Parenteral Manual

Piperacillin/Tazobactam

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

Alternate Name(s): 
TAZOCIN®
Classification: 
Antibiotic with B-lactamase inhibitor
Original Date: 
August 2005
Revised Date: 
January 2021
Indications: 
  • Treatment of infections caused by susceptible bacteria including beta-lactamase producing strains
Reconstitution and Stability: 

VIAL SIZE

STERILE WATER for INJECTION REQUIRED

FINAL CONCENTRATION

2 g P/0.25 g T

18.4 mL

100 mg/mL P/12.5 mg/mL T

3 g P/0.375 g T

27.6 mL

100 mg/mL P/12.5 mg/mL T
4 g P/0.5 g T 36.8 mL 100 mg/mL P/12.5 mg/mL T
12 g P/1.5 g T 102 mL 100 mg/mL P/12.5 mg/mL T
  • Store vials at room temperature
  • Shake well until dissolved
  • Reconstituted vial stable 24 hours at room temperature and 48 hours refrigerated
  • Diluted solutions stable 24 hours at room temperature and 7 days refrigerated
Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl, ringer's lactate

- Additive/Above Cassette Compatible: no information

- Y-site Compatible: clindamycin, dopamine, fluconazole, hydromorphone, magnesium sulfate, metoclopramide, metronidazole, morphine, KCl, ondansetron, sodium bicarbonate, TPN (amino acids/dextrose)

- Incompatible: acyclovir, amiodarone, amphotericin B, azithromycin, chlorpromazine, dobutamine, doxycycline, droperidol, ganciclovir, haloperidol, hydroxyzine, prochlorperazine, promethazine, administration of aminoglycosides and piperacillin/tazobactam should be separated by at least 30-60 minutes

 

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

NO
IV Intermittent Infusion

YES
Usual dilution: 100 mg/mL

- 20 mg/mL for dose less than 200 mg
Infusion time: Q4 - Q6H dosing over 30 minutes 
                          Q8H dosing over 4 hours
IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • Dosage recommendations are based on the piperacillin component

Pediatric:

  • 300 mg IV of piperacillin component/kg/day divided Q6H
  • Maximum: 4 g/dose of piperacillin component (16 g/day of piperacillin component/day)

CF Dosing:

  • 600 mg IV of piperacillin component/kg/day divided Q4-6H
  • Maximum: 4 g/dose of piperacillin component  (24 g/day of piperacillin component/day)

    CF Dosing:

Adult:

  • 3g - 4g of piperacillin component IV Q4 - 6 hours
  • Maximum 4 g/dose of piperacillin component (16 g/day of piperacillin component/day)
  • 3g of piperacillin component = 3.375g of piperacillin-tazobactam

DOSING ADJUSTMENT IN RENAL IMPAIRMENT:

  • CrCl 20-40 mL/minute: Decrease dose by 30% and administer Q6H
  • CrCl <20  mL/minute: Decrease dose by 30% and administer Q8H
Potential hazards of parenteral administration: 
  • Local reactions at injection site: pain, phlebitis, inflammation
  • Hypersensitivity reactions - manifested by rash, pruritus, bronchospasm, anaphylaxis
  • Hypokalemia
  • Increases in liver enzymes, leukopenia, platelet dysfunction, decrease in hemoglobin/hematocrit, prolonged prothrombin time, elevated BUN and creatinine
  • Diarrhea, nausea, vomiting
  • Neuromuscular excitability or convulsions with high doses especially in patients with renal insufficiency
  • If extravasation occurs, see Treatment of Infiltrated Vesicant or Irritant Drugs Guidelines on CHEOnet.
Notes: 
  • Sodium content: 2.35 mmoL sodium per 1 g piperacillin
  • Monitor serum electrolytes, bleeding time (especially in patients with renal impairment); periodic tests of renal, hepatic and hematologic function
  • Cross sensitivity with other beta-lactam antibiotics may occur (penicillins, cephalosporins)
  • If piperacillin/tazobactam is prescribed Q8H, administer each dose over 4 hours (Clinical Infectious Disease 2007; 44:357-63)

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