Piperacillin/Tazobactam Dosing Recommendations
The standard recommended dosage of Piperacillin/Tazobactam for adults with serious infections is 3.375-4.5 grams administered intravenously every 6 hours, with a maximum daily dose of 18 grams of piperacillin component. 1, 2
Standard Adult Dosing by Indication
- For most serious infections: 3.375-4.5g IV every 6 hours 1
- For nosocomial pneumonia: 4.5g IV every 6 hours 2
- For necrotizing infections of skin, fascia, and muscle: 3.37g every 6-8 hours IV 3
- For mixed infections requiring broad coverage: 4.5g IV every 6 hours 3, 1
- For complicated intra-abdominal infections: 3.375-4.5g IV every 6 hours 3, 1
- For carbapenem-resistant Pseudomonas aeruginosa susceptible to other antimicrobials: 3.375-4.5g IV every 6 hours 3
Dosing in Renal Impairment
- Creatinine clearance >40 mL/min: Standard dose (3.375-4.5g every 6 hours) 2
- Creatinine clearance 20-40 mL/min: 2.25g every 6 hours (for standard infections) or 3.375g every 6 hours (for nosocomial pneumonia) 2
- Creatinine clearance <20 mL/min: 2.25g every 8 hours (for standard infections) or 2.25g every 6 hours (for nosocomial pneumonia) 2
- Hemodialysis: 2.25g every 12 hours (for standard infections) or 2.25g every 8 hours (for nosocomial pneumonia), plus 0.75g after each dialysis session 2
- CAPD: 2.25g every 12 hours (for standard infections) or 2.25g every 8 hours (for nosocomial pneumonia) 2
Pediatric Dosing
- For children 2 months to 9 months with appendicitis/peritonitis: 90 mg/kg (80 mg piperacillin and 10 mg tazobactam) every 8 hours 2
- For children 2 months to 9 months with nosocomial pneumonia: 90 mg/kg (80 mg piperacillin and 10 mg tazobactam) every 6 hours 2
- For children older than 9 months: 112.5 mg/kg (100 mg piperacillin and 12.5 mg tazobactam) every 8 hours for appendicitis/peritonitis or every 6 hours for nosocomial pneumonia 2
- Children weighing over 40 kg with normal renal function should receive the adult dose 2
Administration Guidelines
- Standard administration: Intravenous infusion over 30 minutes 2
- For critically ill patients: Extended infusion (3-4 hours) may be considered to maintain plasma concentrations above MIC for optimal efficacy 1, 4
- Duration of therapy: Typically 7-14 days, depending on the infection site and severity 2
Important Considerations
- Compatibility: Piperacillin/tazobactam should be administered separately from aminoglycosides due to in vitro inactivation 2
- For critically ill patients or those with severe infections, higher doses (4.5g) and extended infusions may provide better pharmacodynamic target attainment 4, 5
- Monte Carlo simulations suggest that prolonged infusions (3-4 hours) of 4.5g or 3.375g achieve higher probability of target attainment compared to standard 30-minute infusions 5
- Safety profile: Piperacillin/tazobactam has been shown to be well-tolerated even when administered as IV push through peripheral lines 6