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
  • Off-label: may reduce costs without sacrificing efficacy

Diverticulitis

• 3.375 g IV q6 hours x 7-10 days

Pneumonia

• CAP
  • 3.375 g IV q6 hours x 7-10 days
  • Only for P. aeruginosa caused or from aspiration
• Nosocomial
  • 4.5 g IV q6 hours or 3.375 g IV q4 hours x 7-14 days
  • + aminoglycoside or antipseudomonal fluoroquinolone

Pediatric Dosing

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

Appendicitis and/or Peritonitis

• 2-9 months
  • 80mg piperacillin/kg/dose IV q8 hours
• >9 months
  • ≤40 kg: 100mg piperacillin/kg/dose IV q8 hours
  • >40 kg: 3.375g (3000mg piperacillin) IV q6 hours
• Max: 16 g/day

Cystic Fibrosis, Pseudomonal Infection

• 240-400mg piperacillin/kg/day IV divided q8 hours;
  • Consider higher dose: 450-600mg/kg/day IV divided q4-6 hours

Special Populations

• Pregnancy:
• Lactation:
• Renal Dosing
  • Adult - all indications
    • CrCl 20-40: 2.25 g q6h (3.375 g q6h if HCAP)
    • CrCl < 20: 2.25 g q8h (2.25 g q6h if HCAP)
    • HD: 2.25 g q12h (2.25 g q8h if HCAP), both PLUS 0.75 g supplement after each dialysis
    • PD: 2.25 g q12h (2.25 g q8h if HCAP)
  • Pediatric
• Hepatic Dosing - no change

Contraindications

• Allergy to class/drug

Pharmacology

• Half-life:
• Metabolism:
• Excretion:
• Mechanism of Action:

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	I
	Strep. anginosus gp	S
	Enterococcus faecalis	S
	Enterococcus faecium	I
	MSSA	S
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	S
	C. jeikeium	X1
	L. monocytogenes	X2
Gram Negatives	N. gonorrhoeae	X2
	N. meningitidis	S
	Moraxella catarrhalis	S
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	S
	Enterobacter sp, AmpC pos	S
	Serratia sp	S
	Serratia marcescens	X1
	Salmonella sp	S
	Shigella sp	S
	Proteus mirabilis	S
	Proteus vulgaris	S
	Providencia sp.	S
	Morganella sp.	S
	Citrobacter freundii	S
	Citrobacter diversus	S
	Citrobacter sp.	S
	Aeromonas sp	S
	Acinetobacter sp.	I
	Pseudomonas aeruginosa	S
	Burkholderia cepacia	X1
	Stenotrophomonas maltophilia	I
	Yersinia enterocolitica	X1
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
	Pasteurella multocida	X1
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	R
	Mycoplasm pneumoniae	R
	Rickettsia sp	X1
	Mycobacterium avium	X1
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	S
	Prevotella melaninogenica	S
	Clostridium difficile	X1
	Clostridium (not difficile)	S
	Fusobacterium necrophorum	S
	Peptostreptococcus sp.	S

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

• Antibiotics (Main)

References

Authors

Claire