Piperacillin-Tazobactam
General Information
Anti-pseudomonal penicillin and beta-lactamase inhibitor. Do NOT use if patient is allergic to penicillin.
For adult critical care areas only: Where using piperacillin-tazobactam by continuous Infusion see Adult Intensive Care Medication Guidelines
Restricted formulary antimicrobial: For details see OUH netFormulary
AWaRe antibiotic classification: 'Watch'. Use as per guidelines. All other indications to be discussed with Micro/ID.
Dosage
|
|
Intravenous piperacillin-tazobactam |
|
Standard dose |
4.5g TDS* |
|
Pseudomonas or neutropenic sepsis |
4.5g QDS or 4.5g TDS extended infusion (over 3-4 hours) |
|
Elastomeric device |
13.5g over 24hrs |
*consider 4.5g QDS in obese patients, depending on renal function
Renal Impairment
|
eGFR (mL/min/1.73m2) |
piperacillin-tazobactam dose |
|
40 and over |
No dose adjustment |
|
20-40 |
Max 4.5g TDS |
|
Less than 20 |
Max 4.5g BD |
|
HD/HDF/High Flux |
Max 4.5g BD. Dialysed; give after dialysis |
|
PD |
Max 4.5g BD. Not dialysed |
Hepatic impairment
No dose adjustment required in hepatic impairment.
Notable interactions
Methotrexate: Piperacillin can reduce excretion of methotrexate (increased risk of toxicity).
Vitamin K antagonists: Appropriate monitoring should be undertaken. It would be prudent to monitor coagulation status within 3 days of starting or stopping a penicillin.
This is not a complete list. Please see the BNF, Summary of Product Characteristics or speak to a pharmacist.
Pregnancy and breastfeeding
Both piperacillin and tazobactam must be considered when assessing suitability. Piperacillin is generally considered safe. There is very limited human data on tazobactam.
Pregnancy
Caution. Limited human data. Animal data suggests tazobactam is low risk. Discuss with pharmacy.
Breastfeeding
Caution. No published human evidence of safety. Small amounts of piperacillin in breast milk. Quantity of tazobactam in breastmilk not studied. Discuss with pharmacy.
Additional information
4.5g of piperacillin-tazobactam contains 216mg sodium. This is equivalent to 10.8% of the WHO recommended maximum daily intake of sodium for an adult
References
- Piperacillin/Tazobactam 4 g/0.5 g powder for solution for infusion [online]. Manufacturer - Esteve Pharmaceuticals (formerly Intrapharm Laboratories) – last updated: 2022 Mar. Accessed via: www.emc.medicines.org.uk [Accessed 2023 Sep 6].
- The Renal Drug Database. Tazocin (Piperacillin/tazobactam) - last updated: 2019 Sep 9. Accessed via: https://renaldrugdatabase.com [Accessed 2023 Sep 6].
- UK Medicines Information. How should antibiotics be doses in obesity – last updated 2017 Mar 1. Accessed via: https://www.gloshospitals.nhs.uk/media/documents/Obese_Dosing_2016_update.pdf [Accessed 21/9/23].
- Specialist Pharmacy Service – Lactation Safety Information: Piperacillin-tazobactam – last updated 2020 Aug 3. Accessed via: https://www.sps.nhs.uk/medicines [Accessed 21/9/23].
- Briggs GG, Freeman RK, Towers CV, Forinash AB. Briggs Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk [online]. Lippincott Williams & Wilkins; 2021 Feb 18. Accessed via https://online.lexi.com [Accessed 2022 Nov 30].
- UK Teratology Information Service - USE OF PENICILLINS IN PREGNANCY – last updated 2019 Jan. Accessed via: https://www.uktis.org/ [Accessed 2023 Sep 6]