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piperacillin and tazobactam

Pronunciation

Generic Name: piperacillin and tazobactam (PI per a SIL in and TAZ oh BAK tam)
Brand Name: Zosyn

What is piperacillin and tazobactam?

Piperacillin and tazobactam are penicillin antibiotics that fight bacteria in the body.

Piperacillin and tazobactam is a combination medicine used to treat many different infections caused by bacteria, such as urinary tract infections, bone and joint infections, severe vaginal infections, stomach infections, skin infections, and pneumonia.

This medication is sometimes given together with other antibiotics.

Piperacillin and tazobactam may also be used for purposes not listed in this medication guide.

What is the most important information I should know about piperacillin and tazobactam?

You should not use this medicine if you have ever had an allergic reaction to certain antibiotics (especially a penicillin or cephalosporin antibiotic).

What should I discuss with my healthcare provider before using piperacillin and tazobactam?

You should not use this medicine if you are allergic to:

  • piperacillin or any other penicillin antibiotic (amoxicillin, ampicillin, Augmentin, dicloxacillin, oxacillin, penicillin, ticarcillin, or others);

  • tazobactam; or

  • a cephalosporin antibiotic such as cefdinir (Omnicef), cefprozil (Cefzil), cefuroxime (Ceftin), cephalexin (Keflex), or others.

To make sure piperacillin and tazobactam is safe for you, tell your doctor if you have:

  • kidney disease (or if you are on dialysis);

  • a bleeding or blood clotting disorder;

  • an electrolyte imbalance such as low levels of potassium in your blood;

  • cystic fibrosis;

  • a history of any type of allergy; or

  • if you are on a low-salt diet.

Piperacillin and tazobactam is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant.

Piperacillin and tazobactam can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How should I use piperacillin and tazobactam?

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Piperacillin and tazobactam is injected into a vein through an IV. You may be shown how to use an IV at home. Do not give yourself this medicine if you do not understand how to use the injection and properly dispose of needles, IV tubing, and other items used.

Piperacillin and tazobactam is a powder medicine that must be mixed with a liquid (diluent) before using it. If you are using the injections at home, be sure you understand how to properly mix and store the medicine.

Prepare your dose only when you are ready to give an injection. Do not use if the medicine has changed colors or has particles in it. Call your pharmacist for new medicine.

Use this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Piperacillin and tazobactam will not treat a viral infection such as the common cold or flu.

While using piperacillin and tazobactam, you may need frequent blood tests.

This medicine can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using piperacillin and tazobactam.

Each single-use vial (bottle) of this medicine is for one use only. Throw away after one use, even if there is still some medicine left in it after injecting your dose.

Use a disposable needle and syringe only once. Follow any state or local laws about throwing away used needles and syringes. Use a puncture-proof "sharps" disposal container (ask your pharmacist where to get one and how to throw it away). Keep this container out of the reach of children and pets.

Store the unmixed powder medicine and the liquid diluent at cool room temperature, away from moisture and heat.

Medicine mixed in an IV bag must be used within 24 hours if you keep it at room temperature.

Mixed medication in an IV bag can also be stored in the refrigerator for up to 7 days. Do not freeze. Throw away any unused mixture that has not been used within that time.

Mixed medicine in an infusion pump must be used within 12 hours if you keep it at room temperature.

If your medicine is frozen when you receive it, store the medicine container in a freezer until you are ready to prepare your dose.

You may thaw frozen medicine either in a refrigerator or at room temperature. Do not heat the medicine under hot water or in a microwave.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while using piperacillin and tazobactam?

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Piperacillin and tazobactam side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • severe stomach pain, diarrhea that is watery or bloody;

  • a seizure (convulsions);

  • low white blood cell counts--fever, swollen gums, painful mouth sores, pain when swallowing, skin sores, cold or flu symptoms, cough, trouble breathing;

  • low potassium--leg cramps, constipation, irregular heartbeats, fluttering in your chest, increased thirst or urination, numbness or tingling, muscle weakness or limp feeling;

  • signs of inflammation in your body--swollen glands, flu symptoms, easy bruising or bleeding, severe tingling or numbness, muscle weakness, upper stomach pain, jaundice (yellowing of the skin or eyes), chest pain, new or worsening cough with fever, trouble breathing; or

  • severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common side effects may include:

  • diarrhea, constipation;

  • nausea, vomiting, upset stomach;

  • fever;

  • skin rash or itching;

  • itching or white patches in your mouth or throat;

  • headache, sleep problems (insomnia); or

  • vaginal itching or discharge.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Piperacillin and tazobactam dosing information

Usual Adult Dose for Intraabdominal Infection:

3.375 g IV every 6 hours
Usual duration of therapy: 7 to 10 days

Uses: For the treatment of appendicitis (complicated by rupture or abscess) and peritonitis due to beta-lactamase-producing isolates of Escherichia coli or members of the Bacteroides fragilis group (B fragilis, B ovatus, B thetaiotaomicron, or B vulgatus)

Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) Recommendations: 3.375 g IV every 6 hours
-May increase for infections due to Pseudomonas aeruginosa: 3.375 g IV every 4 hours or 4.5 g IV every 6 hours

Comments:
-Recommended as an initial IV regimen for empiric treatment of complicated intraabdominal infection
-May be used for initial empiric treatment of high-risk/high-severity community-acquired extrabiliary complicated intraabdominal infection (e.g., severe physiologic disturbance, advanced age, immunocompromised state)
-Recommended for healthcare-associated intraabdominal infection, depending on local microbiologic studies
-May be used for initial empiric treatment of: high-risk/high-severity community-acquired acute cholecystitis; acute cholangitis after bilioenteric anastomosis (any severity); healthcare-associated biliary infection (any severity)
-Coadministration with other agents may be recommended.
-Current guidelines should be consulted for additional information.

International Society for Peritoneal Dialysis (ISPD) Recommendations:
Continuous (all exchanges):
-Loading dose: 4 g (piperacillin component) intraperitoneally
-Maintenance dose: 1 g (piperacillin component) intraperitoneally

Comments:
-When a surgical cause of peritoneal dialysis (PD)-related peritonitis is suspected, this drug may be considered as monotherapy.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Peritonitis:

3.375 g IV every 6 hours
Usual duration of therapy: 7 to 10 days

Uses: For the treatment of appendicitis (complicated by rupture or abscess) and peritonitis due to beta-lactamase-producing isolates of Escherichia coli or members of the Bacteroides fragilis group (B fragilis, B ovatus, B thetaiotaomicron, or B vulgatus)

Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) Recommendations: 3.375 g IV every 6 hours
-May increase for infections due to Pseudomonas aeruginosa: 3.375 g IV every 4 hours or 4.5 g IV every 6 hours

Comments:
-Recommended as an initial IV regimen for empiric treatment of complicated intraabdominal infection
-May be used for initial empiric treatment of high-risk/high-severity community-acquired extrabiliary complicated intraabdominal infection (e.g., severe physiologic disturbance, advanced age, immunocompromised state)
-Recommended for healthcare-associated intraabdominal infection, depending on local microbiologic studies
-May be used for initial empiric treatment of: high-risk/high-severity community-acquired acute cholecystitis; acute cholangitis after bilioenteric anastomosis (any severity); healthcare-associated biliary infection (any severity)
-Coadministration with other agents may be recommended.
-Current guidelines should be consulted for additional information.

International Society for Peritoneal Dialysis (ISPD) Recommendations:
Continuous (all exchanges):
-Loading dose: 4 g (piperacillin component) intraperitoneally
-Maintenance dose: 1 g (piperacillin component) intraperitoneally

Comments:
-When a surgical cause of peritoneal dialysis (PD)-related peritonitis is suspected, this drug may be considered as monotherapy.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Appendicitis:

3.375 g IV every 6 hours
Usual duration of therapy: 7 to 10 days

Uses: For the treatment of appendicitis (complicated by rupture or abscess) and peritonitis due to beta-lactamase-producing isolates of Escherichia coli or members of the Bacteroides fragilis group (B fragilis, B ovatus, B thetaiotaomicron, or B vulgatus)

Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) Recommendations: 3.375 g IV every 6 hours
-May increase for infections due to Pseudomonas aeruginosa: 3.375 g IV every 4 hours or 4.5 g IV every 6 hours

Comments:
-Recommended as an initial IV regimen for empiric treatment of complicated intraabdominal infection
-May be used for initial empiric treatment of high-risk/high-severity community-acquired extrabiliary complicated intraabdominal infection (e.g., severe physiologic disturbance, advanced age, immunocompromised state)
-Recommended for healthcare-associated intraabdominal infection, depending on local microbiologic studies
-May be used for initial empiric treatment of: high-risk/high-severity community-acquired acute cholecystitis; acute cholangitis after bilioenteric anastomosis (any severity); healthcare-associated biliary infection (any severity)
-Coadministration with other agents may be recommended.
-Current guidelines should be consulted for additional information.

International Society for Peritoneal Dialysis (ISPD) Recommendations:
Continuous (all exchanges):
-Loading dose: 4 g (piperacillin component) intraperitoneally
-Maintenance dose: 1 g (piperacillin component) intraperitoneally

Comments:
-When a surgical cause of peritoneal dialysis (PD)-related peritonitis is suspected, this drug may be considered as monotherapy.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Skin or Soft Tissue Infection:

3.375 g IV every 6 hours
Usual duration of therapy: 7 to 10 days

Use: For the treatment of uncomplicated and complicated skin and skin structure infections (including cellulitis, cutaneous abscesses, ischemic/diabetic foot infections) due to beta-lactamase-producing isolates of Staphylococcus aureus

IDSA Recommendations:
-Incisional surgical site infection: 3.375 g IV every 6 hours or 4.5 g IV every 8 hours
-Necrotizing infections of the skin, fascia, and muscle: 3.375 g IV every 6 to 8 hours
-Infection after animal bite: 3.375 g IV every 6 to 8 hours

Comments:
-Recommended as a single-drug regimen for treatment of incisional surgical site infections after intestinal or genitourinary tract surgery
-With vancomycin, recommended as a preferred regimen for the treatment of necrotizing infections of the skin, fascia, and muscle due to mixed infections
-Infection after animal bite: This drug does not provide coverage for methicillin-resistant S aureus (MRSA).
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Skin and Structure Infection:

3.375 g IV every 6 hours
Usual duration of therapy: 7 to 10 days

Use: For the treatment of uncomplicated and complicated skin and skin structure infections (including cellulitis, cutaneous abscesses, ischemic/diabetic foot infections) due to beta-lactamase-producing isolates of Staphylococcus aureus

IDSA Recommendations:
-Incisional surgical site infection: 3.375 g IV every 6 hours or 4.5 g IV every 8 hours
-Necrotizing infections of the skin, fascia, and muscle: 3.375 g IV every 6 to 8 hours
-Infection after animal bite: 3.375 g IV every 6 to 8 hours

Comments:
-Recommended as a single-drug regimen for treatment of incisional surgical site infections after intestinal or genitourinary tract surgery
-With vancomycin, recommended as a preferred regimen for the treatment of necrotizing infections of the skin, fascia, and muscle due to mixed infections
-Infection after animal bite: This drug does not provide coverage for methicillin-resistant S aureus (MRSA).
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Pelvic Inflammatory Disease:

3.375 g IV every 6 hours
Usual duration of therapy: 7 to 10 days

Use: For the treatment of postpartum endometritis or pelvic inflammatory disease due to beta-lactamase-producing isolates of E coli

Usual Adult Dose for Endometritis:

3.375 g IV every 6 hours
Usual duration of therapy: 7 to 10 days

Use: For the treatment of postpartum endometritis or pelvic inflammatory disease due to beta-lactamase-producing isolates of E coli

Usual Adult Dose for Pneumonia:

3.375 g IV every 6 hours
Usual duration of therapy: 7 to 10 days

Use: For the treatment of community-acquired pneumonia (moderate severity only) due to beta-lactamase-producing isolates of Haemophilus influenzae

Usual Adult Dose for Nosocomial Pneumonia:

4.5 g IV every 6 hours
Duration of therapy: 7 to 14 days

Comments:
-Initial presumptive therapy should start with this drug plus an aminoglycoside.
-Aminoglycoside therapy should be continued if P aeruginosa is isolated.

Use: For the treatment of moderate to severe nosocomial pneumonia due to beta-lactamase-producing isolates of S aureus and by piperacillin-tazobactam-susceptible Acinetobacter baumannii, H influenzae, Klebsiella pneumoniae, and P aeruginosa

IDSA and American Thoracic Society Recommendations: 4.5 g IV every 6 hours
Duration of therapy: 7 days

Comments:
-Recommended as an empiric treatment regimen for clinically suspected ventilator-associated pneumonia in units where such coverage is appropriate
-Recommended as initial empiric therapy for hospital-acquired pneumonia (non-ventilator-associated pneumonia)
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Surgical Prophylaxis:

American Society of Health-System Pharmacists (ASHP), IDSA, SIS, and Society for Healthcare Epidemiology of America (SHEA) Recommendations:
-Preoperative dose: 3.375 g IV as a single dose
-Redosing interval (from start of preoperative dose): 2 hours

Comments:
-Recommended for perioperative prophylaxis to prevent surgical-site infections in patients undergoing liver transplantation
-This drug should be started within 60 minutes before surgical incision.
-A single prophylactic dose is usually sufficient; if prophylaxis is continued postoperatively, duration should be less than 24 hours.
-To ensure adequate serum and tissue drug levels, readministration may be needed if the procedure duration exceeds the recommended redosing interval.
-Redosing may be needed if drug half-life is shortened (e.g., extensive burns) or if prolonged/excessive bleeding during surgery; redosing may not be needed if drug half-life is prolonged (e.g., renal dysfunction).
-Coadministration with other agents may be recommended.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Pyelonephritis:

Some experts recommend: 3.375 to 4.5 g IV every 6 to 8 hours
Duration of therapy: About 14 days

Comments:
-Dose and therapy duration depend 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.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Intraabdominal Infection:

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

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

Usual duration of therapy: 7 to 10 days

Uses: For the treatment of appendicitis (complicated by rupture or abscess) and peritonitis due to beta-lactamase-producing isolates of E coli or members of the B fragilis group (B fragilis, B ovatus, B thetaiotaomicron, or B vulgatus)

SIS and IDSA Recommendations: 200 to 300 mg/kg/day (piperacillin component) IV in divided doses every 6 to 8 hours
Maximum dose: 12 g/day (based on piperacillin component)

Comments:
-Recommended as an initial IV regimen for treatment of complicated intraabdominal infection
-May be used for initial empiric treatment of community-acquired extrabiliary complicated intraabdominal infection
-Doses should be maximized if undrained intraabdominal abscess may be present.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Peritonitis:

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

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

Usual duration of therapy: 7 to 10 days

Uses: For the treatment of appendicitis (complicated by rupture or abscess) and peritonitis due to beta-lactamase-producing isolates of E coli or members of the B fragilis group (B fragilis, B ovatus, B thetaiotaomicron, or B vulgatus)

SIS and IDSA Recommendations: 200 to 300 mg/kg/day (piperacillin component) IV in divided doses every 6 to 8 hours
Maximum dose: 12 g/day (based on piperacillin component)

Comments:
-Recommended as an initial IV regimen for treatment of complicated intraabdominal infection
-May be used for initial empiric treatment of community-acquired extrabiliary complicated intraabdominal infection
-Doses should be maximized if undrained intraabdominal abscess may be present.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Appendicitis:

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

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

Usual duration of therapy: 7 to 10 days

Uses: For the treatment of appendicitis (complicated by rupture or abscess) and peritonitis due to beta-lactamase-producing isolates of E coli or members of the B fragilis group (B fragilis, B ovatus, B thetaiotaomicron, or B vulgatus)

SIS and IDSA Recommendations: 200 to 300 mg/kg/day (piperacillin component) IV in divided doses every 6 to 8 hours
Maximum dose: 12 g/day (based on piperacillin component)

Comments:
-Recommended as an initial IV regimen for treatment of complicated intraabdominal infection
-May be used for initial empiric treatment of community-acquired extrabiliary complicated intraabdominal infection
-Doses should be maximized if undrained intraabdominal abscess may be present.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Bacterial Infection:

American Academy of Pediatrics (AAP) Recommendations:
Neonates:
7 days or younger: 100 mg/kg (piperacillin component) IV every 12 hours
8 to 28 days: 100 mg/kg (piperacillin component) IV every 8 hours

2 to 9 months:
-Severe infections: 80 mg/kg (piperacillin component) IV 3 times a day

9 months or older:
-Severe infections: 100 mg/kg (piperacillin component) IV 3 times a day
Maximum dose: 16 g/day (based on piperacillin component)

Usual Pediatric Dose for Endocarditis:

American Heart Association Recommendations:
Children and adolescents: 240 mg/kg/day (piperacillin component) IV in divided doses every 8 hours
Maximum dose: 18 g/day (based on piperacillin component)
Duration of therapy: At least 6 weeks

Comments:
-With an aminoglycoside, recommended as an alternative regimen for the treatment of infective endocarditis due to gram-negative enteric bacilli
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Skin or Soft Tissue Infection:

IDSA Recommendations:
1 month or older: 60 to 75 mg/kg (piperacillin component) IV every 6 hours
Maximum dose: 3 g/dose (based on piperacillin component)

Comments:
-With vancomycin, recommended as a preferred regimen for the treatment of necrotizing infections of the skin, fascia, and muscle due to mixed infections
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Skin and Structure Infection:

IDSA Recommendations:
1 month or older: 60 to 75 mg/kg (piperacillin component) IV every 6 hours
Maximum dose: 3 g/dose (based on piperacillin component)

Comments:
-With vancomycin, recommended as a preferred regimen for the treatment of necrotizing infections of the skin, fascia, and muscle due to mixed infections
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Surgical Prophylaxis:

ASHP, IDSA, SIS, and SHEA Recommendations:
Preoperative dose:
-Infants 2 to 9 months: 80 mg/kg (piperacillin component) IV as a single dose
-Children older than 9 months and up to 40 kg: 100 mg/kg (piperacillin component) IV as a single dose
---Maximum dose: 3 g/dose (based on piperacillin component)
Redosing interval (from start of preoperative dose): 2 hours

Comments:
-Recommended for perioperative prophylaxis to prevent surgical-site infections in patients undergoing liver transplantation
-This drug should be started within 60 minutes before surgical incision.
-A single prophylactic dose is usually sufficient; if prophylaxis is continued postoperatively, duration should be less than 24 hours.
-To ensure adequate serum and tissue drug levels, readministration may be needed if the procedure duration exceeds the recommended redosing interval.
-Redosing may be needed if drug half-life is shortened (e.g., extensive burns) or if prolonged/excessive bleeding during surgery; redosing may not be needed if drug half-life is prolonged (e.g., renal dysfunction).
-Coadministration with other agents may be recommended.
-Current guidelines should be consulted for additional information.

What other drugs will affect piperacillin and tazobactam?

Tell your doctor about all your current medicines and any you start or stop using, especially:

  • methotrexate;

  • probenecid;

  • tobramycin, vancomycin, or other injected antibiotics; or

  • medicine to prevent blood clots, such as dabigatran (Pradaxa), heparin, warfarin (Coumadin, Jantoven), and others.

This list is not complete. Other drugs may interact with piperacillin and tazobactam, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

See also: Side effects (in more detail)

Where can I get more information?

  • Your doctor or pharmacist can provide more information about piperacillin and tazobactam.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 5.01.

Date modified: September 05, 2017
Last reviewed: July 21, 2016

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