What is the dosing for Zosyn (piperacillin/tazobactam)?

From the Guidelines

Zosyn (piperacillin-tazobactam) should be dosed at 3.375g (3g piperacillin/0.375g tazobactam) intravenously every 6 hours for most standard infections in adults with normal renal function, as recommended by the most recent guidelines 1.

Key Considerations

• For more severe infections, including pseudomonal pneumonia or neutropenic fever, the dose may be increased to 4.5g (4g piperacillin/0.5g tazobactam) every 6 hours, as suggested by previous guidelines 1.
• Dosage adjustments are necessary for patients with renal impairment:
  • For creatinine clearance 20-40 mL/min, use 2.25g every 6 hours
  • For clearance <20 mL/min, use 2.25g every 8 hours
  • For hemodialysis patients, use 2.25g every 12 hours plus an additional dose after dialysis.
• Extended infusion protocols (administering over 3-4 hours) are increasingly used to optimize drug efficacy by maintaining concentrations above the minimum inhibitory concentration for longer periods.

Treatment Duration and Spectrum

• Treatment duration typically ranges from 7-14 days depending on the infection type and severity.
• Zosyn provides broad-spectrum coverage against many gram-positive, gram-negative, and anaerobic bacteria, making it valuable for complicated infections, but should be used judiciously to prevent antimicrobial resistance.

Pediatric Dosage

• For pediatric patients beyond the neonatal period, the dosage is 60-75 mg/kg/dose of the piperacillin component every 6 hours IV, or 10-13 mg/kg/dose every 8 hours IV, as indicated in the guidelines 1.

From the FDA Drug Label

The usual total daily dosage of piperacillin and tazobactam for injection for adult patients with indications other than nosocomial pneumonia is 3.375 g every six hours [totaling 13.5 g (12 g piperacillin/1. 5 g tazobactam)], to be administered by intravenous infusion over 30 minutes. Initial presumptive treatment of adult 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)], administered by intravenous infusion over 30 minutes. The recommended daily dosage of piperacillin and tazobactam for injection for patients with renal impairment administered by intravenous infusion over 30 minutes is described in Table 1

The recommended dosing for Zosyn (piperacillin and tazobactam) is as follows:

• For adult patients with indications other than nosocomial pneumonia: 3.375 g every 6 hours
• For adult patients with nosocomial pneumonia: 4.5 g every 6 hours plus an aminoglycoside
• For patients with renal impairment, the dosage should be reduced based on the degree of renal impairment, as described in Table 1 2 2 2

From the Research

Zosyn Dosing Information

• Zosyn, also known as piperacillin/tazobactam, is a beta-lactam/beta-lactamase inhibitor combination with a broad spectrum of antibacterial activity 3.
• The typical dosing regimen for piperacillin/tazobactam is not explicitly stated in the provided studies, but its effectiveness in various infections is discussed.
• Piperacillin/tazobactam is used to treat patients with lower respiratory tract, intra-abdominal, urinary tract, gynaecological, and skin/soft tissue infections, as well as fever in patients with neutropenia 3.

Comparison with Other Antibiotics

• Studies have compared the effectiveness of piperacillin/tazobactam with carbapenems in treating bacterial infections 4, 5, 6, 7.
• The results suggest that piperacillin/tazobactam may be less effective than carbapenems in some cases, particularly in treating bloodstream infections due to bacteria producing chromosomal AmpC beta-lactamase 6.
• However, piperacillin/tazobactam may be a suitable alternative to carbapenems in certain situations, such as in areas with low frequency of OXA-1 co-production by ESBL-producing E. coli 5.

Adverse Events and Outcomes

• The incidence of adverse events with piperacillin/tazobactam is higher when the combination is given in combination with an aminoglycoside than when given as monotherapy 3.
• Studies have reported varying outcomes, including all-cause short-term mortality, adverse events, and secondary infections, when comparing piperacillin/tazobactam with carbapenems 4, 6, 7.
• The certainty of evidence for these outcomes is often low or very low, indicating the need for further research to draw robust conclusions 7.