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ANTIINFECTIVES FOR SYSTEMIC USE › ANTIBACTERIALS FOR SYSTEMIC USE › BETA-LACTAM ANTIBACTERIALS, PENICILLINS › Combinations of penicillins, incl. beta-lactamase inhibitors
piperacillin and beta-lactamase inhibitor
J01CR05
Forms & Strengths
- Injection: 2 g piperacillin / 0.25 g tazobactam per vial
- Injection: 3 g piperacillin / 0.375 g tazobactam per vial
- Injection: 4 g piperacillin / 0.5 g tazobactam per vial
- Infusion: 36 g piperacillin / 4.5 g tazobactam per pharmacy bulk package
Adult Dosing
- Standard: 3.375 g IV every 6 hours
- Severe infections: 4.5 g IV every 6 hours
- Nosocomial pneumonia: 4.5 g IV every 6 hours (often with an aminoglycoside)
- Renal adjustment required for CrCl <= 40 mL/min
Pediatric Dosing
- Neonates <= 2 months: 75 mg/kg (piperacillin component) IV every 8 to 12 hours
- Children >= 2 months to 12 years: 100 mg/kg piperacillin / 12.5 mg/kg tazobactam IV every 8 hours
- Severe infections in children: 80 mg/kg piperacillin / 10 mg/kg tazobactam IV every 6 hours
- Maximum daily dose: 16 g piperacillin / 2 g tazobactam
Indications
- Appendicitis and peritonitis
- Uncomplicated and complicated skin and skin structure infections
- Postpartum endometritis or pelvic inflammatory disease
- Community-acquired and nosocomial pneumonia
- Empiric therapy for febrile neutropenia
Mechanism of Action
- Piperacillin inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs)
- Tazobactam is a beta-lactamase inhibitor that protects piperacillin from degradation by certain plasmid- and chromosomally-mediated beta-lactamases
- Provides extended-spectrum bactericidal activity against gram-positive, gram-negative, and anaerobic bacteria
Contraindications
- History of severe hypersensitivity reactions to piperacillin, tazobactam, or other beta-lactam antibiotics (penicillins, cephalosporins)
- Co-administration with live bacterial vaccines
Adverse Reactions
- Diarrhea, nausea, vomiting, and constipation
- Headache, insomnia, and fever
- Injection site reactions, phlebitis, and thrombophlebitis
- Hypersensitivity reactions including rash, pruritus, and severe anaphylaxis
- Hematologic abnormalities including thrombocytopenia, leukopenia, and bleeding manifestations
- Clostridioides difficile-associated diarrhea
Drug Interactions
- Probenecid prolongs the half-life of piperacillin by decreasing renal tubular secretion
- May prolong the neuromuscular blockade of vecuronium and other non-depolarizing neuromuscular blockers
- Reduces the clearance of methotrexate, potentially increasing the risk of methotrexate toxicity
- May reduce the serum concentration of aminoglycosides when mixed in the same IV tubing
Curated Content: Needs Vetting Before Put to Clinical Use