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Beta-lactamase inhibitor/broad-spectrum penicillin (PCN)
Usual: 3.375g q6h for 7-10 days; administer by IV infusion over 30 min
Moderate to Severe:Initial: 4.5g q6h plus an aminoglycoside for 7-14 days; administer Zosyn by IV infusion over 30 min
Aminoglycoside treatment should be continued in patients from whom Pseudomonas aeruginosa is isolated
- Appendicitis (complicated by rupture or abscess)- Peritonitis- Uncomplicated/complicated skin and skin structure infections (eg, cellulitis, cutaneous abscess, ischemic/diabetic foot infections)- Postpartum endometritis- Pelvic inflammatory disease - Moderate community-acquired pneumonia
2-9 Months of Age: (80mg/10mg)/kg q8h≥9 Months of Age: ≤40kg: (100mg/12.5mg)/kg q8h
>40kg: Use adult dose
Administer by IV infusion over 30 min
Renal ImpairmentAdults:All Indications (Except Nosocomial Pneumonia):CrCl >40mL/min: 3.375g q6hCrCl 20-40mL/min: 2.25g q6hCrCl <20mL/min (Not Receiving Hemodialysis): 2.25g q8hHemodialysis: 2.25g q12h (max: 2.25g q12h); administer an additional 0.75g dose following each hemodialysis session on hemodialysis daysContinuous Ambulatory Peritoneal Dialysis: 2.25g q12h
Nosocomial Pneumonia:CrCl >40mL/min: 4.5g q6hCrCl 20-40mL/min: 3.375g q6hCrCl <20mL/min (Not Receiving Hemodialysis): 2.25g q6hHemodialysis: 2.25g q8h (max: 2.25g q8h); administer an additional 0.75g dose following each hemodialysis session on hemodialysis daysContinuous Ambulatory Peritoneal Dialysis: 2.25g q8h
ElderlyStart at lower end of dosing range
Infuse over 30 min.During the infusion it is desirable to d/c the primary infusion sol.
Single-Dose Vials- Reconstitute 2.25g, 3.375g, and 4.5g vials w/ 10mL, 15mL, and 20mL, respectively w/ a compatible reconstitution diluent; swirl until dissolved. - Further dilute reconstituted sol in a compatible IV sol (recommended volume per dose of 50-150mL).- Use immediately after reconstitution; discard any unused portion after 24 hrs if stored at 20-25°C (68-77°F) or after 48 hrs if stored at 2-8°C (36-46°F). Do not freeze vials after reconstitution.
- Do not mix w/ other drugs in a syringe or infusion bottle.- Not chemically stable in sol that contain only sodium bicarbonate and sol that significantly alter the pH.- Do not add to blood products or albumin hydrolysates.
Compatible Reconstitution Diluents: - 0.9% NaCl for inj- Sterile water for inj (SWFI)- D5 - Bacteriostatic saline/parabens- Bacteriostatic water/parabens - Bacteriostatic saline/benzyl alcohol- Bacteriostatic water/benzyl alcohol
Compatible IV Sol: - 0.9% NaCl for inj - SWFI (max recommended volume per dose of SWFI is 50mL)- Dextran 6% in saline - D5- Lactated Ringer's sol (compatible only w/ reformulated Zosyn containing EDTA and is compatible for co-administration via a Y-site)
Galaxy Containers- Administer using sterile equipment, after thawing to room temperature. - Zosyn containing EDTA is compatible for co-administration via a Y-site IV tube w/ Lactated Ringer's inj.- Do not add supplementary medication.- Discard unused portions.- Do not use plastic containers in series connections.
Thawing of Plastic Container:- Thaw frozen container at 20-25°C (68-77°F) or 2-8°C (36-46°F); do not force thaw by immersion in water baths or by microwave irradiation.- Thawed solution is stable for 14 days at 2-8°C (36-46°F) or 24 hrs at 20-25°C (68-77°F); do not refreeze.
Refer to PI for further stability information and for compatibility w/ aminoglycosides.
Inj: (Piperacillin/Tazobactam) 2g/0.25g (2.25g), 3g/0.375g (3.375g), 4g/0.5g (4.5g) [vial]; (2g/0.25g [2.25g])/50mL, (3g/0.375g [3.375g])/50mL, (4g/0.5g [4.5g])/100mL [Galaxy]. Also available as a Pharmacy Bulk Package.
History of allergic reactions to any of the penicillins, cephalosporins, or β-lactamase inhibitors.
See Dosing Considerations. Use w/ care in patients w/ renal impairment or on hemodialysis. Serious and occasionally fatal hypersensitivity (anaphylactic/anaphylactoid) reactions, including shock, reported; d/c and institute appropriate therapy if an allergic reaction occurs. Severe cutaneous adverse reactions (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction w/ eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis) may occur; monitor closely if a skin rash develops and d/c if lesions progress. Clostridium difficile-associated diarrhea (CDAD) reported; may need to d/c if CDAD is suspected or confirmed. Bleeding manifestations, sometimes associated w/ abnormalities of coagulation tests, reported; d/c and institute appropriate therapy if bleeding manifestations occur. Leukopenia/neutropenia may occur and is most frequently associated w/ prolonged administration. May cause neuromuscular excitability or convulsions w/ higher than recommended doses, particularly in the presence of renal failure. Caution in patients w/ restricted salt intake. Monitor electrolytes periodically in patients w/ low K+ reserves. May result in bacterial resistance w/ use in the absence of a proven/suspected bacterial infection. Associated w/ increased incidence of fever and rash in cystic fibrosis patients. Lab test interactions may occur.
Diarrhea, headache, constipation, N/V, rash, pruritus, dyspepsia, insomnia.
Piperacillin may inactivate aminoglycosides. May decrease serum concentrations of tobramycin; monitor aminoglycoside levels in patients w/ ESRD. Probenecid prolongs T1/2; avoid coadministration unless the benefit outweighs the risk. Test coagulation parameters more frequently w/ high doses of heparin, oral anticoagulants, or other drugs that may affect blood coagulation system or thrombocyte function. Caution w/ cytotoxic therapy or diuretics; consider possibility of hypokalemia. Piperacillin: May prolong neuromuscular blockade of vecuronium or any nondepolarizing muscle relaxant. May reduce methotrexate (MTX) clearance; frequently monitor MTX levels as well as for the signs/symptoms of MTX toxicity. Increased incidence of acute kidney injury reported w/ concomitant vancomycin as compared to vancomycin alone; monitor kidney function.
Pregnancy: Category B.Lactation: Caution in nursing.
Piperacillin: Broad-spectrum penicillin (PCN); exerts bactericidal activity by inhibiting septum formation and cell-wall synthesis of susceptible bacteria. Tazobactam: β-lactamase enzyme inhibitor.
Distribution: Plasma protein binding (30%); crosses the placenta. Piperacillin: Found in breast milk in low concentrations. Metabolism: Piperacillin: Desethyl metabolite (minor microbiologically active). Elimination: Kidneys. T1/2=0.7-1.2 hrs. Piperacillin: Urine (68% unchanged), bile. Tazobactam: Urine (80% unchanged), bile.
Refer to PI for additional pharmacokinetic parameters.
Assess for previous hypersensitivity reaction to PCN, cephalosporins, or β-lactamase inhibitors; salt intake restriction; cystic fibrosis; low K+ reserves; renal impairment; pregnancy/nursing status; and possible drug interactions.
Monitor hematopoietic function (especially w/ prolonged therapy [≥21 days]), renal function, and serum electrolytes periodically. Monitor for hypersensitivity reactions, CDAD, severe cutaneous 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 bacterial resistance. Advise to d/c and notify physician if experiencing watery/bloody diarrhea (w/ or w/o stomach cramps and fever) even as late as ≥2 months after the last dose, or an allergic reaction. Instruct to notify physician if pregnant/nursing. Inform that serious hypersensitivity reactions may occur which may require immediate treatment.
Vials: 20-25°C (68-77°F). Galaxy Containers: At or below -20°C (-4°F).