PIPERACILLIN/TAZOBACTAM
| PIPERACILLIN/TAZOBACTAM (pi-per'a-cil-lin/taz-o-bac'tam) Zosyn Classifications: beta-lactam antibiotic; penicillin; Therapeutic: antibiotic Prototype: Piperacillin sodium Pregnancy Category: B |
Availability
2 g, 3 g, 4 g injection
Action
Antibacterial combination product consisting of the semisynthetic piperacillin and the beta-lactamase inhibitor tazobactam. Tazobactam component does not decrease the activity of the piperacillin component against susceptible organisms. Tazobactam is an inhibitor of a wide variety of bacterial beta-lactamases. It has little antibacterial activity itself; however, in combination with piperacillin, it extends the spectrum of bacteria that are susceptible to piperacillin.
Therapeutic Effect
Two-drug combination has antibiotic activity against an extremely broad spectrum of gram-positive, gram-negative, and anaerobic bacteria.
Uses
Treatment of moderate to severe appendicitis, uncomplicated and complicated skin and skin structure infections, endometritis, pelvic inflammatory disease, or nosocomial or community-acquired pneumonia caused by beta-lactamase-producing bacteria.
Contraindications
Hypersensitivity to piperacillin, tazobactam, penicillins; coagulopathy.
Cautious Use
Hypersensitivity to cephalosporins, carbapenem or beta-lactamase inhibitors such as clavulanic acid and sulbactam; GI disease, colitis; cystic fibrosis; eczema; kidney failure; complicated urinary tract infections; pregnancy (category B), lactation.
Route & Dosage
| Moderate to Severe Infections Adult: IV 3.375 g q6h, infused over 30 min, for 7–10 d Child: IV <6 mo, 150–300 mg piperacillin/kg/d divided q6–8h; ≥6 mo, 240 mg piperacillin component/kg/d divided q8h Nosocomial Pneumonia Adult: IV 4.5 g q6h, infused over 30 min, for 7–10 d Renal Insufficiency Clcr 20–40 mL/min: 2.25 g q6h; <20 mL/min: 2.25 g q8h Hemodialysis: 2.25 g q12h (for nosocomial pneumonia dose q8h); give additional 0.75 g after dialysis session |
Administration
Note: Verify correct IV concentration and rate of infusion for administration to infants or children with physician.
| Intravenous PREPARE: Intermittent: Reconstitute powder with 5 mL of diluent (e.g., D5W, NS) for each 1 g or fraction thereof; shake well until dissolved. Further dilute to at least 50 mL of selected diluent [e.g., NS, sterile water for injection (max volume: 50 mL per dose), D5W, dextran 6% in NS, and RL only with solution containing EDTA]. Use single-dose vials immediately after reconstitution. ADMINISTER: Intermittent: Give over at least 30 min. DO NOT administer through a line with another infusion. INCOMPATIBILITIES Solution/additive: Aminoglycosides, lactated Ringer's, albumin, blood products, solutions containing sodium bicarbonate. Y-site: Acyclovir, aminoglycosides, amiodarone, amphotericin B, amphotericin B cholesteryl complex, azithromycin, chlorpromazine, cisatracurium, cisplatin, dacarbazine, daunorubicin, dobutamine, doxorubicin, doxorubicin liposome, doxycycline, droperidol, famotidine, ganciclovir, gatifloxacin, gemcitabine, haloperidol, hydroxyzine, idarubicin, miconazole, minocycline, mitomycin, mitoxantrone, nalbuphine, prochlorperazine, promethazine, streptozocin, vancomycin. |
Adverse Effects (≥1%)
CNS: Headache, insomnia, fever. GI: Diarrhea, constipation, nausea, vomiting, dyspepsia, pseudomembranous colitis. Skin: Rash, pruritus, hypersensitivity reactions.Interactions
Drug: May increase risk of bleeding with anticoagulants; probenecid decreases elimination of piperacillin.Pharmacokinetics
Distribution: Distributes into many tissues, including lung, blister fluid, and bile; crosses placenta; distributed into breast milk. Metabolism: In liver. Elimination: In urine. Half-Life: 0.7–1.2 h.Nursing Implications
Assessment & Drug Effects
- Obtain history of hypersensitivity to penicillins, cephalosporins, or other drugs prior to administration.
- Lab tests: C&S prior to first dose of the drug; start drug pending results. Monitor hematologic status with prolonged therapy (Hct and Hgb, CBC with differential and platelet count).
- Monitor patient carefully during the first 30 min after initiation of the infusion for signs of hypersensitivity (see Appendix F).
Patient & Family Education
- Report rash, itching, or other signs of hypersensitivity immediately.
- Report loose stools or diarrhea as these may indicate pseudomembranous colitis.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug