Neonatal Drug Therapy Manual

Piperacillin/Tazobactam

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Updated January 26, 2022 - 6:00pm

Alternate Name(s): 
Tazocin
Classification: 
Antibiotic with B-Lactamase Inhibitor
Original Date: 
August 2003
Revised Date: 
January 2020
Indications: 
  • Treatment of severe infections caused by susceptible B-Lactamase producing strains. Tazobactam expands activity of piperacillin to include B-Lactamase producing strains of S.aureus, H. influenza, B. fragilis, Klebsiella, E. Coli and Acinetobacter.
Administration: 
  • IV intermittent infusion: over 30 minutes
Dosage: 
  • Dosage recommendations are based on the piperacillin component

< 2 kg:

  • 0-7 days: 150 mg/kg/day divided Q12h
  • > 7 days: 225 mg/kg/day divided Q8h

> 2 kg:

  • 0-7 days: 225 mg/kg/day divided Q8h
  • > 7 days: 300 mg/kg/day divided Q6h
Side Effects: 
  • CVS: hypotension, hypertension, edema
  • Endocrine and metabolic: hypokalemia
  • Hematologic: anemia, leukopenia, eosinophilia, prolonged prothrombin time
  • Hepatic: increased AST,ALT, bilirubin, jaundice
  • Local: phlebitis
  • Renal: BUN and serum creatinine elevated, interstitial nephritis
Parameters to Monitor: 
  • LFTs, bleeding time
  • CBC
  • Serum electrolytes
  • Renal function
Reconstitution and Stability: 

IV Intermittent infusion:

CHEO:

  • Piperacillin (P)/Tazobactam (T)  4 g(P)/0.5 g(T) vial  (doses < 200 mg)
    • Add 36.8 mL SWFI to vial
    • Take 4 mL (400 mg) and add to 16 mL D5W
    • Final concentration: 20 mg/mL (P)
  • Piperacillin (P)/Tazobactam (T)  4 g(P)/0.5 g(T) vial   (doses > 200 mg)
    • Add 36.8 mL SWFI to vial
    • Final concentration: 100 mg/mL (P)

TOH:

  • Piperacillin (P)/Tazobactam (T)  3 g(P)/0.375 g(T) vial
    • Add 15 mL SWFI to vial
    • Take 2.3 mL (400 mg) and add to 18 mL D5W
    • Final concentration: 20 mg/mL (P)
Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl

- Y-site Compatible: calcium gluconate, dexmedetomidine, dopamine, fluconazole, furosemide, heparin, milrinone, morphine, potassium chloride, ranitidine, SMOF, TPN, vasopressin

Incompatible: acyclovir, azithromycin, dobutamine, gentamicin, tobramycin, vancomycin

  • Due to the potential inactivation of aminoglycosides and piperacillin/tazobactam, it is preferable to separate administration of these antibiotics by 30-60 minutes.
References: 

-Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 22nd Edition. Hudson: Lexi-Comp Inc.; 2015

-American Society on Health-System Pharmacists (ASHP).  Handbook on Injectable Drugs. 19th Edition. Bethesda: American Society of Health-System Pharmacists; 2017

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