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Piperacillin/​Tazobactam

    Brands

    DEA Class; Rx

    Common Brand Names; Zosyn

    • Penicillins, Extended-Spectrum

    Extended-spectrum IV penicillin/beta-lactamase inhibitor combination antibiotic
    Used for nosocomial and polymicrobial infections, including intra-abdominal, skin and soft-tissue, and lower respiratory tract infections
    Combination does not have any more activity against P. aeruginosa than does piperacillin alone

    Indicated for treatment of appendicitis (complicated by rupture or abscess) and peritonitis caused by beta-lactamase producing isolates of Escherichia coli or the following members of the Bacteroides fragilis group: B fragilis, B ovatus, B thetaiotaomicron, or B vulgatus

    Indicated for treatment of nosocomial pneumonia (moderate to severe) caused by beta-lactamase producing isolates of Staphylococcus aureus and by piperacillin/tazobactam-susceptible Acinetobacter baumannii, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa

    Indicated for treatment of uncomplicated and complicated skin and skin structure infections, including cellulitis, cutaneous abscesses and ischemic/diabetic foot infections caused by beta-lactamase producing isolates of Staphylococcus aureus

    Indicated in treatment of postpartum endometritis or pelvic inflammatory disease caused by beta-lactamase producing isolates of E coli

    Indicated for the treatment of community-acquired pneumonia (moderate severity only) caused by beta-lactamase producing isolates of H influenzae

    Allergy to penicillins, cephalosporins, imipenem, beta-lactamase inhibitors

    • Diarrhea (7-11%)
    • Constipation (1-8%)
    • Headache (1-8%)
    • Insomnia (4-7%)
    • Nausea (2-7%)
    • Fever (2-5%)
    • Oral candidiasis (2-4%)
    • Rash (2-4%)
    • Vomiting (2-4%)
    • Dyspepsia (3%)
    • Pruritus (3%)
    • Pain (2-3%)
    • Hypertension (2%)
    • Leukopenia (1%)
    • Thrombocytopenia (1.4%)
    • Anaphylaxis
    • Agranulocytosis
    • Thrombocytopenia
    • Eosinophilia, melena
    • Leukopenia
    • Positive Coombs test
    • Prolonged PT and PTT
    • Transient LFT and creatinine elevations
    • Seizure
    • Pulmonary edema
    • Pulmonary embolism

    Risk of bleeding complications, especially in renal impairment; discontinue if thrombocytopenia or bleeding occurs

    Leukopenia/neutropenia associated with prolonged therapy; periodic assessment of hematopoietic function should be performed, especially with prolonged therapy that is ≥ 21 days

    Serious skin reactions reported, including Stevens-Johnson syndrome and toxic epidermal necrolysis, generalized exanthematous pustulosis; discontinue if reaction occurs

    Monitor renal, hepatic, and especially hematopoietic functions during prolonged treatment

    Prolonged use may result in fungal or bacterial superinfection

    Administering drug in absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases risk of development of drug-resistant bacteria

    Clostridium difficile associated diarrhea (CDAD) reported; if CDAD suspected or confirmed, may need to discontinue ongoing antibacterial drug use not directed against C. difficile; appropriate fluid and electrolyte management, protein supplementation may need to be implemented; antibacterial treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated

    Increased frequency of rash and fever reported in cyctic fibrosis patients receiving piperacillin

    Risk of seizures may increase in patients with history of seizures when administered at higher than recommended doses given IV in the presence of renal impairment

    Consider sodium content (2.79 mEq/g piperacillin) in patients requiring sodium restriction

    Perform periodic electrolyte determinations in patients with low potassium reserves and who are receiving cytotoxic therapy or diuretics and consider possibility of hypokalemia in patients who have potentially low potassium reserves

    Increased frequency of fever and rash reported in patients with cystic fibrosis receiving piperacillin

    Piperacillin and tazobactam cross placenta in humans

    Insufficient data available with piperacillin and/or tazobactam in pregnant women to inform a drug-associated risk for major birth defects and miscarriage

    Piperacillin is excreted in human milk; tazobactam concentrations in human milk have not been studied

    Adults

    18 g/day (16 g piperacillin and 2 g tazobactam) IV; however, doses up to 27 g/day (24 g piperacillin and 3 g tazobactam) IV have been used off-label for patients with cystic fibrosis.

    Geriatric

    18 g/day (16 g piperacillin and 2 g tazobactam) IV; however, doses up to 27 g/day (24 g piperacillin and 3 g tazobactam) IV have been used off-label for patients with cystic fibrosis.

    Adolescents

    weighing more than 40 kg: 18 g/day (16 g piperacillin and 2 g tazobactam) IV is FDA-approved dosage; however, doses up to 600 mg/kg/day piperacillin component (675 mg/kg/day piperacillin; tazobactam; Max: 27 g/day [24 g piperacillin and 3 g tazobactam]) IV have been used off-label for patients with cystic fibrosis.
    weighing 40 kg or less: 400 mg/kg/day piperacillin component (450 mg/kg/day piperacillin; tazobactam) IV is FDA-approved dosage; however, doses up to 600 mg/kg/day piperacillin component (675 mg/kg/day piperacillin; tazobactam) IV have been used off-label for patients with cystic fibrosis.

    Children

    weighing more than 40 kg: 18 g/day (16 g piperacillin and 2 g tazobactam) IV is FDA-approved dosage; however, doses up to 600 mg/kg/day piperacillin component (675 mg/kg/day piperacillin; tazobactam; Max: 27 g/day [24 g piperacillin and 3 g tazobactam]) IV have been used off-label for patients with cystic fibrosis.
    weighing 40 kg or less: 400 mg/kg/day piperacillin component (450 mg/kg/day piperacillin; tazobactam) IV is FDA-approved dosage; however, doses up to 600 mg/kg/day piperacillin component (675 mg/kg/day piperacillin; tazobactam) IV have been used off-label for patients with cystic fibrosis.

    Infants

    10 to 11 months: 400 mg/kg/day piperacillin component (450 mg/kg/day piperacillin; tazobactam) IV is FDA-approved dosage; however, doses up to 600 mg/kg/day piperacillin component (675 mg/kg/day piperacillin; tazobactam) IV have been used off-label for patients with cystic fibrosis.
    2 to 9 months: 320 mg/kg/day piperacillin component (360 mg/kg/day piperacillin; tazobactam) IV is FDA-approved dosage; however, doses up to 600 mg/kg/day piperacillin component (675 mg/kg/day piperacillin; tazobactam) IV have been used off-label for patients with cystic fibrosis.
    1 month: Safety and efficacy have not been established; however, doses up to 320 mg/kg/day piperacillin component (360 mg/kg/day piperacillin; tazobactam) IV have been used off-label.

    Neonates

    older than 30 weeks postmenstrual age: Safety and efficacy have not been established; however, doses up to 320 mg/kg/day piperacillin component (360 mg/kg/day piperacillin; tazobactam) IV have been used off-label.
    30 weeks postmenstrual age and younger: Safety and efficacy have not been established; however, doses up to 300 mg/kg/day piperacillin component (337.5 mg/kg/day piperacillin; tazobactam) IV have been used off-label.

    Piperacillin/tazobactam

    injection, lyophilized powder for reconstitution

    • (2g/250mg)/vial: 2.25g
    • (3g/375mg)/vial: 3.375g
    • (4g/500mg)/vial: 4.5g
    • (36g/4.5g)/vial: 40.5g

    premix bag

    • 2.25g/50mL
    • 3.375g/50mL
    • 4.5g/100mL