Excreted Unchanged %
See notes
Half-Life (Normalesrd) Hours
0.7-1.2 (both)/2-6
Plasma Protein Binding %
30 (both)
Volume Of Distribution L/Kg
0.3 (both)
Dose For Normal Renal Function
3.375 -4.5 g q6-8h
Adjustment For Renal Failure Method
D, I
Adjustment For Renal Failure Gfr, Ml/Min >50 [Recommended Level]
100% [B]
Adjustment For Renal Failure Gfr, Ml/Min 10-50 [Recommended Level]
2.25 g q6h (q8h if <20) [B]
Adjustment For Renal Failure Gfr, Ml/Min <10 [Recommended Level]
2.25 g q8h [B]
Supplement For Dialysis [Recommendation Level]: Ihd
IHD: Dose for GFR <10; 1.125 g after HD, [B]
Supplement For Dialysis [Recommendation Level]: Pd
PD: 4.5 g q12h, [B]
Supplement For Dialysis [Recommendation Level]: Crrt
CRRT: 4.5 g q8h
References
Johnson EA, Klimstra DS, Herndon JE 2nd, Catalano E, Canellos GP, Graziano SL, et al. Aberrant p53 staining does not predict cisplatin resistance in locally advanced non-small cell lung cancer. Cancer Invest. 2002; 20: 686-92. [PMID: 12197224] / Mueller SC, Majcher-Peszynska J, Hickstein H, Francke A, Pertschy A, Schulz M, et al. Pharmacokinetics of piperacillin-tazobactam in anuric intensive care patients during continuous venovenous hemodialysis. Antimicrob Agents Chemother. 2002; 46: 1557-60. [PMID: 11959598] / Valtonen M, Tiula E, Takkunen O, Backman JT, Neuvonen PJ. Elimination of the piperacillin/tazobactam combination during continuous venovenous haemofiltration and haemodiafiltration in patients with acute renal failure. J Antimicrob Chemother. 2001; 48: 881-5. [PMID: 11733473] / van der Werf TS, Mulder PO, Zijlstra JG, Uges DR, Stegeman CA. Pharmaco-kinetics of piperacillin and tazobactam in critically ill patients with renal failure, treated with continuous veno-venous hemofiltration (CVVH). Intensive Care Med. 1997; 23: 873-7. [PMID: 9310805]
Toxicity Notes
Doses are for mild/moderate infection. For severe/life-threatening infection use 4.5 g q6-12h, and for Pseudomonas use 3.375 g q4-8h for patients not on dialysis. 3.375 g = 3 g piperacillin and 0.375 g tazobactam (includes 7.04 mEq or 162 mg sodium). HD removes 30-40% of dose. PD removes 6% piperacillin and 10-20% tazobactam. Possible pharmacokinetic and toxic interaction with tobramycin. Renal excretion: piperacillin 60-80%; tazobactam 80%. Alternative dosing: 4.5 g q6-8h for normal renal function if not Pseudomonas infection or nosocomial pneumonia. Some recommend 3.75 g rather than 2.25 g doses for GFR >10 mL/min if Pseudomonas infection and up to 4.5 g q8-12h for severe/life-threatening infection for GFR <50 mL/min.