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

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