2.25g q8h
Hepatic failure: Dosage adjustment not necessary
Dosing during Continuous Renal Replacement Therapy
CVVH (Continuous venovenous hemofiltration): 2.25g IV q6h
CVVHD (Continuous venovenous hemodialysis): 2.25-3.375g IV q6h
CVVHDF (Continuous venovenous hemodiafiltration) 2.25g-3.375g IV q6h
Note: CVVH is mainly for fluid removal alone. Many institutions will employ more CVVHD or CVVHDF which combine dialysis with fluid removal.
Contraindications/Warnings/Precautions:
Precautions: hypersensitivity to penicillins, history of gastrointestinal disease, particularly colitis, renal impairment
Live Typhoid Vaccine - decreased immunological response to the typhoid vaccine
Methotrexate – increased methotrexate toxicity
Probenecid - increased piperacillin levels
Vecuronium - enhanced and/or prolonged neuromuscular blockade which may lead to respiratory depression and paralysis
Category B: No evidence of risk in humans but studies inadequate.
Monitoring Requirements:
Therapeutic: Culture and sensitivities, serum levels, signs and symptoms of infection, white blood cell count
Toxic: Urinalysis, BUN, SCr, AST and ALT, skin rash, Neutropenia and leukopenia,
Brand names/Manufacturer: Zosyn/Wyeth pharmaceuticals