Piperacillin and Tazobactam is a fixed-dose, injectable combination of a broad-spectrum penicillin antibiotic (piperacillin) and a beta-lactamase inhibitor (tazobactam). Piperacillin is an extended-spectrum penicillin with activity against a wide range of Gram-positive and Gram-negative bacteria, including Pseudomonas aeruginosa. Tazobactam irreversibly inhibits many beta-lactamase enzymes, protecting piperacillin from degradation and extending its spectrum to include many beta-lactamase-producing strains. This combination is a cornerstone of empiric therapy for serious hospital-acquired infections in the Indian setting.
Adult: 3.375 g (piperacillin 3g + tazobactam 0.375g) IV every 6 hours OR 4.5 g (piperacillin 4g + tazobactam 0.5g) IV every 8 hours for serious infections. For nosocomial pneumonia, febrile neutropenia, and complicated intra-abdominal infections: 4.5 g every 6 hours.
Note: For IV infusion only. Reconstitute powder with a suitable diluent (e.g., 0.9% Sodium Chloride, 5% Dextrose). Further dilute to a final volume of 50-150 mL. Infuse over 30 minutes. Do not mix with aminoglycosides in the same IV line/bag due to physical incompatibility. Administer separately.
Piperacillin binds to 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, causing cell lysis and death (bactericidal). Tazobactam has weak antibacterial activity but is a potent, irreversible inhibitor of many plasmid- and chromosomally-encoded beta-lactamases, including TEM, SHV, and some OXA enzymes. It protects piperacillin from enzymatic hydrolysis, thereby restoring and extending its antibacterial spectrum.
Pregnancy: Pregnancy Category B. Animal studies have shown no evidence of harm to the fetus. However, no adequate and well-controlled studies in pregnant women. Use only if clearly needed, weighing benefits against potential risks.
Driving: May cause dizziness or headache. Patients should be cautioned about operating machinery or driving until they know how the medication affects them.
| Probenecid | Inhibits renal tubular secretion of piperacillin, increasing and prolonging serum concentrations of both drugs. | Moderate |
| Aminoglycosides (Gentamicin, Amikacin) | Physical incompatibility when mixed in same IV line. In vitro antagonism has been reported for some strains. Clinical significance is uncertain. Monitor renal function. | Moderate |
| Methotrexate | Piperacillin may reduce renal clearance of methotrexate, leading to increased and prolonged serum methotrexate levels and risk of toxicity. | Major |
| Oral Anticoagulants (Warfarin) | May potentiate anticoagulant effect, increasing risk of bleeding. Monitor INR closely. | Major |
| Vecuronium | May prolong neuromuscular blockade. | Moderate |
| Live Bacterial Vaccines (e.g., Typhoid, BCG) | Antibiotics may diminish the therapeutic effect of live bacterial vaccines. | Moderate |
Same composition (Piperacillin (2000mg) + Tazobactum (250mg)), different brands: