What is the recommended dose and frequency of Zosyn (Piperacillin/Tazobactam)?

From the Guidelines

Zosyn (piperacillin-tazobactam) should be dosed at 3.37 g every 6–8 h IV for the treatment of mixed infections, as recommended by the Infectious Diseases Society of America guidelines 1. The dosage of Zosyn can vary depending on the type of infection being treated, with the guidelines providing specific recommendations for different types of infections, including mixed infections, Streptococcus, Staphylococcus aureus, and Clostridium species. Some key points to consider when dosing Zosyn include:

• For adults, the recommended dosage is 3.37 g every 6–8 h IV for mixed infections 1.
• For pediatric patients beyond the neonatal period, the recommended dosage is 60–75 mg/kg/dose of the piperacillin component every 6 h IV or 10–13 mg/kg/dose every 8 h IV 1.
• The guidelines also recommend adjusting the dosage based on renal function, although specific recommendations for renal impairment are not provided in the guidelines 1. It is essential to monitor renal function during therapy and be aware of potential side effects, including diarrhea, headache, insomnia, nausea, and allergic reactions. The typical duration of therapy ranges from 7-14 days, depending on the infection type and severity, and Zosyn provides broad-spectrum coverage against many gram-positive, gram-negative, and anaerobic bacteria by inhibiting cell wall synthesis through the piperacillin component, while the tazobactam protects piperacillin from degradation by beta-lactamase enzymes.

From the FDA Drug Label

The usual daily dosage of piperacillin and tazobactam for injection for adults is 3.375 g every six hours totaling 13.5 g (12 g piperacillin/ 1.5 g tazobactam). Adult Patients with Nosocomial Pneumonia: Initial presumptive treatment of patients with nosocomial pneumonia should start with piperacillin and tazobactam for injection at a dosage of 4.5 g every six hours plus an aminoglycoside, totaling 18 g (16 g piperacillin/2 g tazobactam). Pediatric Patients by Indication and Age: * 2 months to 9 months: 90 mg/kg (80 mg piperacillin/10 mg tazobactam) every 8 hours for Appendicitis and/or Peritonitis, and every 6 hours for Nosocomial Pneumonia * Older than 9 months: 112.5 mg/kg (100 mg piperacillin/12.5 mg tazobactam) every 8 hours for Appendicitis and/or Peritonitis, and every 6 hours for Nosocomial Pneumonia

The recommended dose and frequency of Zosyn (piperacillin and tazobactam) varies based on the patient's age, weight, and renal function, as well as the indication for use.

• For adult patients with indications other than nosocomial pneumonia, the usual dose is 3.375 g every 6 hours.
• For adult patients with nosocomial pneumonia, the initial dose is 4.5 g every 6 hours.
• For pediatric patients, the dose is based on weight and indication, ranging from 90 mg/kg every 6-8 hours for patients 2 months to 9 months, to 112.5 mg/kg every 6-8 hours for patients older than 9 months 2.

From the Research

Zosyn Dose and Frequency

• Zosyn, also known as piperacillin/tazobactam, is a combination antibiotic used to treat various bacterial infections.
• The dose and frequency of Zosyn can vary depending on the type and severity of the infection, as well as the patient's renal function and other factors.
• According to the study 3, the recommended dosage for Zosyn is 2 g of piperacillin every 8 hours or 1 g every 6 hours in the dialysate for patients undergoing continuous ambulatory peritoneal dialysis.
• Another study 4 compared the pharmacodynamics of Zosyn with other antibiotics, such as imipenem-cilastatin and meropenem, for the treatment of skin and soft tissue infections. The study found that Zosyn 3.375 g every 6 hours achieved a high likelihood of achieving bactericidal exposure in serum and blister fluid.
• The study 5 used piperacillin/tazobactam 4 g/500 mg, intravenously every 6 hours for 7-14 days to treat hospital-acquired or ventilator-associated bacterial pneumonia.
• The study 6 used piperacillin-tazobactam 4.5 g every 6 hours to treat bloodstream infections caused by AmpC β-lactamase-producing gram-negative bacteria.

Dosage Recommendations

• For patients with normal renal function, the typical dose of Zosyn is 3.375 g every 6 hours or 4.5 g every 8 hours 4.
• For patients with renal impairment, the dose of Zosyn may need to be adjusted based on the patient's creatinine clearance 3.
• The duration of treatment with Zosyn can vary depending on the type and severity of the infection, but is typically 7-14 days 5.