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Beta-lactamase inhibitor/broad-spectrum penicillin
Treatment of appendicitis, peritonitis, uncomplicated/complicated skin and skin structure infections, postpartum endometritis, pelvic inflammatory disease, moderate community-acquired pneumonia, and moderate to severe nosocomial pneumonia caused by susceptible strains of microorganisms.
Adults: Infuse over 30 min. Usual: 3.375g q6h IV for 7-10 days. CrCl 20-40mL/min: 2.25g q6h. CrCl<20mL/min: 2.25g q8h. Hemodialysis/Continuous Ambulatory Peritoneal Dialysis (CAPD): 2.25g q12h. Give one additional dose of 0.75g following each hemodialysis session. Nosocomial Pneumonia: 4.5g q6h for 7-14 days plus an aminoglycoside. CrCl 20-40mL/min: 3.375g q6h. CrCl <20mL/min: 2.25g q6h. Hemodialysis/CAPD: 2.25g q8h. Give one additional dose of 0.75g following each hemodialysis session.
Pediatrics: Infuse over 30 min. Appendicitis/Peritonitis: ≤40kg: ≥9 Months: 100mg-12.5mg/kg q8h. 2-9 Months: 80mg-10mg/kg q8h. >40kg: Use adult dose.
Inj: (Piperacillin-Tazobactam) 2g-0.25g, 3g-0.375g, 4g-0.5g; 2g-0.25g/50mL, 3g-0.375g/50mL, 4g-0.5g/100mL [Galaxy]
History of allergic reactions to cephalosporins.
Serious, fatal hypersensitivity (anaphylactic/anaphylactoid) reactions, including shock, reported; if these occur, d/c and institute appropriate therapy. Hypersensitivity reactions more likely to occur with history of penicillin (PCN) hypersensitivity or history of sensitivity to multiple allergens. Clostridium difficile-associated diarrhea (CDAD) reported; d/c if CDAD suspected or confirmed. Serious skin reactions (eg, Steven-Johnson syndrome and toxic epidermal necrolysis) reported; monitor closely if skin rash occurs and d/c if lesions progress. D/C if bleeding manifestations occur. May result in bacterial resistance with prolonged use or use in the absence of a proven/suspected bacterial infection or a prophylactic indication; take appropriate measures if superinfection develops. May experience neuromuscular excitability or convulsions with higher than recommended dose. Caution with restricted salt intake. Increased incidence of rash and fever in cystic fibrosis patients reported. Monitor electrolytes periodically with low K+ reserves. Lab test interactions may occur. Caution with renal impairment (CrCl ≤40mL/min). Caution in elderly.
Diarrhea, headache, constipation, N/V, insomnia, rash, fever, dyspepsia, local reactions, pruritus, fever, stool changes, agitation, pain.
May inactivate aminoglycosides. May decrease serum concentrations of tobramycin; monitor aminoglycoside serum concentrations in patients with end-stage renal disease. Probenecid prolongs half-life. Test coagulation parameters more frequently with high doses of heparin, oral anticoagulants, or other drugs that may affect blood coagulation system or thrombocyte function. Piperacillin: May prolong neuromuscular blockade of vecuronium or any nondepolarizing muscle relaxant. May increase risk of hypokalemia with cytotoxic therapy or diuretics. May reduce methotrexate clearance; monitor methotrexate concentrations and for toxicity.
Category B, caution in nursing.
Piperacillin: Broad-spectrum PCN; exerts bactericidal activity by inhibiting septum formation and cell wall synthesis of susceptible bacteria. Tazobactam: β-lactamase enzyme inhibitor.
Absorption: Piperacillin (2.25g, 3.375g, 4.5g): Cmax= 134mcg/mL, 242mcg/mL, 298mcg/mL. Tazobactam (2.25g, 3.375g, 4.5g): Cmax= 15mcg/mL, 24mcg/mL, 34mcg/mL. Tmax= 30 min. Distribution: Plasma protein binding (30%); crosses the placenta. Piperacillin: Vd=0.243L/kg, found in breast milk. Elimination: Kidneys; T1/2=0.7-1.2 hrs. Piperacillin: Urine (68% unchanged). Tazobactam: Urine (80% unchanged, 20% as single metabolite).
Assess for previous hypersensitivity reaction to PCN, cephalosporins, or other allergens. Assess for history of bleeding disorder, conditions with restricted salt intake, cystic fibrosis, renal impairment, hypokalemia, pregnancy/nursing status, and possible drug interactions.
Monitor hematopoietic function, renal function, and serum electrolytes periodically. Monitor for signs/symptoms of electrolyte imbalance (eg, hypokalemia), hypersensitivity reactions, CDAD, superinfections, serious skin reactions, leukopenia/neutropenia, bleeding manifestations, and for neuromuscular excitability or convulsions. Monitor for rash and fever in cystic fibrosis patients.
Inform about risks/benefits of therapy. Counsel that drug only treats bacterial, not viral, infections. Instruct to take ud; inform that skipping doses or not completing full course may decrease effectiveness and increase resistance. Advise to d/c and notify physician if an allergic reaction or watery/bloody diarrhea (with or without stomach cramps and fever) occur. Instruct to notify physician if pregnant/nursing.
Administration: IV route. Refer to PI for instructions for reconstitution and dilution. Storage: Vial: Prior to Reconstitution: 20-25°C (68-77°F). Reconstituted: Use immediately after reconstitution. Discard any unused portion after 24 hours if stored at 20-25°C (68-77°F) or after 48 hours if stored at 2-8°C (36-46°F). Do not freeze vials after reconstitution. Galaxy Container: -20°C (-4°F). Thawed Sol: 2-8°C (36-46°F) for 14 days, or 20-25°C (68-77°F) for 24 hrs. Do not refreeze thawed antibiotics.