Piperacillin-Tazobactam Pediatric Dosing
For pediatric patients with normal renal function, administer piperacillin-tazobactam at 80-100 mg/kg (of the piperacillin component) every 6-8 hours, with the specific dose and interval determined by age, indication, and infection severity. 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
Children >9 Months to 6 Years
- 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
Broader Guideline Recommendations
The Infectious Diseases Society of America provides a wider dosing range of 200-300 mg/kg/day of the piperacillin component, divided every 6-8 hours for complicated intra-abdominal infections 2. This broader range allows for dose escalation in severe infections or when undrained abscesses may be present, as β-lactam dosages should be maximized in these scenarios 2.
For endocarditis and other severe infections, the American Heart Association recommends 240 mg/kg/day divided every 8 hours, up to a maximum of 18 g daily 2.
Administration Guidelines
- Infusion duration: 30 minutes for standard dosing 1
- Maximum daily dose: Do not exceed 24 g/day (24,000 mg) of piperacillin 3
- Administer by intravenous infusion; do not mix with other drugs in the same syringe or infusion bottle 1
Important Clinical Considerations
Extended infusions (3-4 hours) may be superior for critically ill children, particularly when targeting resistant organisms with MICs of 16-32 mg/liter 4, 5. Research demonstrates that 100 mg/kg every 6 hours infused over 3 hours achieves optimal pharmacodynamic targets against Pseudomonas aeruginosa at the Clinical Laboratory Standards Institute breakpoint of 16 mg/liter 4.
Weight-based dosing should use total body weight, not ideal body weight 2. For neonates with postmenstrual age ≤30 weeks, reduce to 80 mg/kg/dose every 8 hours; for those >30 weeks, use 80 mg/kg/dose every 6 hours 3.
Common Pitfalls to Avoid
- Do not use in patients with renal impairment without dose adjustment—the FDA label does not provide pediatric renal dosing adjustments, requiring clinical judgment and potentially therapeutic drug monitoring 1
- Avoid mixing with lactated Ringer's solution, as it is incompatible with piperacillin-tazobactam 1
- Do not add to blood products or albumin hydrolysates 1
- Monitor for site infiltrations with extended infusions, as these were the most common adverse events in pediatric studies 6