What is the dose of Zosyn (Piperacillin/Tazobactam)?

From the Guidelines

Zosyn (piperacillin-tazobactam) should be dosed at 3.375 grams intravenously every 6 hours for most adult infections, with each dose administered over 30 minutes, as recommended by the most recent and highest quality study 1.

Key Considerations for Dosing

• For more severe infections, the dose may be increased to 4.5 grams every 6 hours.
• Dosing requires adjustment for patients with renal impairment:
  • For creatinine clearance 20-40 mL/min, use 2.25 grams every 6 hours.
  • For clearance less than 20 mL/min, use 2.25 grams every 8 hours.
• Hemodialysis patients should receive 2.25 grams every 12 hours plus an additional 0.75 grams after each dialysis session.

Treatment Duration and Spectrum of Activity

• Treatment duration typically ranges from 7-14 days depending on the infection type and severity.
• Zosyn combines piperacillin (an extended-spectrum penicillin) with tazobactam (a beta-lactamase inhibitor) to provide broad-spectrum coverage against many gram-positive, gram-negative, and anaerobic bacteria, making it effective for complicated infections including intra-abdominal infections, pneumonia, skin infections, and febrile neutropenia, as supported by guidelines from the Infectious Diseases Society of America 1.

From the FDA Drug Label

1. 2 Dosage in Adult Patients with Indications Other Than Nosocomial Pneumonia

The usual total daily dosage of piperacillin and tazobactam for injection for adult patients with indications other than nosocomial pneumonia is 3.375 g every six hours [totaling 13.5 g (12 g piperacillin/1. 5 g tazobactam)], to be administered by intravenous infusion over 30 minutes.

• Dosage: The usual total daily dosage is 3.375 g every six hours, totaling 13.5 g (12 g piperacillin/1.5 g tazobactam) for adult patients with indications other than nosocomial pneumonia.
• Administration: Administered by intravenous infusion over 30 minutes.
• Duration: The usual duration of treatment is from 7 to 10 days. 2

From the Research

Zosyn Dosing

• Zosyn, also known as piperacillin/tazobactam, is a combination antibiotic used to treat various infections.
• The dosing of Zosyn can be affected by several factors, including renal function and the severity of the infection.

Factors Affecting Zosyn Dosing

• Renal function: Patients with augmented renal clearance (ARC) may require higher doses of Zosyn to achieve optimal antibiotic exposure 3, 4, 5.
• Severity of infection: Patients with severe infections may require higher doses of Zosyn to ensure adequate treatment 6.
• Minimum inhibitory concentration (MIC): The MIC of the infecting organism can affect the dosing of Zosyn, with higher MICs requiring higher doses 4, 5.

Dosing Regimens

• Standard dosing regimens for Zosyn may not be sufficient for critically ill patients with ARC, and higher doses may be needed to achieve optimal antibiotic exposure 3, 4, 5.
• Continuous infusion of Zosyn may be more effective than intermittent dosing in achieving optimal antibiotic exposure 5.
• Dosing regimens of 16g/2g/day or 20g/2.5g/24h may be needed to achieve optimal antibiotic exposure in patients with ARC 5.

Nephrotoxicity

• Zosyn has been associated with nephrotoxicity in some patients, particularly those with pre-existing renal impairment 6, 7.
• The risk of nephrotoxicity may be higher with higher doses of Zosyn, and patients should be monitored closely for signs of renal impairment 6, 7.