Piperacillin + Tazobactam (Tazocin)

Tazocin is a combination of piperacillin (a broad-spectrum penicillin) and tazobactam (a beta-lactamase inhibitor). It has activity against many Gram + ve, Gram –ve and anaerobic bacteria.Tazocin may act synergistically with aminoglycosides against Gram –ve organisms including Pseudomonas aeruginosa. However, it remains susceptible to chromosomal beta-lactamases expressed by Enterobacteriaceae such as Enterobacter spp. and Citrobacter spp. and is unreliable for organisms expressing extendedspectrum beta-lactamases (ESBLs). Tazocin appears to have a lower propensity to cause superinfection with Clostridium difficile compared with fluoroquinolones and cephalosporins.

Uses
Intra-abdominal infection
Respiratory tract infection particularly nosocomial pneumonia
Severe upper urinary tract infection
Empirical therapy of a range of severe infections prior to availability of sensitivities
Febrile neutropenia (usually combined with an aminoglycoside)

Contraindications
Penicillin hypersensitivity
Cephalosporin hypersensitivity

Administration
Reconstitute 2.25 g with 10 ml WFI
Reconstitute 4.5 g with 20 ml WFI
• IV bolus: 2.25–4.5 g 6–8 hourly, given over 3–5 min
• IV infusion: dilute the reconstituted solution to at least 50 ml with
5% glucose or sodium chloride 0.9% given over 20–30 min

In renal impairment:

Infection	Dose (g)	Interval (h)
Mild–moderate	2.25	8
Moderate–serious	4.5	6–8

How not to use tazocin

CC (ml/min)	Dose (g)	Interval (h)
20–80	4.5	8
10–20	4.5	8–12
< 10	4.5	12

Not for intrathecal use (encephalopathy)

Do not mix in the same syringe with an aminoglycoside (efficacy of aminoglycoside reduced)

Adverse effects

Diarrhoea

Muscle pain or weakness

Hallucination

Convulsion (high dose or renal failure)

Cautions

Owing to the sodium content (~2 mmol/g), high doses may lead to

hypernatraemia

Organ failure

Renal: reduce dose

Renal replacement therapy

No further dose modification is required during high-clearance

CVVH; though in low-clearance techniques reduce dose to 4.5 g 12 hourly. HD dialysed, dose 4.5 g 12 hourly or 2.25 g 8 hourly. PD not dialysed, dose 4.5 g 12 hourly or 2.25 g 8 hourly.