Recommended Dosage and Treatment Duration for Piperacillin-Tazobactam
For most bacterial infections in adults, the recommended dosage of piperacillin-tazobactam is 4.5 g (4 g piperacillin/0.5 g tazobactam) administered intravenously every 6 hours. 1, 2
Adult Dosing Recommendations
Standard Dosing by Infection Type
- Nosocomial pneumonia: 4.5 g IV every 6 hours for 7-14 days 1
- Complicated intra-abdominal infections: 3.375-4.5 g IV every 6-8 hours for 5-7 days (up to 10 days for immunocompromised patients) 3, 2
- Complicated skin and soft tissue infections: 3.375-4.5 g IV every 6-8 hours for 7-14 days 3, 2
- Complicated urinary tract infections: 3.375-4.5 g IV every 6-8 hours for 5-10 days 3, 2, 4
- Necrotizing infections: 3.375-4.5 g IV every 6-8 hours plus clindamycin (600-900 mg IV every 8 hours) 3, 2
Dosing in Renal Impairment
- CrCl >40 mL/min: Standard dose (4.5 g every 6 hours)
- CrCl 20-40 mL/min: 3.375 g every 6 hours or 4.5 g every 8 hours
- CrCl <20 mL/min: 2.25 g every 6-8 hours
- Hemodialysis: 2.25 g every 8-12 hours plus 0.75 g after each dialysis session
- CAPD: 2.25 g every 8-12 hours 1
Pediatric Dosing Recommendations
By Age and Infection Type
- 2-9 months:
- Appendicitis/peritonitis: 90 mg/kg every 8 hours
- Nosocomial pneumonia: 90 mg/kg every 6 hours
- >9 months to <40 kg:
- Appendicitis/peritonitis: 112.5 mg/kg every 8 hours
- Nosocomial pneumonia: 112.5 mg/kg every 6 hours
- ≥40 kg: Use adult dosing 1
- Postmenstrual age >30 weeks: 80 mg/kg/dose IV every 6 hours (maximum 4.5 g per dose) 2
Treatment Duration
Treatment duration varies by infection type:
- Complicated urinary tract infections: 5-10 days 3, 2
- Intra-abdominal infections: 5-7 days after adequate source control 2
- Skin and soft tissue infections: 7-14 days depending on severity 2
- Lower respiratory tract infections: 7-10 days 2
- Nosocomial pneumonia: 7-14 days 1
- Bloodstream infections: 10-14 days 3
Administration Considerations
- Administer by intravenous infusion over at least 30 minutes 1
- For severe infections, consider extended infusion over 3-4 hours to optimize pharmacokinetic/pharmacodynamic properties 2
- Do not mix with aminoglycosides in the same solution due to physical incompatibility 1
Combination Therapy Recommendations
- Nosocomial pneumonia: Add an aminoglycoside, especially when Pseudomonas aeruginosa is suspected 1
- Necrotizing soft tissue infections: Combine with clindamycin (600-900 mg IV every 8 hours) to suppress toxin production 3, 2
- Suspected MRSA infections: Add vancomycin or linezolid 2
- Carbapenem-resistant Pseudomonas aeruginosa: Consider alternative agents such as colistin, ceftolozane/tazobactam, or ceftazidime/avibactam 3
Monitoring and Adjustments
- Monitor renal function and adjust dosing accordingly
- Consider procalcitonin monitoring to guide antimicrobial discontinuation in severe infections 3
- De-escalate to narrower therapy once culture results are available 2
- For patients with severe infections, optimize dosing to maintain drug concentrations above the MIC for the entire dosing interval 5
Special Considerations
- In critically ill patients with augmented renal clearance, higher doses or more frequent administration may be required 5
- For patients with multidrug-resistant organisms, follow local susceptibility patterns and consider combination therapy 3
- Source control (drainage, debridement) is essential for successful treatment of complicated infections 2
Piperacillin-tazobactam remains a valuable broad-spectrum antibiotic for various severe infections, but dosing and duration must be tailored to the specific infection type, patient characteristics, and local resistance patterns.