Piperacillin/Tazobactam for Wound Infections
Piperacillin/tazobactam (Pip/Taz) is recommended for moderate to severe wound infections at a dosage of 3.375g IV every 6-8 hours for adults with normal renal function. 1, 2
Indications for Piperacillin/Tazobactam
- Recommended for moderate to severe skin and soft tissue infections, particularly those that are polymicrobial or where anaerobic coverage is needed 1
- First-line therapy for severe wound infections with suspected mixed aerobic-anaerobic pathogens 1
- Particularly effective for necrotizing skin and soft tissue infections as part of a broad empiric regimen 1
- Indicated for surgical site infections involving the trunk, axilla, or perineum 1
- Appropriate for severe infections requiring intravenous therapy, including those with systemic symptoms 3
Dosing Recommendations
Adult Dosing
- Standard dosage: 3.375g IV every 6 hours or 4.5g every 8 hours for adults with normal renal function 1, 2
- For nosocomial pneumonia: 4.5g every 6 hours 2
- Renal adjustment required for creatinine clearance <40 mL/min 2:
- CrCl 20-40 mL/min: 2.25g every 6 hours
- CrCl <20 mL/min: 2.25g every 8 hours
- Hemodialysis: 2.25g every 12 hours plus 0.75g after each dialysis session
Pediatric Dosing
- For children >9 months to <40kg: 112.5 mg/kg (100 mg piperacillin/12.5 mg tazobactam) every 8 hours 2
- For children 2-9 months: 90 mg/kg (80 mg piperacillin/10 mg tazobactam) every 8 hours 2
- Children >40kg should receive adult dosing 2
Administration
- Administer by intravenous infusion over 30 minutes 2
- Reconstitute with compatible diluent (0.9% sodium chloride, sterile water for injection, or dextrose 5%) 2
- Further dilute to a volume of 50-150 mL before administration 2
- Not compatible with Lactated Ringer's solution 2
Clinical Efficacy
- Piperacillin/tazobactam has demonstrated high clinical success rates (90-93%) in treating skin and soft tissue infections 4, 5
- Provides broad-spectrum coverage against most Gram-positive and Gram-negative aerobic bacteria and anaerobic bacteria, including many beta-lactamase producing pathogens 6
- Particularly useful for polymicrobial infections, which are common in wound infections 6, 7
- In clinical trials, piperacillin/tazobactam was superior to ticarcillin/clavulanic acid for community-acquired infections 6
Specific Wound Types
- For necrotizing fasciitis: Combine with vancomycin or linezolid for empiric therapy until culture results are available 1
- For surgical site infections following operations on intestinal tract or female genitalia: Piperacillin/tazobactam as monotherapy is appropriate 1
- For palm thorn puncture infections requiring IV therapy: Piperacillin/tazobactam is recommended for severe infections 3
- For animal or human bite wounds with severe infection: Consider piperacillin/tazobactam for broad coverage 8
Treatment Duration
- For uncomplicated wound infections with adequate source control: 5-7 days 8
- For complicated infections: Continue until clinical improvement is observed, typically 7-10 days 8
- For necrotizing infections: Longer duration may be necessary, guided by clinical response 1
Potential Adverse Effects
- Most common adverse events are gastrointestinal symptoms (particularly diarrhea) and skin reactions 6
- Higher incidence of adverse events when combined with aminoglycosides 6
- Monitor for allergic reactions, which may require discontinuation 4
Important Considerations
- Surgical debridement and proper wound care are essential components of treatment alongside antibiotic therapy 1, 8
- For elderly patients, monitor renal function closely and adjust dosing accordingly 8, 2
- Consider local resistance patterns when selecting empiric therapy 1
- In settings with high prevalence of MRSA, addition of vancomycin or linezolid may be necessary 1
Piperacillin/tazobactam remains a valuable broad-spectrum antibiotic for moderate to severe wound infections, particularly those that are polymicrobial or involve anaerobic pathogens. Its efficacy, safety profile, and broad coverage make it an excellent choice when empiric therapy is needed before culture results are available.