piperacillin sodium and tazobactam sodium
Pharmacologic class: Penicillin (extended-spectrum), beta-lactamase inhibitor
Therapeutic class: Anti-infective
Pregnancy risk category B
Action
Piperacillin inhibits bacterial cell-wall synthesis, resulting in cell death. Tazobactam increases piperacillin efficacy.
Availability
Powder for injection: 2 g piperacillin and 0.25 g tazobactam/vial, 3 g piperacillin and 0.375 g tazobactam/vial, 4 g piperacillin and 0.5 g tazobactam/vial
Indications and dosages
➣ Community-acquired pneumonia; ruptured appendix; peritonitis; pelvic inflammatory disease; skin and skin-structure infections
Adults and children older than age 12: 3.375 g (3 g piperacillin and 0.375 g tazobactam) I.V. q 6 hours for 7 to 10 days
➣ Nosocomial pneumonia
Adults and children ages 12 and older: 3.375 g (3 g piperacillin and 0.375 g tazobactam) I.V. over 30 minutes q 4 hours for 7 to 14 days, given with an aminoglycoside
Dosage adjustment
• Renal impairment
Contraindications
• Hypersensitivity to penicillins, cephalosporins, imipenems, or beta-lactamase inhibitors
• Neonates
Precautions
Use cautiously in:
• heart failure, renal insufficiency (in children), seizures, bleeding disorders, uremia, hypokalemia, cystic fibrosis
• patients with sodium restrictions
• pregnant or breastfeeding patient
• children younger than age 12 (safety and efficacy not established).
Administration
• Ask patient about allergy to penicillins, cephalosporins, imipenems, or beta-lactamase inhibitors before giving.
• Dilute each gram with 5 ml of diluent, such as sterile or bacteriostatic water for injection, normal saline solution for injection, dextrose 5% in water, dextrose 5% in normal saline solution for injection, or 6% dextran in normal saline solution. Don't use lactated Ringer's solution.
• Shake vial until drug dissolves. Dilute again to a final volume of 50 ml; infuse over 30 minutes.
• Don't mix with other drugs. If possible, stop primary infusion while piperacillin infuses.
• Don't mix in same container with aminoglycosides, which are chemically incompatible with piperacillin.
Adverse reactions
CNS: headache, insomnia, agitation, dizziness, anxiety, lethargy, hallucinations, depression, twitching, coma, seizures
CV: hypertension, chest pain, tachycardia
EENT: rhinitis, glossitis
GI: nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain, pseudomembranous colitis
GU: proteinuria, hematuria, vaginal candidiasis, vaginitis, oliguria, interstitial nephritis, glomerulonephritis
Hematologic: anemia, increased bleeding, bone marrow depression, leukopenia, thrombocytopenia
Metabolic: hypokalemia, hypernatremia
Respiratory: dyspnea
Skin: rash, pruritus
Other: fever; pain, edema, inflammation, or phlebitis at I.V. site; superinfection; hypersensitivity reactions including serum sickness and anaphylaxis
Interactions
Drug-drug. Aminoglycosides: aminoglycoside inactivation
Aspirin, probenecid: increased piperacillin blood level
Hormonal contraceptives: decreased contraceptive efficacy
Methotrexate: increased risk of methotrexate toxicity
Tetracyclines: decreased piperacillin efficacy
Vecuronium: prolonged neuromuscular blockade
Drug-diagnostic tests. Coombs' test, urine glucose tests using copper reduction method (Clinitest, Benedict's or Fehling's solution), urine protein: false-positive results
Eosinophils: increased count
Granulocytes, hemoglobin, platelets, white blood cells: decreased levels
Patient monitoring
• Assess neurologic status, especially for seizures.
• Monitor vital signs and fluid intake and output.
• Evaluate electrolyte levels, CBC with white cell differential, and culture and sensitivity tests. Watch for evidence of hypokalemia and blood dyscrasias.
• In patients receiving high doses or prolonged therapy, monitor for signs and symptoms of bacterial or fungal superinfection and pseudomembranous colitis.
• Monitor patient's dietary sodium intake (drug has high sodium content).
☞ Immediately report rash, hives, severe diarrhea, black tongue, sore throat, fever, or unusual bleeding or bruising.
Patient teaching
• Tell patient to monitor urinary output and report significant changes.
• Instruct patient to report unusual pain, redness, swelling, or other changes at infusion site.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.