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Beta-lactamase inhibitor/broad-spectrum penicillin (PCN)
Treatment of 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, and moderate to severe nosocomial pneumonia caused by susceptible strains of microorganisms.
3.375g q6h for 7-10 days
Initial: 4.5g q6h for 7-14 days plus an aminoglycoside
Aminoglycoside treatment should be continued in patients from whom Pseudomonas aeruginosa is isolated
Appendicitis (complicated by rupture or abscess)PeritonitisUncomplicated/complicated skin and skin structure infections (eg, cellulitis, cutaneous abscess, ischemic/diabetic foot infections)Postpartum endometritisPelvic inflammatory disease Moderate community-acquired pneumoniaModerate to severe nosocomial pneumonia
≤40kg:2-9 Months of Age: 80mg-10mg/kg q8h≥9 Months of Age: 100mg-12.5mg/kg q8h
>40kg:Use adult dose
Usual Dosage:CrCl >40mL/min: 3.375g q6hCrCl 20-40mL/min: 2.25g q6hCrCl <20mL/min: 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: 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
IV route. Infuse over 30 minDo not mixed w/ other drugs
Compatible Reconstitution Diluents 0.9% NaCl for injSterile water for injDextrose 5%Bacteriostatic saline/parabensBacteriostatic water/parabensBacteriostatic saline/benzyl alcoholBacteriostatic water/benzyl alcohol
Compatible IV Sol0.9% NaCl for injSterile water for injDextran 6% in salineDextrose 5%Lactated Ringer's solIV PreparationUse single dose vials immediately after reconstitutionReconstitute 2.25g, 3.375g, and 4.5g single dose vials w/ 10mL, 15mL, and 20mL, respectively w/ a compatible reconstitution diluent Further dilute reconstituted sol in a compatible IV sol (recommended volume per dose of 50mL to 150mL)During the infusion it is desirable to discontinue the primary infusion sol
Refer to PI for further preparation/administration instructions and compatibility w/ aminoglycosides
Inj: (Piperacillin/Tazobactam) 2g/0.25g, 3g/0.375g, 4g/0.5g [vial]; 2g/0.25g/50mL, 3g/0.375g/50mL, 4g/0.5g/100mL [Galaxy]. Also available as a Pharmacy Bulk Package.
History of allergic reactions to cephalosporins.
Serious and occasionally fatal hypersensitivity (anaphylactic/anaphylactoid) reactions, including shock, reported; d/c and institute appropriate therapy if an allergic reaction occurs. Serious skin reactions (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis) reported; monitor closely if skin rash occurs and d/c if lesions progress. Clostridium difficile-associated diarrhea (CDAD) reported; d/c if CDAD is suspected or confirmed. Bleeding manifestations, sometimes associated with abnormalities of coagulation tests, reported; d/c and institute appropriate therapy if bleeding manifestations occur. Leukopenia/neutropenia may occur and is most frequently associated with prolonged administration. May cause neuromuscular excitability or convulsions with higher than recommended dose, particularly in the presence of renal failure. Caution with restricted salt intake. Monitor electrolytes periodically with low K+ reserves. May result in bacterial resistance with use in the absence of a proven/suspected bacterial infection. Increased incidence of rash and fever in cystic fibrosis patients reported. Lab test interactions may occur. Caution with renal impairment (CrCl ≤40mL/min). Caution in elderly patients.
Diarrhea, headache, constipation, N/V, insomnia, rash, fever, dyspepsia, pruritus, oral candidiasis.
May inactivate aminoglycosides. May decrease serum concentrations of tobramycin; monitor aminoglycoside serum concentrations in patients with end-stage renal disease. Probenecid prolongs T1/2; avoid coadministration unless the benefit outweighs the risk. 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 relaxants. 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 penicillin (PCN); exerts bactericidal activity by inhibiting septum formation and cell-wall synthesis of susceptible bacteria. Tazobactam: β-lactamase enzyme inhibitor.
Absorption: IV administration of multiple doses resulted in different parameters. Distribution: Plasma protein binding (30%); crosses the placenta. Piperacillin: Vd=0.243L/kg, found in breast milk. Elimination: Kidneys. Piperacillin: Urine (68% unchanged). Tazobactam: Urine (80% unchanged). Refer to PI for information on additional pharmacokinetic parameters.
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 (especially with prolonged therapy [≥21 days]), renal function, and serum electrolytes periodically. Monitor for signs/symptoms of electrolyte imbalance, hypersensitivity reactions, CDAD, 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 watery/bloody diarrhea (with or without stomach cramps and fever) even as late as ≥2 months after the last dose, or an allergic reaction occurs. Instruct to notify physician if pregnant/nursing.
Vial: Prior to Reconstitution: 20-25°C (68-77°F). Reconstituted: Use immediately after reconstitution. Discard any unused portion after 24 hrs 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.