Piperacillin-Tazobactam Pediatric Dosing
For pediatric patients ≥2 months of age, the standard dosing of piperacillin-tazobactam is 100 mg/kg (based on piperacillin component) every 8 hours for children >9 months, and 80 mg/kg every 8 hours for infants 2-9 months of age. 1
FDA-Approved Dosing by Age and Indication
The FDA label provides clear age-stratified dosing based on indication 1:
For Appendicitis and/or Peritonitis:
- Infants 2-9 months: 90 mg/kg (80 mg piperacillin/10 mg tazobactam) every 8 hours 1
- Children >9 months: 112.5 mg/kg (100 mg piperacillin/12.5 mg tazobactam) every 8 hours 1
For Nosocomial Pneumonia:
- Infants 2-9 months: 90 mg/kg (80 mg piperacillin/10 mg tazobactam) every 6 hours 1
- Children >9 months: 112.5 mg/kg (100 mg piperacillin/12.5 mg tazobactam) every 6 hours 1
Maximum Daily Dose:
- Do not exceed 24,000 mg/day (based on piperacillin component) 2
Alternative Guideline-Based Dosing for Neonates
For neonates and very young infants, Taiwan guidelines provide postmenstrual age (PMA)-based dosing 2:
Administration Guidelines
Administer piperacillin-tazobactam by intravenous infusion over 30 minutes for both standard dosing regimens 1. However, emerging evidence suggests extended infusions may optimize pharmacodynamic targets, particularly in critically ill children 3, 4.
Critical Dosing Considerations
Weight-Based Dosing Applies Up to 40 kg:
- The FDA-approved weight-based dosing applies to pediatric patients weighing up to 40 kg 1
- For children >40 kg, consider transitioning to adult dosing regimens 1
Renal Function Adjustments:
- Dosage reduction is required for patients with creatinine clearance ≤40 mL/min 1
- Monitor renal function during treatment, especially in critically ill patients, as piperacillin-tazobactam is an independent risk factor for renal failure in this population 1
Concomitant Furosemide:
- Furosemide administration significantly affects piperacillin clearance and may require dosing adjustments 3
Common Pitfalls to Avoid
Do not underdose nosocomial pneumonia - the every 6-hour regimen (not every 8 hours) is required for adequate coverage of resistant organisms 1. The more frequent dosing interval for pneumonia reflects the need for higher drug exposure against Pseudomonas aeruginosa and other nosocomial pathogens.
Do not use adult dosing in children <40 kg - pediatric pharmacokinetics differ significantly from adults, particularly in children under 2 years where renal maturation affects drug clearance 5.
Monitor for nephrotoxicity in critically ill patients - alternative antibiotics should be considered when possible in the ICU setting, as piperacillin-tazobactam carries increased risk of renal injury compared to other beta-lactams 1.
Practical Dosing Examples
For a typical 15 kg child (approximately 18 months old) with appendicitis:
- Dose: 112.5 mg/kg = 1,687.5 mg (round to 1,700 mg) every 8 hours 1
For the same child with nosocomial pneumonia:
- Dose: 112.5 mg/kg = 1,687.5 mg (round to 1,700 mg) every 6 hours 1