Piperacillin / Tazobactam Dosage

This dosage information may not include all the information needed to use Piperacillin / Tazobactam safely and effectively. See additional information for Piperacillin / Tazobactam.

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for Intraabdominal Infection

3.375 g IV every 6 hours; 4.5 g IV every 8 hours has also been used

Duration: for 7 to 10 days, depending on the nature and severity of the infection; once the patient is stable and able to tolerate oral medications, oral antibiotic therapy may be substituted according to microbiology sensitivity data

In severe infections, piperacillin trough levels (drawn immediately before the 4th or 5th dose) may be helpful. Serum piperacillin trough levels greater than 16 mcg/mL have been associated with improved efficacy.

Usual Adult Dose for Peritonitis

3.375 g IV every 6 hours; 4.5 g IV every 8 hours has also been used

Duration: for 7 to 10 days, depending on the nature and severity of the infection

Usual Adult Dose for Skin or Soft Tissue Infection

3.375 g IV every 6 hours; 4.5 g IV every 8 hours has also been used

Duration: for 7 to 10 days, depending on the nature and severity of the infection

Usual Adult Dose for Endometritis

3.375 g IV every 6 hours; 4.5 g IV every 8 hours has also been used

Duration: Parenteral therapy should be continued for at least 24 hours after the patient has remained afebrile, pain-free, and the leukocyte count has normalized. Doxycycline therapy for 14 days is recommended if concurrent chlamydial infection is present in late postpartum patients (breast-feeding should be discontinued).

Usual Adult Dose for Pelvic Inflammatory Disease

3.375 g IV every 6 hours; 4.5 g IV every 8 hours has also been used

Duration: for 7 to 10 days, depending on the nature and severity of the infection

If the patient is not pregnant, oral doxycycline therapy for 14 days should be considered to treat possible concurrent chlamydial infection. The patient's sexual partner(s) should also be evaluated.

Usual Adult Dose for Pneumonia

Community-acquired pneumonia (moderate severity): 3.375 g IV every 6 hours; 4.5 g IV every 8 hours has also been used

Duration: for 7 to 10 days, depending on the nature and severity of the infection

Usual Adult Dose for Nosocomial Pneumonia

Moderate to severe: 4.5 g IV every 6 hours

Duration: for 7 to 14 days, depending on the nature and severity of the infection

Initial empiric treatment with broad-spectrum coverage according to the hospital's and/or ICU's antibiogram is recommended if multidrug-resistant organisms are suspected.

If the causative organism is not Pseudomonas aeruginosa, the duration of treatment should be as short as clinically possible (e.g., as little as 7 days) to reduce the risk of superinfections with resistant organisms.

Usual Adult Dose for Aspiration Pneumonia

3.375 g IV every 6 hours; 4.5 g IV every 8 hours has also been used

Duration: Parenteral therapy should be continued until the patient's clinical condition stabilizes and fever subsides. Oral antibiotic therapy may then be substituted according to microbiology sensitivity data. Therapy of documented anaerobic pleuropulmonary infections should be continued until the infiltrate is cleared, or a residual scar forms, sometimes for as long as 2 to 4 months.

Usual Adult Dose for Bacteremia

3.375 g IV every 6 hours; 4.5 g IV every 8 hours has also been used

Duration: for approximately 14 days, depending on the nature and severity of the infection; once the patient is stable and able to tolerate oral medications, oral antibiotic therapy may be substituted according to microbiology sensitivity data

In severe infections, piperacillin trough levels (drawn immediately before the 4th or 5th dose) may be helpful. Serum piperacillin trough levels greater than 16 mcg/mL have been associated with improved efficacy.

Usual Adult Dose for Deep Neck Infection

3.375 g IV every 6 hours; 4.5 g IV every 8 hours has also been used

Duration: for approximately 2 to 3 weeks, depending on the nature and severity of the infection; once the patient is stable and able to tolerate oral medications, oral antibiotic therapy may be substituted according to microbiology sensitivity data

Usual Adult Dose for Febrile Neutropenia

3.375 g IV every 6 hours; 4.5 g IV every 8 hours has also been used

Duration: Therapy should be continued for about 14 days, or until more specific therapy may be substituted for a proven infection, or until the patient is afebrile for 24 hours after the absolute neutrophil count is greater than 500/mm3. The total duration of therapy depends on the nature and severity of the infection. Once the patient is stable and able to tolerate oral medications, oral antibiotic therapy may be substituted according to microbiology sensitivity data.

In severe infections, piperacillin trough levels (drawn immediately before the 4th or 5th dose) may be helpful. Serum piperacillin trough levels greater than 16 mcg/ml have been associated with improved efficacy.

Usual Adult Dose for Joint Infection

3.375 g IV every 6 hours; 4.5 g IV every 8 hours has also been used

Duration: Therapy should be continued for approximately 3 to 4 weeks, depending on the nature and severity of the infection. Longer therapy, 6 weeks or more, may be required for prosthetic joint infections. In addition, removal of the involved prosthesis is usually required.

Usual Adult Dose for Osteomyelitis

3.375 g IV every 6 hours; 4.5 g IV every 8 hours has also been used

Duration: Therapy should be continued for approximately 4 to 6 weeks, depending on the nature and severity of the infection. Chronic osteomyelitis may require additional oral antibiotic therapy, possibly for up to 6 months. Surgical debridement of devitalized bone is critical to the management of osteomyelitis.

Usual Adult Dose for Pyelonephritis

3.375 g IV every 6 hours; 4.5 g IV every 8 hours has also been used

Duration: for approximately 14 days, depending on the nature and severity of the infection; once the patient is stable and able to tolerate oral medications, oral antibiotic therapy may be substituted according to microbiology sensitivity data

Usual Adult Dose for Urinary Tract Infection

3.375 g IV every 6 hours; 4.5 g IV every 8 hours has also been used

Duration: for approximately 7 to 10 days, depending on the nature and severity of the infection; once the patient is stable and able to tolerate oral medications, oral antibiotic therapy may be substituted according to microbiology sensitivity data

Usual Pediatric Dose for Peritonitis

2 to 9 months: 80 mg/kg (piperacillin component) IV every 8 hours

9 months or older:
40 kg or less: 100 mg/kg (piperacillin component) IV every 8 hours
Greater than 40 kg: 3.375 g IV every 6 hours

Usual Pediatric Dose for Appendicitis

2 to 9 months: 80 mg/kg (piperacillin component) IV every 8 hours

9 months or older:
40 kg or less: 100 mg/kg (piperacillin component) IV every 8 hours
Greater than 40 kg: 3.375 g IV every 6 hours

Renal Dose Adjustments

Adults:
CrCl greater than 40 mL/min: No adjustment recommended.

CrCl 20 to 40 mL/min:
Nosocomial pneumonia: 3.375 g IV every 6 hours
Other indications: 2.25 g IV every 6 hours

CrCl less than 20 mL/min:
Nosocomial pneumonia: 2.25 g IV every 6 hours
Other indications: 2.25 g IV every 8 hours

Pediatric patients: There are no dosing recommendations for pediatric patients with impaired renal function.

Liver Dose Adjustments

No adjustment recommended.

Dose Adjustments

For patients with renal failure, measurement of serum levels of piperacillin and tazobactam will provide additional guidance for adjusting dosage.

Precautions

Serious and occasionally fatal hypersensitivity reactions have been reported with antibiotics. The drug should be discontinued immediately at the first appearance of a skin rash or other signs of hypersensitivity. Severe, acute hypersensitivity reactions may require treatment with epinephrine and other resuscitative measures including oxygen, intravenous fluids, antihistamines, corticosteroids, cardiovascular support and airway management as clinically indicated.

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following penicillin therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Penicillins may be associated with a fall in prothrombin activity and bleeding. Risk factors include renal or hepatic impairment, poor nutritional state, a protracted course of antimicrobial therapy, and chronic anticoagulation therapy. Prothrombin times should be monitored and vitamin K therapy initiated if indicated.

Caution is recommended in patients with a history of colitis or other gastrointestinal disorders.

Penicillins have been associated with neuromuscular excitability and convulsions with high intravenous doses, especially in patients with renal failure.

Renal function should be monitored, especially in elderly patients. Elderly patients may have a greater risk of developing adverse effects. Dose adjustments are recommended for renally impaired patients.

Patients with low potassium reserves, or who are on diuretic or cytotoxic therapy may be at risk of developing hypokalemia during piperacillin-tazobactam therapy. Electrolytes should be monitored periodically in patients with low potassium reserves.

Hematopoietic function should be monitored periodically, especially during prolonged therapy (21 days or longer).

Penicillins may cause false-positive urine glucose tests (with Clinitest(R), Benedict's or Fehling's solution). Enzymatic glucose oxidase tests are recommended for urine glucose measurements.

Safety and efficacy have not been established in pediatric patients less than 2 months of age.

Dialysis

Hemodialysis:
Nosocomial pneumonia: 2.25 g IV every 8 hours
Other indications: 2.25 g IV every 12 hours

A supplemental dose of 0.75 g piperacillin-tazobactam should be given following each dialysis session.

CRRT: Clearance may be significantly increased in patients undergoing continuous renal replacement therapy (CRRT) and higher doses may be necessary which should be individualized based on the estimated piperacillin-tazobactam clearance. In addition, tazobactam has a longer half-life than piperacillin, resulting in relative serum concentration increases compared to piperacillin. Some experts recommend piperacillin-tazobactam 2.25 to 3.375 g every 8 hours for initial therapy of patients undergoing continuous venovenous hemofiltration (CVVH), and then intermittent doses of piperacillin alone to prevent tazobactam accumulation.

CAPD:
Nosocomial pneumonia: 2.25 g IV every 8 hours
Other indications: 2.25 g IV every 12 hours

No supplemental doses are necessary.

Other Comments

3.375 g piperacillin-tazobactam is 3 g piperacillin and 375 mg tazobactam

Piperacillin-tazobactam should be infused over 30 minutes.

Piperacillin-tazobactam contains approximately 2.79 mEq (64 mg) of sodium per gram of piperacillin. This should be considered in patients on a salt restriction and in geriatric patients who may respond with blunted natriuresis.

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