piperacillin sodium and tazobactam sodium

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).

See 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.