What is the recommended treatment and dosage for Piperacillin (Tazobactam)?

Piperacillin-Tazobactam: Recommended Treatment and Dosage

For most hospital-acquired infections, administer piperacillin-tazobactam 4.5 g IV every 6 hours (totaling 18 g daily), infused over 30 minutes, with treatment duration of 5-14 days depending on infection site and severity. 1

Standard Dosing by Clinical Indication

Nosocomial Pneumonia (Hospital-Acquired/Ventilator-Associated)

• Dose: 4.5 g IV every 6 hours (4 g piperacillin/0.5 g tazobactam) 2, 1
• Infusion time: 30 minutes 1
• Duration: 7-14 days 2, 3
• Combination therapy: Add vancomycin 15 mg/kg IV every 8-12 hours or linezolid 600 mg IV every 12 hours for MRSA coverage in high-risk patients 2
• Note: Consider adding an aminoglycoside (amikacin 15-20 mg/kg daily, gentamicin 5-7 mg/kg daily, or tobramycin 5-7 mg/kg daily) for patients with prior IV antibiotic use within 90 days or high mortality risk 2

Intra-Abdominal Infections

• Dose: 3.375 g IV every 6 hours (totaling 13.5 g daily) 1
• Alternative for critically ill: 4.5 g IV every 6 hours, or 16 g/2 g by continuous infusion 2
• Duration: 5-7 days after adequate source control 3
• Loading dose for critically ill: 6 g/0.75 g, then 4 g/0.5 g every 6 hours 2

Skin and Soft Tissue Infections

• Uncomplicated: 3.375 g IV every 6 hours 1
• Necrotizing infections: 4.5 g IV every 6 hours, combined with vancomycin or linezolid for MRSA coverage 2, 3
• Duration: 5-10 days, extending if infection has not improved 3

Community-Acquired Pneumonia with Risk Factors

• Dose: 4.5 g IV every 6 hours when empiric Pseudomonas coverage needed 2
• Alternative dosing: Cefepime 2 g every 8 hours, ceftazidime 2 g every 8 hours, meropenem 1 g every 8 hours, or imipenem 500 mg every 6 hours 2
• Duration: Based on clinical response, typically 5-7 days 2

Carbapenem-Resistant Pseudomonas aeruginosa (CRPA)

• Dose: 3-4 g IV every 6 hours when susceptibility testing confirms susceptibility 2
• Duration: 5-10 days for complicated UTI/intra-abdominal infections; 10-14 days for pneumonia/bloodstream infections 2

Pediatric Dosing (≥2 Months, Normal Renal Function)

Ages 2-9 Months

• Appendicitis/peritonitis: 90 mg/kg (80 mg piperacillin/10 mg tazobactam) every 8 hours 1
• Nosocomial pneumonia: 90 mg/kg every 6 hours 1

Ages >9 Months (Up to 40 kg)

• Appendicitis/peritonitis: 112.5 mg/kg (100 mg piperacillin/12.5 mg tazobactam) every 8 hours 1
• Nosocomial pneumonia: 112.5 mg/kg every 6 hours 1

Renal Dose Adjustments

• CrCl ≤40 mL/min: Reduce dosage based on degree of impairment 1
• Dialysis patients: Dosage reduction required 1

Critical Administration Considerations

Infusion Optimization

• Standard infusion: 30 minutes 1
• Prolonged infusion for high MIC organisms (8-16 mg/L): Infuse over 3 hours to maintain serum concentration above MIC for 86.82% of dosing interval versus 42.84% with standard infusion 4
• Continuous infusion option: 16 g/2 g daily for critically ill patients with intra-abdominal infections 2

Combination Therapy Precautions

• Aminoglycosides: Reconstitute, dilute, and administer separately; Y-site co-administration possible under specific conditions 1
• Never mix directly with aminoglycosides in the same container 1

Common Pitfalls to Avoid

1. Underdosing nosocomial pneumonia: Use 4.5 g every 6 hours, not the lower 3.375 g dose 2, 1
2. Inadequate MRSA coverage: Add vancomycin or linezolid for patients with prior IV antibiotics within 90 days or in units where MRSA prevalence >20% 2
3. Prolonged therapy without reassessment: Patients with ongoing infection beyond 7 days warrant diagnostic investigation 2
4. Monotherapy for severe infections: Combine with aminoglycoside for high-risk patients or structural lung disease 2

Antimicrobial Stewardship Principles

• Reserve for moderate-to-severe infections requiring broad-spectrum coverage 3
• Narrow therapy once culture results available 3
• Avoid empiric use for community-acquired infections unless validated local risk factors for Pseudomonas present 2