What is Piperacillin/Tazobactam?
Piperacillin/Tazobactam injection is used to treat bacterial infections in many different parts of the body.
Piperacillin/Tazobactam combination is an antibiotic that belongs to the group of medicines known as penicillins and beta-lactamase inhibitors. It works by killing the bacteria and preventing their growth. However, Piperacillin/Tazobactam will not work for colds, flu, or other virus infections.
Piperacillin/Tazobactam is to be given only by or under the direct supervision of your doctor.
Piperacillin/Tazobactam indications
Piperacillin/Tazobactam is indicated for the treatment of the following systemic and/or local bacterial infections in which susceptible organisms have been detected or are suspected: Lower respiratory tract infections; urinary tract infections (complicated and uncomplicated); intra-abdominal infections; skin and skin structure infections; bacterial septicemia. Polymicrobial infections: Piperacillin/Tazobactam is indicated for polymicrobial infections including those where aerobic and anaerobic organisms are suspected (intra-abdominal, skin and skin structure, lower respiratory tract).
Piperacillin/Tazobactam, in combination with an aminoglycoside, is indicated for bacterial infections in neutropenic adults or children.
Children Under the Age of 12 Years: In hospitalized children aged 2 to 12 years, Piperacillin/Tazobactam is indicated for the treatment of intra-abdominal infections including appendicitis complicated by rupture or abscess, peritonitis, and biliary infections. It has not been evaluated in this indication for pediatric patients below the age of 2 years.
Whilst Piperacillin/Tazobactam is indicated only for the conditions listed above, infections caused by Piperacillin/Tazobactam susceptible organisms are also amendable to Piperacillin/Tazobactam treatment due to its Piperacillin/Tazobactam content. Therefore, the treatment of mixed infections caused by Piperacillin/Tazobactam susceptible organisms and β-beta lactamase producing organisms susceptible to Piperacillin/Tazobactam should not require the addition of another antibiotic.
Piperacillin/Tazobactam is particularly useful in the treatment of mixed infections and in presumptive therapy prior to the availability of the results of sensitivity tests because of its broad spectrum of activity.
Piperacillin/Tazobactam acts synergistically with aminoglycosides against certain strains of Pseudomonas aeruginosa. Combined therapy has been successful, especially in patients with impaired host defences. Both drugs should be used in full therapeutic doses. As soon as results of culture and susceptibility tests become available, antimicrobial therapy should be adjusted if necessary.
How should I use Piperacillin/Tazobactam?
Use Piperacillin/Tazobactam as directed by your doctor. Check the label on the medicine for exact dosing instructions.
- Piperacillin/Tazobactam is usually given as an injection at your doctor's office, hospital, or clinic. If you will be using Piperacillin/Tazobactam at home, a health care provider will teach you how to use it. Be sure you understand how to use Piperacillin/Tazobactam. Follow the procedures you are taught when you use a dose. Contact your health care provider if you have any questions.
- Do not use Piperacillin/Tazobactam if it contains particles, is cloudy or discolored, or if the vial is cracked or damaged.
- Keep this product, as well as syringes and needles, out of the reach of children and away from pets. Do not reuse needles, syringes, or other materials. Ask your health care provider how to dispose of these materials after use. Follow all local rules for disposal.
- If you miss a dose of Piperacillin/Tazobactam, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.
Ask your health care provider any questions you may have about how to use Piperacillin/Tazobactam.
Uses of Piperacillin/Tazobactam in details
Use: Labeled Indications
Intra-abdominal infections: Treatment of appendicitis complicated by rupture or abscess and peritonitis caused by beta-lactamase-producing strains of Escherichia coli, Bacteroides fragilis, Bacteroides ovatus, Bacteroides thetaiotaomicron, or Bacteroides vulgatus.
Pelvic infections: Treatment of postpartum endometritis or pelvic inflammatory disease caused by beta-lactamase-producing strains of E. coli.
Pneumonia, community-acquired: Treatment of moderate severity community-acquired pneumonia (CAP) caused by beta-lactamase-producing strains of Haemophilus influenzae.
Pneumonia, hospital-acquired (nosocomial): Treatment of moderate to severe hospital-acquired (nosocomial) pneumonia caused by beta-lactamase-producing strains of Staphylococcus aureus and by Piperacillin/Tazobactam-susceptible Acinetobacter baumannii, H. influenzae, Klebsiella pneumoniae, and P. aeruginosa.
Skin and skin structure infections: Treatment of skin and skin structure infections, including cellulitis, cutaneous abscesses, and ischemic/diabetic foot infections caused by beta-lactamase-producing strains of S. aureus.
Off Label Uses
Bite wound infection, treatment (animal or human bite)
Based on the Infectious Diseases Society of America (IDSA) guidelines for the diagnosis and management of skin and soft tissue infections (SSTIs), Piperacillin/Tazobactam is an effective and recommended treatment of animal bite wound infections.
Clinical experience supports the utility of Piperacillin/Tazobactam in the treatment of human bite wound infections.
Piperacillin/Tazobactam description
Each 2.25 g single-dose vial contains Piperacillin/Tazobactam sodium equivalent to Piperacillin/Tazobactam 2 g and tazobactam sodium equivalent to tazobactam 0.25 g and edetate disodium (dihydrate) (EDTA) 0.5 mg.
Each 4.5 g single-dose vial contains Piperacillin/Tazobactam sodium equivalent to Piperacillin/Tazobactam 4 g and tazobactam sodium equivalent to tazobactam 0.5 g and edetate disodium (dihydrate) (EDTA) 1 mg.
Piperacillin/Tazobactam is an injectable antibacterial combination consisting of the semisynthetic antibiotic Piperacillin/Tazobactam sodium and the beta-lactamase inhibitor tazobactam sodium for intravenous administration. Piperacillin/Tazobactam sodium is derived from D(-)-a-aminobenzylpenicillin. The chemical name of Piperacillin/Tazobactam sodium is sodium (2S, 5R, 6R)-6-[(R)-2-(4-ethyl-2,3-dioxo-1-piperazinecarboxamido)-2-phenylacetamido] – 3,3 –dimethyl-7-oxo-4-thia-1-azabicyclo[3.2.0] heptane – 2 – carboxylate. Piperacillin/Tazobactam sodium is a white, crystalline powder. Piperacillin/Tazobactam sodium is freely soluble in water, in alcohol, and in methyl alcohol; practically insoluble in ethyl acetate. Tazobactam sodium is a derivative of the penicillin nucleus. Chemically, tazobactam is a penicillanic acid sulfone. Its chemical name is sodium (2S-,3S-,5R) – 3 – methyl-7-oxo-3-(1H-1,2,3-triazol-1-ylmethyl)-4-thia-1-azabicyclo[3.2.0]heptane-2-carboxylate,4,4-dioxide. Tazobactam sodium is a white to pale yellow non-hydroscopic crystalline powder.
Piperacillin/Tazobactam also contains the following excipients: Piperacillin/Tazobactam monohydrate, tazobactam, sodium hydrogen carbonate, citric acid (monohydrate), EDTA, water for injections and nitrogen.
Piperacillin/Tazobactam dosage
Piperacillin/Tazobactam should be administered by intravenous infusion over 30 minutes.
The usual daily dose of Piperacillin/Tazobactam for adults is 3.375 g every six hours totaling 13.5 g (12.0 g Piperacillin/Tazobactam/1.5 g tazobactam).
Nosocomial Pneumonia
Initial presumptive treatment of patients with nosocomial pneumonia should start with Piperacillin/Tazobactam at a dosage of 4.5 g every six hours plus an aminoglycoside, totaling 18.0 g (16.0 g Piperacillin/Tazobactam/2.0 g tazobactam). Treatment with the aminoglycoside should be continued in patients from whom Pseudomonas aeruginosa is isolated. If Pseudomonas aeruginosa is not isolated, the aminoglycoside may be discontinued at the discretion of the treating physician.
Due to the in vitro inactivation of the aminoglycoside by beta-lactam antibiotics, Piperacillin/Tazobactam and the aminoglycoside are recommended for separate administration. Piperacillin/Tazobactam and the aminoglycoside should be reconstituted, diluted, and administered separately when concomitant therapy with aminoglycosides is indicated.
In circumstances where coadministration via Y-site is necessary, reformulated Piperacillin/Tazobactam containing EDTA supplied in Galaxy containers is compatible for simultaneous coadministration via Y-site infusion only with the following aminoglycosides under the following conditions:
The following compatibility information does not apply to the Piperacillin/Tazobactam (Piperacillin/Tazobactam) formulation not containing EDTA. This information does not apply to Piperacillin/Tazobactam in vials or bulk pharmacy containers. Refer to the package insert for Piperacillin/Tazobactam vials or bulk pharmacy containers for instructions.
| Aminoglycoside | Piperacillin/Tazobactam Dose (grams) | Aminoglycoside Concentration Range* (mg/mL) | Acceptable Diluents |
|---|---|---|---|
| Amikacin | 2.25, 3.375, 4.5 | 1.75 – 7.5 | 0.9% Sodium Chloride or 5% Dextrose |
| Gentamicin | 2.25, 3.375, 4.5 | 0.7 – 3.32 | 0.9% Sodium Chloride or 5% Dextrose |
| *The concentration ranges in Table 5 are based on administration of the aminoglycoside in divided doses (10-15 mg/kg/day in two daily doses for amikacin and 3-5 mg/kg/day in three daily doses for gentamicin). Administration of amikacin or gentamicin in a single daily dose or in doses exceeding those stated above via Y-site with Piperacillin/Tazobactam containing EDTA has not been evaluated. See package insert for each aminoglycoside for complete Dosage and Administration instructions. | |||
Piperacillin/Tazobactam is not compatible with tobramycin for simultaneous coadministration via Y-site infusion. Compatibility of Piperacillin/Tazobactam with other aminoglycosides has not been established. Only the concentration and diluents for amikacin or gentamicin with the dosages of Piperacillin/Tazobactam listed above have been established as compatible for coadministration via Y-site infusion. Simultaneous coadministration via Y-site infusion in any manner other than listed above may result in inactivation of the aminoglycoside by Piperacillin/Tazobactam.
Renal Insufficiency
In patients with renal insufficiency (Creatinine Clearance ≤ 40 mL/min), the intravenous dose of Piperacillin/Tazobactam should be adjusted to the degree of actual renal function impairment. In patients with nosocomial pneumonia receiving concomitant aminoglycoside therapy, the aminoglycoside dosage should be adjusted according to the recommendations of the manufacturer. The recommended daily doses of Piperacillin/Tazobactam for patients with renal insufficiency are as follows:
| Renal Function (Creatinine Clearance, mL/min) | All Indications (except nosocomial pneumonia) | Nosocomial Pneumonia |
|---|---|---|
| >40 mL/min | 3.375 q 6 h | 4.5 q 6 h |
| 20-40 mL/min* | 2.25 q 6 h | 3.375 q 6 h |
| <20 mL/min* | 2.25 q 8 h | 2.25 q 6 h |
| Hemodialysis** | 2.25 q 12 h | 2.25 q 8 h |
| CAPD | 2.25 q 12 h | 2.25 q 8 h |
| * Creatinine clearance for patients not receiving hemodialysis ** 0.75 g should be administered following each hemodialysis session on hemodialysis days | ||
For patients on hemodialysis, the maximum dose is 2.25 g every twelve hours for all indications other than nosocomial pneumonia and 2.25 g every eight hours for nosocomial pneumonia. Since hemodialysis removes 30% to 40% of the administered dose, an additional dose of 0.75 g Piperacillin/Tazobactam should be administered following each dialysis period on hemodialysis days. No additional dosage of Piperacillin/Tazobactam is necessary for CAPD patients.
Duration of Therapy
The usual duration of Piperacillin/Tazobactam treatment is from seven to ten days. However, the recommended duration of Piperacillin/Tazobactam treatment of nosocomial pneumonia is 7 to 14 days. In all conditions, the duration of therapy should be guided by the severity of the infection and the patient's clinical and bacteriological progress.
Pediatric Patients
For children with appendicitis and/or peritonitis 9 months of age or older, weighing up to 40 kg, and with normal renal function, the recommended Piperacillin/Tazobactam dosage is 100 mg Piperacillin/Tazobactam/12.5 mg tazobactam per kilogram of body weight, every 8 hours. For pediatric patients between 2 months and 9 months of age, the recommended Piperacillin/Tazobactam dosage based on pharmacokinetic modeling, is 80 mg Piperacillin/Tazobactam/10 mg tazobactam per kilogram of body weight, every 8 hours. Pediatric patients weighing over 40 kg and with normal renal function should receive the adult dose. There are no dosage recommendations for Piperacillin/Tazobactam in pediatric patients with impaired renal function.
Piperacillin/Tazobactam in Galaxy containers should not be used in pediatric patients who require less than the full adult dose of Piperacillin/Tazobactam in order to prevent unintentional overdose. The other available formulations of Piperacillin/Tazobactam can be used in this population.
DIRECTIONS FOR USE OF Piperacillin/Tazobactam (Piperacillin/Tazobactam INJECTION) IN GALAXY CONTAINERS (PL 2040 PLASTIC)
Piperacillin/Tazobactam Injection (PL 2040 Plastic) is to be administered using sterile equipment after thawing to room temperature.
Piperacillin/Tazobactam containg EDTA is compatible for co-administration via a Y-site intravenous tube with Lactated Ringer's injection, USP.
Administer by infusion over a period of at least 30 minutes. During the infusion it is desirable to discontinue the primary infusion solution.
Piperacillin/Tazobactam should not be mixed with other drugs in a syringe or infusion bottle since compatibility has not been established.
Piperacillin/Tazobactam is not chemically stable in solutions that contain only sodium bicarbonate and solutions that significantly alter the pH.
Piperacillin/Tazobactam should not be added to blood products or albumin hydrolysates.
Piperacillin/Tazobactam interactions
See also:
What other drugs will affect Piperacillin/Tazobactam?
The following drug interactions are chosen on the basis of their potential clinical significance:
Aminoglycosides: The mixing of Piperacillin/Tazobactam in vitro can result in substantial inactivation of the aminoglycosides.
When Piperacillin/Tazobactam is administered together with tobramycin, the AUC, renal clearance and urinary recovery of tobramycin were decreased by 11%, 32% and 38%, respectively. The alterations in the pharmacokinetics of tobramycin when administered in conjunction with Piperacillin/Tazobactam may be due to inactivation of tobramycin in the presence of Piperacillin/Tazobactam. It has been postulated that penicillin-aminoglycoside complexes form and these complexes are micobiologically inactive and unknown toxicity.
Probenecid: Probenecid administered concomitantly with Piperacillin/Tazobactam prolongs the t½ of Piperacillin/Tazobactam by 21% and that of tazobactam by 71%.
Heparin, Anticoagulants and Drugs Affecting the Blood: Coagulation parameters should be tested more frequently and monitored regularly during simultaneous administration of high doses of heparin, anticoagulants and Piperacillin/Tazobactam that may affect the blood coagulation system or the thrombocyte function.
Vecuronium: Piperacillin/Tazobactam when used concomitantly with vecuronium has been implicated in the prolongation of vecuronium's neuromuscular blockade. It is also expected that neuromuscular blockade produced by any of the nondepolarizing muscle muscle relaxants could be prolonged in the presence of Piperacillin/Tazobactam.
Methotrexate: Limited data suggest that the clearance of methotrexate is reduced when co-administered with Piperacillin/Tazobactam, due to competition for renal secretion. The impact of tazobactam on the elimination of methotrexate has not been evaluated. If Piperacillin/Tazobactam and methotrexate are administered concomitantly, serum concentrations of methotrexate as well as signs and symptoms of methotrexate toxicity should be closely monitored.
Drug/Laboratory Test Interactions: As with other penicillins, the administration of Piperacillin/Tazobactam may result in a false positive reaction of glucose in the urine using copper-reduction method (Clinitest). It is recommended that glucose tests based on enzymatic glucose oxidase reactions be used.
In patients with renal failure, Piperacillin/Tazobactam is reported to cause abnormalities in clotting time, platelet aggregation and prothrombin time that close monitoring of the patient's coagulation tests is recommended.
Piperacillin/Tazobactam side effects
See also:
What are the possible side effects of Piperacillin/Tazobactam?
Adverse drug reactions reported with Piperacillin/Tazobactam are similar to those reported with Piperacillin/Tazobactam alone and generally are transient and mild to moderate in severity. Adverse events have been reported in about ≤10% of patients receiving parenteral Piperacillin/Tazobactam and have been severe enough to require discontinuance in ≤3% of patients.
The most common frequent adverse effects reported with Piperacillin/Tazobactam are gastrointestinal (GI) effects, headache and hypersensitivity reactions.
Hypersensitivity Reactions: Rash, pruritus and fever have been reported in up to 4% of patients receiving Piperacillin/Tazobactam. Rare reports of bronchospasm have also been reported.
Gastrointestinal Effects: Diarrhea, nausea, constipation have been reported in up to 11% of patients receiving Piperacillin/Tazobactam. Vomiting, dyspepsia, stool changes and abdominal pain can occur in up to 3%, while melena, flatulence, hemorrhage, gastritis, hiccups and ulcerative stomatitis are reported in ≤1% of patients.
Clostridium difficile-associated diarrhea and colitis or antibiotic-associated pseudomembranous colitis have been reported in at least 1 patient receiving Piperacillin/Tazobactam. Colitis may occur during or following discontinuance of anti-infective therapy and may range in severity from mild to life-threatening.
Hematologic Effects: Transient leukopenia, neutropenia and thrombocytopenia have been reported in patients receiving Piperacillin/Tazobactam for a prolonged period of time (eg, after ≥21 days) and generally were reversible, systemic symptoms (eg, fever, rigors and chills) may also occur in some patients. Epistaxis and purpura have been reported in ≤1% patients.
Hepatic Effects: Transient increases in aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase and bilirubin can occur.
Renal Effects: Increases in serum concentrations of creatinine and blood urea nitrogen (BUN) may be observed. Urinary retention, dysuria, oliguria, hematuria and incontinence have been reported in ≤1% and proteinuria, pyuria, leukorrhea and vaginitis can also occur.
Effect on the Central Nervous System: Headache and insomnia have been reported in up to 7-8%, while agitation, dizziness and anxiety have been reported in ≤2% patients. Tremors, seizures, vertigo, confusion, hallucination, malaise and depression have been reported in ≤1% of patients receiving Piperacillin/Tazobactam. Neuromuscular excitability or seizures could occur in higher than recommended doses are given IV, especially in patients with kidney failure.
Local Reactions: Adverse reactions at the injection site have been reported in ≤1% of patients. Adverse local reactions include phlebitis, pain, inflammation, thrombophlebitis and edema.
Other Adverse Effects: Hypertension, chest pain, edema, moniliasis, rhinitis, dyspnea, hypotension, ileus, syncope and rigors have been reported in ≤2% of patients. Tachycardia, bradycardia, heart failure and myocardial infarction have been reported in at most 1%.
Piperacillin/Tazobactam contraindications
See also:
What is the most important information I should know about Piperacillin/Tazobactam?
Piperacillin/Tazobactam for injection is contraindicated in patients with a history of allergic reactions to any of the penicillins, cephalosporins, or β-lactamase inhibitors.
Active ingredient matches for Piperacillin/Tazobactam:
Piperacillin/Tazobactam
References
- PubChem. "piperacillin". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
- PubChem. "Tazobactam". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
- DrugBank. "Tazobactam". http://www.drugbank.ca/drugs/DB01606 (accessed September 17, 2018).
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Information checked by Dr. Sachin Kumar, MD Pharmacology
