Piperacillin / Tazobactam Dosage

Medically reviewed by Drugs.com. Last updated on Jul 12, 2023.

Usual Adult Dose for Intraabdominal Infection

3.375 g IV every 6 hours
Usual duration of therapy: 7 to 10 days

Uses: For the treatment of appendicitis (complicated by rupture or abscess) and peritonitis due to beta-lactamase-producing isolates of Escherichia coli or members of the Bacteroides fragilis group (B fragilis, B ovatus, B thetaiotaomicron, or B vulgatus)

Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) Recommendations: 3.375 g IV every 6 hours

• May increase for infections due to Pseudomonas aeruginosa: 3.375 g IV every 4 hours or 4.5 g IV every 6 hours

Comments:

• Recommended as an initial IV regimen for empiric treatment of complicated intraabdominal infection
• May be used for initial empiric treatment of high-risk/high-severity community-acquired extrabiliary complicated intraabdominal infection (e.g., severe physiologic disturbance, advanced age, immunocompromised state)
• Recommended for healthcare-associated intraabdominal infection, depending on local microbiologic studies
• May be used for initial empiric treatment of: high-risk/high-severity community-acquired acute cholecystitis; acute cholangitis after bilioenteric anastomosis (any severity); healthcare-associated biliary infection (any severity)
• Coadministration with other agents may be recommended.
• Current guidelines should be consulted for additional information.

International Society for Peritoneal Dialysis (ISPD) Recommendations:
Continuous (all exchanges):

• Loading dose: 4 g (piperacillin component) intraperitoneally
• Maintenance dose: 1 g (piperacillin component) intraperitoneally

Comments:

• When a surgical cause of peritoneal dialysis (PD)-related peritonitis is suspected, this drug may be considered as monotherapy.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Peritonitis

3.375 g IV every 6 hours
Usual duration of therapy: 7 to 10 days

Uses: For the treatment of appendicitis (complicated by rupture or abscess) and peritonitis due to beta-lactamase-producing isolates of Escherichia coli or members of the Bacteroides fragilis group (B fragilis, B ovatus, B thetaiotaomicron, or B vulgatus)

Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) Recommendations: 3.375 g IV every 6 hours

• May increase for infections due to Pseudomonas aeruginosa: 3.375 g IV every 4 hours or 4.5 g IV every 6 hours

Comments:

• Recommended as an initial IV regimen for empiric treatment of complicated intraabdominal infection
• May be used for initial empiric treatment of high-risk/high-severity community-acquired extrabiliary complicated intraabdominal infection (e.g., severe physiologic disturbance, advanced age, immunocompromised state)
• Recommended for healthcare-associated intraabdominal infection, depending on local microbiologic studies
• May be used for initial empiric treatment of: high-risk/high-severity community-acquired acute cholecystitis; acute cholangitis after bilioenteric anastomosis (any severity); healthcare-associated biliary infection (any severity)
• Coadministration with other agents may be recommended.
• Current guidelines should be consulted for additional information.

International Society for Peritoneal Dialysis (ISPD) Recommendations:
Continuous (all exchanges):

• Loading dose: 4 g (piperacillin component) intraperitoneally
• Maintenance dose: 1 g (piperacillin component) intraperitoneally

Comments:

• When a surgical cause of peritoneal dialysis (PD)-related peritonitis is suspected, this drug may be considered as monotherapy.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Appendicitis

3.375 g IV every 6 hours
Usual duration of therapy: 7 to 10 days

Uses: For the treatment of appendicitis (complicated by rupture or abscess) and peritonitis due to beta-lactamase-producing isolates of Escherichia coli or members of the Bacteroides fragilis group (B fragilis, B ovatus, B thetaiotaomicron, or B vulgatus)

Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) Recommendations: 3.375 g IV every 6 hours

• May increase for infections due to Pseudomonas aeruginosa: 3.375 g IV every 4 hours or 4.5 g IV every 6 hours

Comments:

• Recommended as an initial IV regimen for empiric treatment of complicated intraabdominal infection
• May be used for initial empiric treatment of high-risk/high-severity community-acquired extrabiliary complicated intraabdominal infection (e.g., severe physiologic disturbance, advanced age, immunocompromised state)
• Recommended for healthcare-associated intraabdominal infection, depending on local microbiologic studies
• May be used for initial empiric treatment of: high-risk/high-severity community-acquired acute cholecystitis; acute cholangitis after bilioenteric anastomosis (any severity); healthcare-associated biliary infection (any severity)
• Coadministration with other agents may be recommended.
• Current guidelines should be consulted for additional information.

International Society for Peritoneal Dialysis (ISPD) Recommendations:
Continuous (all exchanges):

• Loading dose: 4 g (piperacillin component) intraperitoneally
• Maintenance dose: 1 g (piperacillin component) intraperitoneally

Comments:

• When a surgical cause of peritoneal dialysis (PD)-related peritonitis is suspected, this drug may be considered as monotherapy.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Nosocomial Pneumonia

4.5 g IV every 6 hours
Duration of therapy: 7 to 14 days

Comments:

• Nosocomial pneumonia due to P aeruginosa should be treated in combination with an aminoglycoside.
• Initial presumptive therapy should start with this drug plus an aminoglycoside.
• Aminoglycoside therapy should be continued if P aeruginosa is isolated.

Use: For the treatment of moderate to severe nosocomial pneumonia due to beta-lactamase-producing isolates of Staphylococcus aureus and by piperacillin-tazobactam-susceptible Acinetobacter baumannii, Haemophilus influenzae, Klebsiella pneumoniae, and P aeruginosa

IDSA and American Thoracic Society Recommendations: 4.5 g IV every 6 hours
Duration of therapy: 7 days

Comments:

• Recommended as an empiric treatment regimen for clinically suspected ventilator-associated pneumonia in units where such coverage is appropriate
• Recommended as initial empiric therapy for hospital-acquired pneumonia (non-ventilator-associated pneumonia)
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Skin or Soft Tissue Infection

3.375 g IV every 6 hours
Usual duration of therapy: 7 to 10 days

Use: For the treatment of uncomplicated and complicated skin and skin structure infections (including cellulitis, cutaneous abscesses, ischemic/diabetic foot infections) due to beta-lactamase-producing isolates of S aureus

IDSA Recommendations:

• Incisional surgical site infection: 3.375 g IV every 6 hours or 4.5 g IV every 8 hours
• Necrotizing infections of the skin, fascia, and muscle: 3.375 g IV every 6 to 8 hours
• Infection after animal bite: 3.375 g IV every 6 to 8 hours

Comments:

• Recommended as a single-drug regimen for treatment of incisional surgical site infections after intestinal or genitourinary tract surgery
• With vancomycin, recommended as a preferred regimen for the treatment of necrotizing infections of the skin, fascia, and muscle due to mixed infections
• Infection after animal bite: This drug does not provide coverage for methicillin-resistant S aureus (MRSA).
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Skin and Structure Infection

3.375 g IV every 6 hours
Usual duration of therapy: 7 to 10 days

Use: For the treatment of uncomplicated and complicated skin and skin structure infections (including cellulitis, cutaneous abscesses, ischemic/diabetic foot infections) due to beta-lactamase-producing isolates of S aureus

IDSA Recommendations:

• Incisional surgical site infection: 3.375 g IV every 6 hours or 4.5 g IV every 8 hours
• Necrotizing infections of the skin, fascia, and muscle: 3.375 g IV every 6 to 8 hours
• Infection after animal bite: 3.375 g IV every 6 to 8 hours

Comments:

• Recommended as a single-drug regimen for treatment of incisional surgical site infections after intestinal or genitourinary tract surgery
• With vancomycin, recommended as a preferred regimen for the treatment of necrotizing infections of the skin, fascia, and muscle due to mixed infections
• Infection after animal bite: This drug does not provide coverage for methicillin-resistant S aureus (MRSA).
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Pelvic Inflammatory Disease

3.375 g IV every 6 hours
Usual duration of therapy: 7 to 10 days

Use: For the treatment of postpartum endometritis or pelvic inflammatory disease due to beta-lactamase-producing isolates of E coli

Usual Adult Dose for Endometritis

3.375 g IV every 6 hours
Usual duration of therapy: 7 to 10 days

Use: For the treatment of postpartum endometritis or pelvic inflammatory disease due to beta-lactamase-producing isolates of E coli

Usual Adult Dose for Pneumonia

3.375 g IV every 6 hours
Usual duration of therapy: 7 to 10 days

Use: For the treatment of community-acquired pneumonia (moderate severity only) due to beta-lactamase-producing isolates of H influenzae

Usual Adult Dose for Surgical Prophylaxis

American Society of Health-System Pharmacists (ASHP), IDSA, SIS, and Society for Healthcare Epidemiology of America (SHEA) Recommendations:

• Preoperative dose: 3.375 g IV as a single dose
• Redosing interval (from start of preoperative dose): 2 hours

Comments:

• Recommended for perioperative prophylaxis to prevent surgical-site infections in patients undergoing liver transplantation
• This drug should be started within 60 minutes before surgical incision.
• A single prophylactic dose is usually sufficient; if prophylaxis is continued postoperatively, duration should be less than 24 hours.
• To ensure adequate serum and tissue drug levels, readministration may be needed if the procedure duration exceeds the recommended redosing interval.
• Redosing may be needed if drug half-life is shortened (e.g., extensive burns) or if prolonged/excessive bleeding during surgery; redosing may not be needed if drug half-life is prolonged (e.g., renal dysfunction).
• Coadministration with other agents may be recommended.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Pyelonephritis

Some experts recommend: 3.375 to 4.5 g IV every 6 to 8 hours
Duration of therapy: About 14 days

Comments:

• Dose and therapy duration depend on the nature and severity of the infection.
• Once the patient is stable and able to tolerate oral medications, oral antibiotic therapy may be substituted according to microbiology sensitivity data.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Intraabdominal Infection

DOSE EXPRESSED AS PIPERACILLIN-TAZOBACTAM:
2 to 9 months: 90 mg/kg IV every 8 hours
Older than 9 months:

• Up to 40 kg: 112.5 mg/kg IV every 8 hours
• Greater than 40 kg: 3.375 g IV every 6 hours

DOSE EXPRESSED AS PIPERACILLIN:
2 to 9 months: 80 mg/kg (piperacillin component) IV every 8 hours
Older than 9 months:

• Up to 40 kg: 100 mg/kg (piperacillin component) IV every 8 hours
• Greater than 40 kg: 3 g (piperacillin component) IV every 6 hours

Usual Duration of Therapy: 7 to 10 days

Uses: For the treatment of appendicitis (complicated by rupture or abscess) and peritonitis due to beta-lactamase-producing isolates of E coli or members of the B fragilis group (B fragilis, B ovatus, B thetaiotaomicron, or B vulgatus)

SIS and IDSA Recommendations: 200 to 300 mg/kg/day (piperacillin component) IV in divided doses every 6 to 8 hours
Maximum dose: 12 g/day (piperacillin component)

Comments:

• Recommended as an initial IV regimen for treatment of complicated intraabdominal infection
• May be used for initial empiric treatment of community-acquired extrabiliary complicated intraabdominal infection
• Doses should be maximized if undrained intraabdominal abscess may be present.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Peritonitis

DOSE EXPRESSED AS PIPERACILLIN-TAZOBACTAM:
2 to 9 months: 90 mg/kg IV every 8 hours
Older than 9 months:

• Up to 40 kg: 112.5 mg/kg IV every 8 hours
• Greater than 40 kg: 3.375 g IV every 6 hours

DOSE EXPRESSED AS PIPERACILLIN:
2 to 9 months: 80 mg/kg (piperacillin component) IV every 8 hours
Older than 9 months:

• Up to 40 kg: 100 mg/kg (piperacillin component) IV every 8 hours
• Greater than 40 kg: 3 g (piperacillin component) IV every 6 hours

Usual Duration of Therapy: 7 to 10 days

Uses: For the treatment of appendicitis (complicated by rupture or abscess) and peritonitis due to beta-lactamase-producing isolates of E coli or members of the B fragilis group (B fragilis, B ovatus, B thetaiotaomicron, or B vulgatus)

SIS and IDSA Recommendations: 200 to 300 mg/kg/day (piperacillin component) IV in divided doses every 6 to 8 hours
Maximum dose: 12 g/day (piperacillin component)

Comments:

• Recommended as an initial IV regimen for treatment of complicated intraabdominal infection
• May be used for initial empiric treatment of community-acquired extrabiliary complicated intraabdominal infection
• Doses should be maximized if undrained intraabdominal abscess may be present.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Appendicitis

DOSE EXPRESSED AS PIPERACILLIN-TAZOBACTAM:
2 to 9 months: 90 mg/kg IV every 8 hours
Older than 9 months:

• Up to 40 kg: 112.5 mg/kg IV every 8 hours
• Greater than 40 kg: 3.375 g IV every 6 hours

DOSE EXPRESSED AS PIPERACILLIN:
2 to 9 months: 80 mg/kg (piperacillin component) IV every 8 hours
Older than 9 months:

• Up to 40 kg: 100 mg/kg (piperacillin component) IV every 8 hours
• Greater than 40 kg: 3 g (piperacillin component) IV every 6 hours

Usual Duration of Therapy: 7 to 10 days

Uses: For the treatment of appendicitis (complicated by rupture or abscess) and peritonitis due to beta-lactamase-producing isolates of E coli or members of the B fragilis group (B fragilis, B ovatus, B thetaiotaomicron, or B vulgatus)

SIS and IDSA Recommendations: 200 to 300 mg/kg/day (piperacillin component) IV in divided doses every 6 to 8 hours
Maximum dose: 12 g/day (piperacillin component)

Comments:

• Recommended as an initial IV regimen for treatment of complicated intraabdominal infection
• May be used for initial empiric treatment of community-acquired extrabiliary complicated intraabdominal infection
• Doses should be maximized if undrained intraabdominal abscess may be present.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Nosocomial Pneumonia

DOSE EXPRESSED AS PIPERACILLIN-TAZOBACTAM:
2 to 9 months: 90 mg/kg IV every 6 hours
Older than 9 months:

• Up to 40 kg: 112.5 mg/kg IV every 6 hours
• Greater than 40 kg: 4.5 g IV every 6 hours

DOSE EXPRESSED AS PIPERACILLIN:
2 to 9 months: 80 mg/kg (piperacillin component) IV every 6 hours
Older than 9 months:

• Up to 40 kg: 100 mg/kg (piperacillin component) IV every 6 hours
• Greater than 40 kg: 4 g (piperacillin component) IV every 6 hours

Duration of Therapy: 7 to 14 days

Comments:

• Nosocomial pneumonia due to P aeruginosa should be treated in combination with an aminoglycoside.
• Pediatric patients over 40 kg: Initial presumptive therapy should start with this drug plus an aminoglycoside.
• Pediatric patients over 40 kg: Aminoglycoside therapy should be continued if P aeruginosa is isolated.

Use: For the treatment of moderate to severe nosocomial pneumonia due to beta-lactamase-producing isolates of S aureus and by piperacillin-tazobactam-susceptible A baumannii, H influenzae, K pneumoniae, and P aeruginosa

Usual Pediatric Dose for Bacterial Infection

American Academy of Pediatrics Recommendations:
Neonates:

• Postmenstrual age up to 30 weeks: 100 mg/kg (piperacillin component) IV every 8 hours
• Postmenstrual age over 30 weeks: 80 mg/kg (piperacillin component) IV every 6 hours

1 month or older: 240 to 300 mg/kg/day (piperacillin component) IV divided in 3 to 4 doses

• Maximum dose: 16 g/day (piperacillin component)

1 month or older with cystic fibrosis: 400 to 600 mg/kg/day (piperacillin component) IV divided in 6 doses may be appropriate in some patients

• Maximum dose: 24 g/day (piperacillin component)

Comments:

• Patients 1 month or older: Extended infusion may be needed for susceptible dose-dependent infections.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Endocarditis

American Heart Association Recommendations:
Children and adolescents: 240 mg/kg/day (piperacillin component) IV in divided doses every 8 hours
Maximum dose: 18 g/day (piperacillin component)
Duration of therapy: At least 6 weeks

Comments:

• With an aminoglycoside, recommended as an alternative regimen for the treatment of infective endocarditis due to gram-negative enteric bacilli
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Skin or Soft Tissue Infection

IDSA Recommendations:
1 month or older: 60 to 75 mg/kg (piperacillin component) IV every 6 hours
Maximum dose: 3 g/dose (piperacillin component)

Comments:

• With vancomycin, recommended as a preferred regimen for the treatment of necrotizing infections of the skin, fascia, and muscle due to mixed infections
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Skin and Structure Infection

IDSA Recommendations:
1 month or older: 60 to 75 mg/kg (piperacillin component) IV every 6 hours
Maximum dose: 3 g/dose (piperacillin component)

Comments:

• With vancomycin, recommended as a preferred regimen for the treatment of necrotizing infections of the skin, fascia, and muscle due to mixed infections
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Surgical Prophylaxis

ASHP, IDSA, SIS, and SHEA Recommendations:
Preoperative dose:

• Infants 2 to 9 months: 80 mg/kg (piperacillin component) IV as a single dose
• Children older than 9 months and up to 40 kg: 100 mg/kg (piperacillin component) IV as a single dose
• Maximum dose: 3 g/dose (piperacillin component)

Redosing interval (from start of preoperative dose): 2 hours

Comments:

• Recommended for perioperative prophylaxis to prevent surgical-site infections in patients undergoing liver transplantation
• This drug should be started within 60 minutes before surgical incision.
• A single prophylactic dose is usually sufficient; if prophylaxis is continued postoperatively, duration should be less than 24 hours.
• To ensure adequate serum and tissue drug levels, readministration may be needed if the procedure duration exceeds the recommended redosing interval.
• Redosing may be needed if drug half-life is shortened (e.g., extensive burns) or if prolonged/excessive bleeding during surgery; redosing may not be needed if drug half-life is prolonged (e.g., renal dysfunction).
• Coadministration with other agents may be recommended.
• Current guidelines should be consulted for additional information.

Renal Dose Adjustments

Adult patients:
CrCl greater than 40 mL/min: No adjustment recommended.

CrCl 20 to 40 mL/min:

• Nosocomial pneumonia: 3.375 g IV every 6 hours
• Other indications: 2.25 g IV every 6 hours

CrCl less than 20 mL/min:

• Nosocomial pneumonia: 2.25 g IV every 6 hours
• Other indications: 2.25 g IV every 8 hours

Pediatric patients: Data not available

Liver Dose Adjustments

Hepatic cirrhosis: No adjustment recommended.

Precautions

CONTRAINDICATIONS:
History of allergic reactions to any penicillin, cephalosporin, or beta-lactamase inhibitor

Safety and efficacy have not been established in patients younger than 2 months.

Consult WARNINGS section for additional precautions.

Dialysis

Adult patients:
Hemodialysis, CAPD:

• Nosocomial pneumonia: 2.25 g IV every 8 hours
• Other indications: 2.25 g IV every 12 hours

Continuous venovenous hemofiltration (CVVH): Some experts recommend piperacillin-tazobactam 2.25 to 3.375 g every 8 hours for initial therapy of patients undergoing CVVH, and then intermittent doses of piperacillin alone to prevent tazobactam accumulation.

Pediatric patients: Data not available

Comments:

• A supplemental dose of 0.75 g piperacillin-tazobactam should be given after each hemodialysis session on hemodialysis days.
• No supplemental dose is needed for CAPD patients.
• Clearance may be significantly increased in patients undergoing continuous renal replacement therapy (CRRT) and higher doses may be necessary which should be individualized based on estimated piperacillin-tazobactam clearance. In addition, tazobactam has a longer half-life than piperacillin, resulting in relative serum level increases compared to piperacillin.

Other Comments

Dose expressed as piperacillin-tazobactam unless otherwise specified.

4.5 g piperacillin-tazobactam contains 4 g piperacillin and 500 mg tazobactam
3.375 g piperacillin-tazobactam contains 3 g piperacillin and 375 mg tazobactam
2.25 g piperacillin-tazobactam contains 2 g piperacillin and 250 mg tazobactam
0.75 g piperacillin-tazobactam contains 670 mg piperacillin and 80 mg tazobactam
112.5 mg/kg piperacillin-tazobactam contains 100 mg/kg piperacillin and 12.5 mg/kg tazobactam
90 mg/kg piperacillin-tazobactam contains 80 mg/kg piperacillin and 10 mg/kg tazobactam

Administration advice:

• Administer via IV infusion over 30 minutes.
• During infusion of this drug, discontinue the primary infusion solution.
• Do not mix with other drugs in a syringe or infusion bottle.
• Galaxy Containers: Do not use plastic containers in series connections.
• Reconstitute, dilute, and administer this drug and aminoglycosides separately when concurrent use of aminoglycosides is indicated; consult the manufacturer product information regarding coadministration via Y-site infusion.

Storage requirements:

• Galaxy Containers: Store at or below -20C (-4F); thawed solution is stable for 24 hours at 20C to 25C (68F to 77F) or for 14 days at 2C to 8C (36F to 46F); do not refreeze.
• Vials: The manufacturer product information should be consulted regarding storage and stability of reconstituted and/or further diluted solutions.

Reconstitution/preparation techniques:

• Galaxy Containers: Thaw frozen container at room temperature 20C to 25C (68F to 77F) or in refrigerator 2C to 8C (36F to 46F); do not force thaw by immersion in water baths or by microwave irradiation.
• Vials: Reconstitution and further dilution needed; the manufacturer product information should be consulted.

IV compatibility:

• Compatible reconstitution diluents for vials: 0.9% sodium chloride injection; sterile water for injection; dextrose 5%; bacteriostatic saline/parabens; bacteriostatic water/parabens; bacteriostatic saline/benzyl alcohol
• Compatible IV solutions for vials: 0.9% sodium chloride injection; sterile water for injection; dextran 6% in saline; dextrose 5%
• Lactated Ringers Solution is compatible only with the reformulated product containing edetate disodium dihydrate (EDTA); compatible for coadministration via Y-site.
• Incompatible: Solutions containing only sodium bicarbonate; solutions that alter pH significantly; blood products; albumin hydrolysates
• Galaxy Containers: Do not add supplementary medication; product containing EDTA is compatible for coadministration via Y-site IV tube with Lactated Ringers injection, USP.

General:

• This drug is for the treatment of moderate to severe infections due to susceptible isolates of the designated bacteria.
• To reduce the development of drug-resistant organisms and maintain effective therapy, this drug should be used only to treat or prevent infections proven or strongly suspected to be caused by susceptible bacteria.
• Culture and susceptibility information should be considered when selecting/modifying antibacterial therapy or, if no data are available, local epidemiology and susceptibility patterns may be considered when selecting empiric therapy.
• Sodium content is about 2.84 mEq (65 mg) per gram of piperacillin; at usual recommended doses, patients would receive about 34.1 to 45.5 mEq/day (780 to 1040 mg/day) of sodium.

Monitoring:

• Hematologic: Hematopoietic function (periodically, especially during prolonged therapy)
• Metabolic: Electrolytes in patients with low potassium reserves (periodically)
• Nervous System: For signs/symptoms of neuromuscular excitability or seizures in patients with renal dysfunction or seizure disorders
• Renal: Renal function in critically ill patients (during therapy); renal function in elderly patients

Patient advice:

• Avoid missing doses and complete the entire course of therapy.
• Consult physician at once if watery and bloody stools (with or without stomach cramps and fever) develop.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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