piperacillin + tazobactam: clinical use

Prescribing considerations

• Confirm appropriateness for infection severity, suspected pathogens and local susceptibility data.
• Obtain cultures where appropriate and review treatment when microbiology results become available.
• Assess renal function before and during treatment.
• Consider sodium burden in patients with heart failure, renal impairment or a controlled-sodium diet.
• The selected SmPC does not recommend use for adult bacteraemia caused by ceftriaxone-non-susceptible ESBL-producing Escherichia coli or Klebsiella pneumoniae.

Contraindications and cautions

• Hypersensitivity to piperacillin, tazobactam, another penicillin antibacterial or an excipient.
• Previous acute severe allergic reaction to another beta-lactam, including a cephalosporin, monobactam or carbapenem.

Monitoring

• Clinical and microbiological response, including reassessment for resistant organisms or superinfection.
• Renal function, especially with renal impairment, critical illness or concomitant vancomycin.
• Full blood count during prolonged treatment.
• Electrolytes, particularly potassium in at-risk patients.
• Liver tests and coagulation where clinically indicated.

Clinical pharmacology

Piperacillin is a bactericidal beta-lactam that inhibits bacterial septum and cell-wall synthesis. Tazobactam inhibits many beta-lactamases but not metallo-beta-lactamases or AmpC enzymes. Both components are eliminated mainly through the kidneys.

Formulation and product differences

• The selected product is a single-use two-chamber infusion bag containing powder and solvent, with specific reconstitution, sodium-content and compatibility characteristics.
• Compatibility cannot be assumed across brands or generic presentations. Check the exact product information before mixing or simultaneous administration.
• The selected bag must not generally be mixed with other medicines, blood products or albumin hydrolysates.