Piperacillin-Tazobactam (Tazocin) 💊
Irish hospital reference for piperacillin-tazobactam (Tazocin): adult dosing, renal adjustment, infusion, spectrum, and safety. Confirm local antimicrobial guidelines.
⚠️ Educational note
- This is an educational reference topic only. Always follow local hospital protocols, antimicrobial guidelines, pharmacy advice, and senior clinical review when prescribing.
💡 About
- Contraindicated in penicillin allergy. Also avoid if history of severe immediate allergy to other β-lactams (e.g. cephalosporin, carbapenem).
- Broad-spectrum IV penicillin + β-lactamase inhibitor (piperacillin 4 g + tazobactam 0.5 g per "4.5 g" vial).
- Covers many gram-positives, gram-negatives (including Pseudomonas), and anaerobes. Not MRSA, and not a substitute for local AMS/micro advice.
- De-escalate when cultures allow.
📋 Common adult uses (examples)
- Hospital-acquired / severe pneumonia (often q6h per SmPC)
- Complicated intra-abdominal infection
- Complicated UTI / pyelonephritis
- Complicated skin & soft tissue infection (including diabetic foot)
- Febrile neutropenia (often q6h; follow local oncology/haematology protocol)
- Empiric cover where Pseudomonas or polymicrobial infection is a concern; confirm local policy
💊 Adult dosing (normal renal function)
- Standard adult vial: 4 g / 0.5 g (commonly charted as 4.5 g) IV.
- Usual dose: 4.5 g every 8 hours.
- Severe pneumonia, febrile neutropenia, or other particularly severe infection: 4.5 g every 6 hours (per SmPC).
- Typical course duration 5-14 days, guided by clinical response, pathogen, and local AMS advice.
- Doses below assume adults/adolescents with CrCl > 40 mL/min. Confirm local protocol.
Most indicated infections
- Usual adult dose
- 4.5 g IV every 8 h
- Notes
- Complicated UTI, intra-abdominal, SSTI
Severe / nosocomial pneumonia
- Usual adult dose
- 4.5 g IV every 6 h
- Notes
- Per SmPC; check local CAP/HAP pathway
Febrile neutropenia
- Usual adult dose
- 4.5 g IV every 6 h
- Notes
- Follow local FN protocol ± other agents
| Indication / setting | Usual adult dose | Notes |
|---|---|---|
| Most indicated infections | 4.5 g IV every 8 h | Complicated UTI, intra-abdominal, SSTI |
| Severe / nosocomial pneumonia | 4.5 g IV every 6 h | Per SmPC; check local CAP/HAP pathway |
| Febrile neutropenia | 4.5 g IV every 6 h | Follow local FN protocol ± other agents |
🩺 Renal adjustment (adults)
- Renal dosing below follows The Renal Drug Handbook / Renal Drug Database (RDD). Confirm the current monograph and local pharmacy advice.
- Use eGFR (or CrCl if your local guide specifies) to choose the band; for severe infection discuss with micro/pharmacy before under-dosing.
- Haemodialysis: drug is dialysed. Dose as for eGFR < 20 and give after dialysis (per RDD-aligned hospital guidance). SmPC also describes an extra 2 g/0.25 g dose after each session; confirm local protocol.
- Peritoneal dialysis: max 4.5 g every 12 hours (not significantly dialysed); confirm current RDH/RDD monograph.
- Hepatic impairment: no routine dose change.
≥ 40
- Suggested adult dose (RDH / RDD)
- No adjustment; use indication-based 4.5 g every 6-8 h
20-40
- Suggested adult dose (RDH / RDD)
- Maximum 4.5 g every 8 hours
< 20
- Suggested adult dose (RDH / RDD)
- Maximum 4.5 g every 12 hours
HD / HDF
- Suggested adult dose (RDH / RDD)
- Max 4.5 g every 12 h; give after dialysis
PD
- Suggested adult dose (RDH / RDD)
- Max 4.5 g every 12 hours
| eGFR (mL/min/1.73 m²) | Suggested adult dose (RDH / RDD) |
|---|---|
| ≥ 40 | No adjustment; use indication-based 4.5 g every 6-8 h |
| 20-40 | Maximum 4.5 g every 8 hours |
| < 20 | Maximum 4.5 g every 12 hours |
| HD / HDF | Max 4.5 g every 12 h; give after dialysis |
| PD | Max 4.5 g every 12 hours |
⚠️ Safety & stewardship
- Contraindicated in penicillin allergy; also avoid if history of severe immediate allergy to other β-lactams (e.g. cephalosporin, carbapenem).
- Significant sodium load per vial (~9-11 mmol / ~200-260 mg sodium, product-dependent); relevant in heart failure, fluid overload, or strict sodium restriction.
- C. difficile risk with broad-spectrum agents; review need daily and stop/de-escalate when appropriate.
- No reliable oral switch (poor oral bioavailability) per HSE AMRIC IV to oral toolkit; discuss alternatives with micro/AMS/pharmacy.
- ESBL bacteraemia: SmPC advises against relying on piperacillin-tazobactam for ESBL E. coli / K. pneumoniae bacteraemia in adults; seek micro advice.
- Check interactions and concomitant nephrotoxins; review allergy status and cultures before charting.
Educational reference only. Medical disclaimer