What is the recommended dosage for piperacillin-tazobactam (Pip-Taz)?

Piperacillin-Tazobactam (Pip-Taz) Dosage Recommendations

The recommended adult dosage for piperacillin-tazobactam is 3.375-4.5 g IV every 6-8 hours, with specific dosing based on infection type, severity, and renal function. 1

Adult Dosing Guidelines

Standard Infections

• 3.375 g IV every 6 hours (13.5 g total daily dose) for most infections 1
• Administered as intravenous infusion over 30 minutes 1

Severe Infections

• 4.5 g IV every 6 hours (18 g total daily dose) for nosocomial pneumonia 1
• Consider extended infusion (3-4 hours) for critically ill patients with severe infections to improve clinical outcomes 2, 3

Specific Clinical Scenarios

• Intra-abdominal infections: 3.375 g every 6 hours or 4.5 g every 8 hours IV 2
• Skin and soft tissue infections: 3.375 g every 6 hours or 4.5 g every 8 hours IV 2
• Gram-negative enteric bacilli infections: 240 mg/kg/day divided every 8 hours (up to 18 g daily) 2

Pediatric Dosing Guidelines

By Age and Indication

• 2-9 months: 90 mg/kg (80 mg piperacillin/10 mg tazobactam) every 8 hours for appendicitis/peritonitis; every 6 hours for nosocomial pneumonia 1
• >9 months: 112.5 mg/kg (100 mg piperacillin/12.5 mg tazobactam) every 8 hours for appendicitis/peritonitis; every 6 hours for nosocomial pneumonia 1

General Pediatric Dosing

• 240-300 mg/kg/day of piperacillin component divided in 3-4 doses 2
• Maximum daily dose: 16 g piperacillin/2 g tazobactam 4
• For complicated intra-abdominal infections: 200-300 mg/kg/day of piperacillin component every 6-8 hours 2

Dosing in Renal Impairment

• Dosage adjustment required for patients with creatinine clearance ≤40 mL/min 1
• For CrCl 20-40 mL/min: Consider 4.5 g or 3.375 g every 8 hours as prolonged infusions 5
• For CrCl 1-19 mL/min: Consider 4.5 g or 3.375 g every 12 hours as prolonged infusions 5

Administration Considerations

Extended Infusion Strategy

• Extended infusion (3-4 hours) provides better pharmacodynamic target attainment compared to standard 30-minute infusions 2, 3
• For critically ill patients with septic shock, extended or continuous infusions may improve clinical cure rates 2
• Consider 3.375 g IV infused over 4 hours every 8 hours or 4.5 g IV infused over 3 hours every 6 hours for resistant organisms 5

Combination Therapy

• For nosocomial pneumonia, consider combination with an aminoglycoside 1
• For necrotizing skin/soft tissue infections, may combine with vancomycin or linezolid for broader coverage 2

Clinical Pearls

• Piperacillin-tazobactam achieves 16-85% of plasma concentrations in skin, muscle, lung, gallbladder, and intestinal mucosa within 30 minutes of infusion 6
• Plasma and tissue levels remain above the MIC90s of major pathogens for approximately 2 hours post-administration 6
• Extended infusion dosing (4 hours) of 3.375 g every 8 hours has shown similar efficacy to traditional dosing for piperacillin-resistant organisms 7
• In critically ill patients with high APACHE II scores, extended infusion may reduce 14-day mortality compared to intermittent infusion 3

Common Pitfalls to Avoid

• Underdosing in severe infections, particularly those caused by Pseudomonas aeruginosa 3
• Failure to adjust dosing based on renal function 1, 5
• Not considering extended infusion strategies for critically ill patients 2, 3
• Inadequate duration of therapy (typically 5-14 days depending on infection site and clinical response) 2