piperacillin sodium + tazobactam sodium: clinical use

Prescribing considerations

• Confirm that broad-spectrum therapy is appropriate using infection severity, likely pathogens, microbiology and local resistance information.
• Obtain a detailed beta-lactam allergy history before treatment.
• Account for renal impairment or haemodialysis because reduced clearance increases exposure and neurological toxicity risk.
• Consider the sodium contribution in patients requiring sodium restriction.
• Review intravenous compatibility, particularly with aminoglycosides or multiple intravenous medicines.
• Use for adult bacteraemia caused by ceftriaxone-non-susceptible ESBL-producing Escherichia coli or Klebsiella pneumoniae is not recommended in the selected SmPC.

Contraindications and cautions

• Hypersensitivity to piperacillin, tazobactam or another penicillin antibacterial
• History of an acute severe allergic reaction to another beta-lactam, such as a cephalosporin, monobactam or carbapenem

Monitoring

• Clinical and microbiological response, including emergence of superinfection
• Renal function, especially with renal impairment, critical illness or concurrent vancomycin
• Electrolytes, particularly potassium
• Full blood count during prolonged therapy
• Liver tests where clinically indicated
• Coagulation and signs of bleeding in susceptible patients or those receiving anticoagulants
• Neurological status where accumulation or renal impairment is possible

Clinical pharmacology

Piperacillin is a time-dependent bactericidal beta-lactam that inhibits bacterial cell-wall synthesis. Tazobactam inhibits many beta-lactamases and protects piperacillin from enzymatic degradation, but does not inhibit all clinically important enzymes. Both components are cleared predominantly through the kidneys.

Formulation and product differences

• The selected product is a white to off-white powder for intravenous infusion.
• Compatibility is product-specific; the selected preparation is incompatible with Hartmann’s solution and sodium bicarbonate-containing solutions and must not be mixed with aminoglycosides.