PIPERACILLIN/TAZOBACTAM
(pi-per'a-cil-lin/taz-o-bac'tam)
Zosyn
Classifications: antiinfective; beta-lactam antibiotic; antipseudomonal penicillin
Prototype: Piperacillin Sodium
Pregnancy Category: B

Availability

2 g, 3 g, 4 g injection

Actions

Antibacterial combination product consisting of the semisynthetic piperacillin and the beta-lactamase inhibitor tazobactam. Tazobactam component does not decrease the activity of the piperacillin component against susceptible organisms.

Therapeutic Effects

Tazobactam is an inhibitor of a wide variety of bacterial beta–lactamases. It has little antibacterial activity itself; however, in combination with piperacillin, it extends the spectrum of bacteria that are susceptible to piperacillin. Two-drug combination has antibiotic activity against an extremely broad spectrum of gram-positive, gram-negative, and anaerobic bacteria.

Uses

Treatment of moderate to severe appendicitis, uncomplicated and complicated skin and skin structure infections, endometritis, pelvic inflammatory disease, or nosocomial or community-acquired pneumonia caused by piperacillin-resistant, piperacillin/tazobactam-susceptible, beta-lactamase-producing bacteria.

Contraindications

Hypersensitivity to piperacillin, tazobactam, penicillins, cephalosporins, or beta-lactamase inhibitors such as clavulanic acid and sulbactam.

Cautious Use

Kidney failure; pregnancy (category B), lactation.

Route & Dosage

Moderate to Severe Infections
Adult: IV 3.375 g q6h, infused over 30 min, for 7–10 d
Child: IV <6 mo, 150–300 mg piperacillin/kg/d divided q6–8h;

6 mo, 240 mg piperacillin component/kg/d divided q8h

Nosocomial Pneumonia
Adult: IV 4.5 g q6h, infused over 30 min, for 7–10 d

Renal Insufficiency
Cl_cr 20–40 mL/min: 2.25 g q6h; <20 mL/min: 2.25 g q8h

Administration

Note: Verify correct IV concentration and rate of infusion for administration to infants or children with physician.

Intravenous

For hemodialysis patients, the maximum dose is 2.25 g q8h; give one extra 0.75-g dose after each dialysis period.

PREPARE: Intermittent: Reconstitute powder with 5 mL of diluent (e.g., D5W, NS); shake well until dissolved. Further dilute to at least 50 mL of selected diluent. Use single-dose vials immediately after reconstitution.

ADMINISTER: Intermittent: Give over at least 30 min.

INCOMPATIBILITIES Solution/additive: Aminoglycosides, Lactated Ringer's, albumin, blood products, solutions containing sodium bicarbonate. Y-site: Acyclovir, aminoglycosides, amiodarone, amphotericin B, amphotericin B cholesteryl complex, azithromycin, chlorpromazine, cisplatin, dacarbazine, daunorubicin, doxorubicin, doxycycline, droperidol, famotidine, ganciclovir, gemcitabine, hydroxyzine, idarubicin, minocycline, mitomycin, mitoxantrone, nalbuphine, prochlorperazine, promethazine, vancomycin.

Adverse Effects (1%)

CNS: Headache, insomnia, fever. GI: Diarrhea, constipation, nausea, vomiting, dyspepsia, pseudomembranous colitis. Skin: Rash, pruritus, hypersensitivity reactions.

Interactions

Drug: May increase risk of bleeding with anticoagulants; probenecid decreases elimination of piperacillin.

Pharmacokinetics

Distribution: Distributes into many tissues, including lung, blister fluid, and bile; crosses placenta; distributed into breast milk. Metabolism: Metabolized in liver. Elimination: Piperacillin and tazobactam are excreted in urine. Half-Life: 0.7–1.2 h.

Nursing Implications

Assessment & Drug Effects

Obtain history of hypersensitivity to penicillins, cephalosporins, or other drugs prior to administration.
Lab tests: C&S prior to first dose of the drug; start drug pending results. Monitor hematologic status with prolonged therapy (Hct and Hgb, CBC with differential and platelet count).
Monitor patient carefully during the first 30 min after initiation of the infusion for signs of hypersensitivity (see Appendix F).

Patient & Family Education

Report rash, itching, or other signs of hypersensitivity immediately.
Report loose stools or diarrhea as these may indicate pseudomembranous colitis.
Do not breast feed while taking this drug without consulting physician.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug