Pediatric Dosing of Piperacillin-Tazobactam (Piptaz)
For pediatric patients 9 months and older, administer piperacillin-tazobactam at 100 mg/kg (of piperacillin component) every 8 hours for appendicitis/peritonitis and every 6 hours for nosocomial pneumonia; for infants 2-9 months, reduce the dose to 80 mg/kg every 8 hours for appendicitis/peritonitis and every 6 hours for nosocomial pneumonia. 1
Standard Dosing by Age and Indication
Infants 2-9 Months
- Appendicitis/Peritonitis: 90 mg/kg (80 mg piperacillin/10 mg tazobactam) every 8 hours 1
- Nosocomial Pneumonia: 90 mg/kg (80 mg piperacillin/10 mg tazobactam) every 6 hours 1
- The dose reduction in this age group accounts for immature renal function, which affects drug clearance 2
Children >9 Months 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 (100 mg piperacillin/12.5 mg tazobactam) every 6 hours 1
Children >40 kg
- Use adult dosing: 3.375 g every 6 hours for most infections, or 4.5 g every 6 hours for nosocomial pneumonia 1
Alternative Guideline-Based Dosing
For complicated intra-abdominal infections, the Surgical Infection Society and IDSA recommend a broader dosing range of 200-300 mg/kg/day (of piperacillin component) divided every 6-8 hours 3. This higher dosing range may be appropriate for severe infections or when undrained abscesses are present 3.
Maximum Daily Dose
The maximum daily dose should not exceed 24,000 mg/day (based on piperacillin component), regardless of weight-based calculations 4.
Administration Details
- Infusion time: Administer by intravenous infusion over 30 minutes 1
- Duration of therapy: Typically 7-10 days for most infections 1
- Renal impairment: Dosing adjustments have not been established for pediatric patients with renal impairment 1
Critical Considerations for Optimal Dosing
Extended Infusions for Resistant Organisms
Standard 0.5-hour infusions may be inadequate for organisms with higher MICs (≥16 mg/L), particularly in children older than 6 months 5. For infections caused by organisms with MICs of 16 mg/L:
- Infants 2-6 months: 90 mg/kg every 8 hours as a 2-hour infusion achieves optimal target attainment 5
- Children >6 months to 6 years: 100 mg/kg every 8 hours as a 4-hour infusion achieves optimal target attainment 5
For critically ill children aged 1-6 years with suspected Pseudomonas aeruginosa (MIC 16-32 mg/L), 100 mg/kg every 6 hours as a 3-hour prolonged infusion or 400 mg/kg as a 24-hour continuous infusion are the only regimens that achieve optimal pharmacodynamic targets 6.
Common Pitfalls to Avoid
- Do not use the same dose for all age groups: Infants 2-9 months require dose reduction due to immature renal function 2
- Do not underdose nosocomial pneumonia: This indication requires more frequent dosing (every 6 hours vs every 8 hours) 1
- Do not use standard infusions for resistant organisms: Consider extended infusions (2-4 hours) when MICs are ≥16 mg/L 6, 5
- Do not mix with aminoglycosides in the same solution: These must be reconstituted and administered separately, though Y-site co-administration is acceptable under certain conditions 1