piperacillin/tazobactam (Rx)

Brand and Other Names:Zosyn
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

piperacillin/tazobactam

injection, lyophilized powder for reconstitution

  • (2g/250mg)/vial: 2.25g
  • (3g/375mg)/vial: 3.375g
  • (4g/500mg)/vial: 4.5g
  • (36g/4.5g)/vial: 40.5g

premix bag

  • 2.25g/50mL
  • 3.375g/50mL
  • 4.5g/100mL

Intra-abdominal Infections

Indicated for treatment of appendicitis (complicated by rupture or abscess) and peritonitis caused by beta-lactamase producing isolates of Escherichia coli or the following members of the Bacteroides fragilis group: B fragilis, B ovatus, B thetaiotaomicron, or B vulgatus

3.375 g IV q6hr (totaling 13.5 g [12 g piperacillin/1.5 g tazobactam]) for 7-10 days

Nosocomial Pneumonia

Indicated for treatment of nosocomial pneumonia (moderate to severe) caused by beta-lactamase producing isolates of Staphylococcus aureus and by piperacillin/tazobactam-susceptible Acinetobacter baumannii, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa

Nosocomial pneumonia caused by P aeruginosa should be treated in combination with an aminoglycoside

4.5 g IV q6hr (totaling 18 g [16 g piperacillin/2 g tazobactam]) for 7-14 days; continue aminoglycoside in P. aeruginosa patients

Skin and Skin Structure infections

Indicated for treatment of uncomplicated and complicated skin and skin structure infections, including cellulitis, cutaneous abscesses and ischemic/diabetic foot infections caused by beta-lactamase producing isolates of Staphylococcus aureus

3.375 g IV q6hr (totaling 13.5 g [12 g piperacillin/1.5 g tazobactam]) for 7-10 days

Female Pelvic Infections

Indicated in treatment of postpartum endometritis or pelvic inflammatory disease caused by beta-lactamase producing isolates of E coli

3.375 g IV q6hr (totaling 13.5 g [12 g piperacillin/1.5 g tazobactam]) for 7-10 days

Community-acquired Pneumonia

Indicated for the treatment of community-acquired pneumonia (moderate severity only) caused by beta-lactamase producing isolates of H influenzae

3.375 g IV q6hr (totaling 13.5 g [12 g piperacillin/1.5 g tazobactam]) for 7-10 days

Dosage Modifications

Renal impairment

  • All indications except nosocomial pneumonia
    • CrCl >40 mL/min: 3.375 g IV q6hr
    • CrCl 20-40 mL/min (without hemodialysis): 2.25 IV q6hr
    • CrCl <20 mL/min (without hemodialysis): 2.25 g IV q8hr
    • Hemodialysis: 2.25 g IV q12hr; administer an additional dose of 0.75 g (0.67 g piperacillin/0.08 g tazobactam) following each dialysis period on hemodialysis days
    • CAPD: 2.25 g IV q12hr
  • Nosocomial pneumonia
    • CrCl >40 mL/min: 4.5 g IV q6hr
    • CrCl 20-40 mL/min (without hemodialysis): 3.375 IV q6hr
    • CrCl <20 mL/min (without hemodialysis): 2.25 g IV q6hr
    • Hemodialysis: 2.25 g IV q8hr; administer an additional dose of 0.75 g (0.67 g piperacillin/0.08 g tazobactam) following each dialysis period on hemodialysis days
    • CAPD: 2.25 g IV q8hr

Hepatic impairment

  • Dosage adjustment not warranted in patients with hepatic cirrhosis

Cystic fibrosis patients

  • As with other semisynthetic penicillins, piperacillin therapy has been associated with an increased incidence of fever and rash in cystic fibrosis patients

Dosing Considerations

Administering drug in absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases risk of development of drug-resistant bacteria

When culture and susceptibility information are available, consider selecting or modifying antibacterial therapy

In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy

Dosage Forms & Strengths

piperacillin/tazobactam

injection, lyophilized powder for reconstitution

  • (2g/250mg)/vial: 2.25g
  • (3g/375mg)/vial: 3.375g
  • (4g/500mg)/vial: 4.5g
  • (36g/4.5g)/vial: 40.5g

premix bag

  • 2.25g/50mL
  • 3.375g/50mL
  • 4.5g/100mL

Intra-abdominal Infections

Indicated for treatment of appendicitis (complicated by rupture or abscess) and/or peritonitis in adult and pediatric patients aged ≥2 months caused by beta-lactamase producing isolates of Escherichia coli or the following members of the Bacteroides fragilis group: B fragilis, B ovatus, B thetaiotaomicron, or B vulgatus

<2 months: Safety and efficacy not established

2-9 months

  • ≤40 kg: 90 mg/kg (80 mg piperacillin/10 mg tazobactam) IV q8hr  

>9 months

  • ≤40 kg: 112.5 mg/kg (100 mg piperacillin/12.5 mg tazobactam) IV q8hr  
  • >40 kg: 3.375 g IV q6hr (totaling 13.5 g [12 g piperacillin/1.5 g tazobactam]) for 7-10 days

Nosocomial Pneumonia

Indicated for treatment of nosocomial pneumonia (moderate to severe) in adult and pediatric patients aged ≥2 months caused by beta-lactamase producing isolates of Staphylococcus aureus and by piperacillin/tazobactam-susceptible Acinetobacter baumannii, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa

Nosocomial pneumonia caused by P. aeruginosa should be treated in combination with an aminoglycoside

<2 months: Safety and efficacy not established

2-9 months

  • ≤40 kg: 90 mg/kg (80 mg piperacillin/10 mg tazobactam) IV q6hr  

>9 months

  • ≤40 kg: 112.5 mg/kg (100 mg piperacillin/12.5 mg tazobactam) IV q6hr  
  • >40 kg: 4.5 g IV q6hr (totaling 18 g [16 g piperacillin/2 g tazobactam]) for 7-14 days

Dosage Modifications

Renal impairment

  • Dosage in pediatric patients with renal impairment has not been determined

Hepatic impairment

  • Dosage adjustment not warranted in patients with hepatic cirrhosis

Cystic fibrosis patients

  • As with other semisynthetic penicillins, piperacillin therapy has been associated with an increased incidence of fever and rash in patients with cystic fibrosis

Dosing Considerations

Administering drug in absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases risk of development of drug-resistant bacteria

When culture and susceptibility information are available, consider selecting or modifying antibacterial therapy

In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy

Because of limitations of available strengths and administration requirements (ie, administration of fractional doses not recommended) of injection supplied in GALAXY Containers; to avoid unintentional overdose, this product not recommended for use if a dose of injection in GALAXY Containers that does not equal 2.25 g, 3.375 g, or 4.5 g is required and an alternative formulation of the drug should be considered

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Interactions

Interaction Checker

and piperacillin/tazobactam

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    Contraindicated

      Serious - Use Alternative

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            Contraindicated (0)

              Serious - Use Alternative (12)

              • antithrombin alfa

                piperacillin increases effects of antithrombin alfa by pharmacodynamic synergism. Avoid or Use Alternate Drug.

              • antithrombin III

                piperacillin increases effects of antithrombin III by pharmacodynamic synergism. Avoid or Use Alternate Drug.

              • argatroban

                piperacillin will increase the level or effect of argatroban by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

              • BCG vaccine live

                piperacillin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until antibiotic treatment complete to administer live bacterial vaccine; antibiotics may diminish therapeutic effects of BCG.

              • bivalirudin

                piperacillin will increase the level or effect of bivalirudin by anticoagulation. Avoid or Use Alternate Drug. cephalosporins may decrease prothrombin activity

              • cholera vaccine

                piperacillin, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

              • dalteparin

                piperacillin increases effects of dalteparin by anticoagulation. Avoid or Use Alternate Drug. Piperacillin can inhibit platelet aggregation.

              • enoxaparin

                piperacillin increases effects of enoxaparin by anticoagulation. Avoid or Use Alternate Drug. Piperacillin can inhibit platelet aggregation.

              • heparin

                piperacillin will increase the level or effect of heparin by anticoagulation. Avoid or Use Alternate Drug. piperacillin can inhibit platelet aggregation

              • omadacycline

                omadacycline decreases effects of piperacillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Tetracyclines may interfere with the bactericidal action of penicillins. Monitor for decreased therapeutic effects of penicillins if concomitantly used with a tetracycline.

              • sarecycline

                sarecycline decreases effects of piperacillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Tetracyclines may interfere with the bactericidal action of penicillins. Monitor for decreased therapeutic effects of penicillins if concomitantly used with a tetracycline.

              • warfarin

                piperacillin increases effects of warfarin by anticoagulation. Avoid or Use Alternate Drug. Piperacillin can inhibit platelet aggregation.

              Monitor Closely (17)

              • azithromycin

                azithromycin decreases effects of piperacillin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • bazedoxifene/conjugated estrogens

                piperacillin will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • chloramphenicol

                chloramphenicol decreases effects of piperacillin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • clarithromycin

                clarithromycin decreases effects of piperacillin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • demeclocycline

                demeclocycline decreases effects of piperacillin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • dichlorphenamide

                dichlorphenamide and piperacillin both decrease serum potassium. Use Caution/Monitor.

              • doxycycline

                doxycycline decreases effects of piperacillin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • erythromycin base

                erythromycin base decreases effects of piperacillin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • erythromycin ethylsuccinate

                erythromycin ethylsuccinate decreases effects of piperacillin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • erythromycin lactobionate

                erythromycin lactobionate decreases effects of piperacillin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • erythromycin stearate

                erythromycin stearate decreases effects of piperacillin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • minocycline

                minocycline decreases effects of piperacillin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • probenecid

                probenecid will increase the level or effect of piperacillin by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.

              • sodium picosulfate/magnesium oxide/anhydrous citric acid

                piperacillin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

              • tetracycline

                tetracycline decreases effects of piperacillin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

              • vancomycin

                piperacillin increases toxicity of vancomycin by unspecified interaction mechanism. Use Caution/Monitor. Monitor kidney function in patients concomitantly administered with piperacillin and vancomycin.

              • vecuronium

                piperacillin increases toxicity of vecuronium by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Neuromuscular blockade may be prolonged.

              Minor (15)

              • amikacin

                piperacillin increases effects of amikacin by pharmacodynamic synergism. Minor/Significance Unknown.

              • aspirin

                piperacillin, aspirin. Either increases effects of the other by receptor binding competition. Minor/Significance Unknown. Salicylic acid could be displaced from protein binding sites or it could itself displace other protein-bound drugs and result in an enhanced effect of the displaced drug.

              • aspirin rectal

                piperacillin will increase the level or effect of aspirin rectal by plasma protein binding competition. Minor/Significance Unknown. Salicylic acid could be displaced from protein binding sites or it could itself displace other protein-bound drugs and result in an enhanced effect of the displaced drug

              • aspirin/citric acid/sodium bicarbonate

                piperacillin will increase the level or effect of aspirin/citric acid/sodium bicarbonate by plasma protein binding competition. Minor/Significance Unknown. Salicylic acid could be displaced from protein binding sites or it could itself displace other protein-bound drugs and result in an enhanced effect of the displaced drug

              • chlorothiazide

                chlorothiazide increases levels of piperacillin by decreasing renal clearance. Minor/Significance Unknown.

              • choline magnesium trisalicylate

                piperacillin will increase the level or effect of choline magnesium trisalicylate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown. Salicylate saltscould be displaced from binding sites or could displace other highly protein-bound drugs such as penicillins

              • gentamicin

                piperacillin increases effects of gentamicin by pharmacodynamic synergism. Minor/Significance Unknown.

              • hydrochlorothiazide

                hydrochlorothiazide increases levels of piperacillin by decreasing renal clearance. Minor/Significance Unknown.

              • ibuprofen IV

                piperacillin will increase the level or effect of ibuprofen IV by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • meclofenamate

                piperacillin will increase the level or effect of meclofenamate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • neomycin PO

                piperacillin increases effects of neomycin PO by pharmacodynamic synergism. Minor/Significance Unknown.

              • rose hips

                rose hips will increase the level or effect of piperacillin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

              • streptomycin

                piperacillin increases effects of streptomycin by pharmacodynamic synergism. Minor/Significance Unknown.

              • tobramycin

                piperacillin increases effects of tobramycin by pharmacodynamic synergism. Minor/Significance Unknown.

              • willow bark

                piperacillin will increase the level or effect of willow bark by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.

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              Adverse Effects

              >10%

              Diarrhea (7-11%)

              1-10%

              Constipation (1-8%)

              Headache (1-8%)

              Insomnia (4-7%)

              Nausea (2-7%)

              Fever (2-5%)

              Oral candidiasis (2-4%)

              Rash (2-4%)

              Vomiting (2-4%)

              Dyspepsia (3%)

              Pruritus (3%)

              Pain (2-3%)

              Hypertension (2%)

              Leukopenia (1%)

              Thrombocytopenia (1.4%)

              <1%

              Anaphylaxis

              Agranulocytosis

              Thrombocytopenia

              Eosinophilia, melena

              Leukopenia

              Positive Coombs test

              Prolonged PT and PTT

              Transient LFT and creatinine elevations

              Seizure

              Pulmonary edema

              Pulmonary embolism

              Postmarketing Reports

              Gastrointestinal: Hepatitis, jaundice

              Hematologic: Hemolytic anemia, agranulocytosis, pancytopenia

              Immune: Hypersensitivity reactions, anaphylactic/anaphylactoid reactions (including shock)

              Renal: Interstitial nephritis

              Skin and appendages: Erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, dermatitis exfoliative

              Respiratory, thoracic and mediastinal disorders: Epistaxis, eosinophilic pneumonia

              Psychiatric disorders: Delirium

              Drug reaction with eosinophilia and systemic symptoms (DRESS)

              Acute generalized exanthematous pustulosis

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              Warnings

              Contraindications

              Allergy to penicillins, cephalosporins, imipenem, beta-lactamase inhibitors

              Cautions

              Risk of bleeding complications, especially in renal impairment; discontinue if thrombocytopenia or bleeding occurs

              Leukopenia/neutropenia associated with prolonged therapy; periodic assessment of hematopoietic function should be performed, especially with prolonged therapy that is ≥ 21 days

              Serious skin reactions reported, including Stevens-Johnson syndrome and toxic epidermal necrolysis, generalized exanthematous pustulosis; discontinue if reaction occurs

              Monitor renal, hepatic, and especially hematopoietic functions during prolonged treatment

              Prolonged use may result in fungal or bacterial superinfection

              Administering drug in absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases risk of development of drug-resistant bacteria

              Clostridium difficile associated diarrhea (CDAD) reported; if CDAD suspected or confirmed, may need to discontinue ongoing antibacterial drug use not directed against C. difficile; appropriate fluid and electrolyte management, protein supplementation may need to be implemented; antibacterial treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated

              Increased frequency of rash and fever reported in cyctic fibrosis patients receiving piperacillin

              Risk of seizures may increase in patients with history of seizures when administered at higher than recommended doses given IV in the presence of renal impairment

              Consider sodium content (2.79 mEq/g piperacillin) in patients requiring sodium restriction

              Perform periodic electrolyte determinations in patients with low potassium reserves and who are receiving cytotoxic therapy or diuretics and consider possibility of hypokalemia in patients who have potentially low potassium reserves

              Increased frequency of fever and rash reported in patients with cystic fibrosis receiving piperacillin

              Use caution in patients with renal impairment or underdeveloped kidneys due to sodium load and adverse effects of high serum concentrations of penicillin; dose adjustment may be necessary

              Patients may experience neuromuscular excitability or convulsions if higher than recommended doses are given IV (particularly in presence of renal failure); closely monitor patients with renal impairment or seizure disorders for signs and symptoms of neuromuscular excitability or convulsions (seizures)

              Drug interaction overview

              • Piperacillin when used concomitantly with vecuronium has been implicated in prolongation of neuromuscular blockade of vecuronium
              • Treatment could produce the same phenomenon if given along with vecuronium; due to their similar mechanism of action, it is expected that neuromuscular blockade produced by any of the non-depolarizing neuromuscular blockers could be prolonged in the presence of piperacillin
              • Monitor for adverse reactions related to neuromuscular blockade
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              Pregnancy & Lactation

              Pregnancy

              Piperacillin and tazobactam cross placenta in humans

              Insufficient data available with piperacillin and/or tazobactam in pregnant women to inform a drug-associated risk for major birth defects and miscarriage

              Animal data

              • No fetal structural abnormalities observed in rats or mice when drug administered IV during organogenesis at doses 1 to 2 times and 2 to 3 times human dose of piperacillin and tazobactam, respectively; based on body-surface area (mg/m2)
              • Fetotoxicity in presence of maternal toxicity was observed in developmental toxicity and peri/postnatal studies conducted in rats (intraperitoneal administration prior to mating and throughout gestation or from gestation day 17 through lactation day 21) at doses less than maximum recommended human daily dose based on body-surface area (mg/m2)

              Lactation

              Piperacillin is excreted in human milk; tazobactam concentrations in human milk have not been studied

              No information available on effects of piperacillin and tazobactam on breastfed child or on milk production

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Antipseudomonal penicillin plus beta-lactamase inhibitor; inhibits biosynthesis of cell wall mucopeptide synthesis by binding to 1 or more of the penicillin-binding proteins and is effective during active-multiplication stage

              Absorption

              Peak plasma concentration

              • Piperacillin: 134 mcg/mL (2.25-g dose); 242 mcg/mL (3.375-g dose); 298 mcg/mL (4.5-g dose)
              • Tazobactam: 15 mcg/mL (2.25-g dose); 24 mcg/mL (3.375-g dose); 34 mcg/mL (4.5-g dose)

              AUC

              • Piperacillin: 131 mcg⋅hr/mL (2.25-g dose); 242 mcg⋅hr/mL (3.375-g dose); 322 mcg⋅hr/mL (4.5-g dose)
              • Tazobactam: 16 mcg⋅hr/mL (2.25-g dose); 25 mcg⋅hr/mL (3.375-g dose); 39.8 mcg⋅hr/mL (4.5-g dose)

              Distribution

              Protein bound: ~30%

              Lungs, intestinal mucosa, skin, muscle, uterus, ovary, prostate, gallbladder, and bile; low CSF penetration in noninflamed meninges

              Metabolism

              Hepatic to desethyl metabolite (piperacillin) and inactive metabolite (tazobactam)

              Elimination

              Half-life: 0.7-1.2 hr

              Excretion

              • Piperacillin: Urine (68%); feces (10-20%)
              • Tazobactam: Urine (80%)
              • Both also excreted in bile

              Clearance

              • Piperacillin: 257 mL/min (2.25-g dose); 207 mL/min (3.375-g dose); 210 mL/min (4.5-g dose)
              • Tazobactam: 258 mL/min (2.25-g dose); 251 mL/min (3.375-g dose); 206 mL/min (4.5-g dose)
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              Administration

              IV Incompatibilities

              • Do not mix with other drugs in syringe or infusion bottle since compatibility has not been established
              • Not chemically stable in solutions that contain only sodium bicarbonate and solutions that significantly alter the pH
              • Do not add to blood products or albumin hydrolysates

              IV Compatibilities

              • 0.9% NaCl
              • Sterile water for injection (maximum volume: 50 mL)
              • Dextran 6% in NS
              • Dextrose 5%
              • Lactated Ringer (compatible only with reformulated piperacillin/tazobactam containing EDTA and is compatible for coadministration via a Y-site)
              • Refer to prescribing information for specific Y-site compatibility information

              Reconstitution

              Compatible for reconstitution

              • 0.9% NaCl
              • Sterile water for injection
              • Dextrose 5%
              • Bacteriostatic saline/parabens
              • Bacteriostatic water/parabens
              • Bacteriostatic saline/benzyl alcohol
              • Bacteriostatic water/benzyl alcohol

              Bulk vial

              • Reconstitute with exactly 152 mL of compatible reconstitution diluent (final concentration: 200 mg/mL of piperacillin and 25 mg/mL of tazobactam)
              • Shake well until dissolved
              • Visually inspect for particulate matter and discoloration before and during administration whenever solution and container permit

              IV Preparation

              Premix frozen bag

              • Check for minute leaks by squeezing container firmly
              • If leaks are detected, discard solution as sterility may be impaired.
              • Visually inspect product; components of solution may precipitate while frozen and will dissolve upon reaching room temperature with little or no agitation; agitate after solution has reached room temperature
              • If after visual inspection, the solution remains cloudy or if an insoluble precipitate is noted or if any seals or outlet ports are not intact, discard the container

              IV Administration

              Infuse over 30 min

              Storage

              Unopened Vials

              • Store at room temperature (20-25ºC [68-77ºF])

              Premix frozen bag

              • Unused: Freeze at -20ºC [-4ºF])
              • Thawed bag: Refrigerate at (2-8ºC [36-46ºF]) for up to 14 days or store at room temperature (20-25ºC [68-77ºF]) for up to 24 hr; do not refreeze thawed bag

              Diluted IV solutions

              • Store at room temperature (20-25ºC [68-77ºF]) for up to 24 hr, or after 1 week if refrigerated (2-8ºC [36-46ºF])

              Reconstituted single-dose vials or pharmacy bulk vials

              • Store at room temperature (20-25vC [68-77ºF]) for up to 24 hr, or after 48 hours if refrigerated (2-8ºC [36-46ºF])
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              Patient Handout

              A Patient Handout is not currently available for this monograph.
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              Formulary

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              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.