Piperacillin-Tazobactam (Piptaz) Dosing in Pediatric Patients
For pediatric patients aged 2 months and older weighing up to 40 kg, the FDA-approved dosing is 90 mg/kg (based on piperacillin component) every 8 hours for appendicitis/peritonitis and 90 mg/kg every 6 hours for nosocomial pneumonia, with infants 2-9 months receiving 90 mg/kg every 8 hours for appendicitis/peritonitis and every 6 hours for nosocomial pneumonia. 1
Standard FDA-Approved 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
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
Maximum Daily Dose
- The maximum daily dose should not exceed 24,000 mg/day (based on piperacillin component), regardless of weight-based calculations 2
Administration Guidelines
- All doses should be administered by intravenous infusion over 30 minutes 1
- Extended infusions (3-4 hours) have been studied in children and may optimize pharmacodynamic targets, particularly for critically ill patients or infections with higher MICs 3, 4
Severe Infections and Complicated Intra-Abdominal Infections
- For severe infections or when undrained abscesses are present, the Surgical Infection Society and IDSA recommend a dosing range of 200-300 mg/kg/day (of piperacillin component) divided every 6-8 hours 2
- This higher dosing range is appropriate when treating critically ill children or infections caused by organisms with elevated MICs 4
Critical Dosing Considerations for Optimal Outcomes
For Critically Ill Children (Ages 1-6 Years)
- Recent pharmacokinetic data demonstrate that 100 mg/kg every 6 hours administered as a 3-hour prolonged infusion achieves optimal probability of target attainment (≥90%) at the CLSI susceptibility breakpoint of 16 μg/mL against Pseudomonas aeruginosa 4
- Standard 30-minute infusions may be inadequate for critically ill children with severe infections 4
For Infants <61 Days
- PMA-based dosing is recommended: 100 mg/kg every 8 hours for PMA ≤30 weeks, 80 mg/kg every 6 hours for PMA 30-35 weeks, and 80 mg/kg every 4 hours for PMA 35-49 weeks 5
- This approach accounts for developmental changes in drug clearance and achieves therapeutic targets in 90% of infants 5
Common Pitfalls to Avoid
- Do not underdose critically ill children: Standard FDA dosing may not achieve adequate drug exposure in PICU patients or those with augmented renal clearance 4
- Avoid ordering errors: Dosing should be calculated based on the piperacillin component (not total piperacillin-tazobactam), as this is the standard in pediatric references 6
- Consider extended infusions when feasible: Extended infusions (3-4 hours) are feasible in 92% of hospitalized children and optimize pharmacodynamic targets 6
- Adjust for renal impairment: Dosing in pediatric patients with renal impairment has not been established by the FDA; use clinical judgment and consider therapeutic drug monitoring 1
Practical Implementation
For most hospitalized children with moderate-to-severe infections:
- Start with FDA-approved dosing (90-112.5 mg/kg every 6-8 hours based on age and indication) 1
- Consider extended infusions (3-4 hours) for critically ill patients or when treating Pseudomonas infections 4
- For life-threatening infections in PICU patients, consider 100 mg/kg every 6 hours as a 3-hour infusion to maximize probability of target attainment 4
Compatibility considerations: