Piperacillin and Tazobactam is a fixed-dose, injectable combination of an extended-spectrum penicillin antibiotic (Piperacillin) and a beta-lactamase inhibitor (Tazobactam). Piperacillin exerts bactericidal activity by inhibiting bacterial cell wall synthesis. Tazobactam protects Piperacillin from degradation by many beta-lactamase enzymes, thereby extending its spectrum of activity to include many beta-lactamase-producing bacteria. It is a cornerstone therapy for serious nosocomial and community-acquired infections in India, particularly where resistance to other agents is suspected.
Adult: 3.375g (Piperacillin 3g + Tazobactam 0.375g) IV every 6 hours OR 4.5g (Piperacillin 4g + Tazobactam 0.5g) IV every 8 hours for most infections. For nosocomial pneumonia, febrile neutropenia, and serious Pseudomonas infections: 4.5g IV every 6 hours.
Note: For IV use only. Reconstitute powder with a compatible diluent (e.g., 10-20 mL Sterile Water for Injection). Further dilute in at least 50-150 mL of compatible IV solution (0.9% NaCl, 5% Dextrose, Lactated Ringer's). Infuse over 30 minutes. Do not mix with aminoglycosides in the same IV line/bag due to physical incompatibility.
Piperacillin binds to specific penicillin-binding proteins (PBPs) located inside the bacterial cell wall, inhibiting the final transpeptidation step of peptidoglycan synthesis. This leads to the formation of defective cell walls and osmotically unstable cells, resulting in cell lysis and death (bactericidal). Tazobactam has very weak antibacterial activity but is an irreversible, competitive inhibitor of many beta-lactamase enzymes (including TEM, SHV, and some OXA types) produced by bacteria. By binding covalently to these enzymes, it prevents them from hydrolyzing and inactivating Piperacillin.
Pregnancy: Pregnancy Category B. Animal studies show no risk, but no adequate, well-controlled studies in pregnant women. Use only if clearly needed, as per treating physician's judgment. Crosses the placenta.
Driving: May cause dizziness or headache. Patients should be cautioned about driving or operating machinery if they experience these effects.
| Probenecid | Inhibits renal tubular secretion of Piperacillin/Tazobactam, increasing and prolonging serum concentrations. | Moderate |
| Aminoglycosides (e.g., Gentamicin, Amikacin) | Physical incompatibility when mixed in same IV line. May have synergistic antibacterial effect but Piperacillin can inactivate aminoglycosides in vitro if mixed. | Moderate |
| Methotrexate | Piperacillin may reduce renal clearance of Methotrexate, increasing risk of Methotrexate toxicity (myelosuppression, mucositis). | Major |
| Oral Anticoagulants (Warfarin) | May increase INR and risk of bleeding due to effects on platelet function, vitamin K-dependent clotting factors, and gut flora. | Major |
| Vecuronium | May prolong neuromuscular blockade. | Moderate |
| Oral Contraceptives | Potential reduction in efficacy due to altered gut flora; advise use of alternative non-hormonal contraception. | Moderate |
Same composition (Piperacillin (4000mg) + Tazobactum (500mg)), different brands: