Piperacillin + tazobactam

Hypersensitivity to piperacillin, tazobactam, β-lactamase inhibitors and history of severe allergic reactions to β-lactams (e.g. cephalosporins, carbapenems, monobactams).

Patient with cystic fibrosis, previous CNS disease, including history of seizure disorder. Neonates and children. Renal impairment, including haemodialysis patients. Pregnancy and lactation. Monitoring Parameters Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Evaluate the patient's allergy history before treatment initiation. Monitor creatinine, BUN, urinalysis, LFTs, serum electrolytes, and haematologic parameters (e.g. CBC with differential, prothrombin time) periodically with prolonged therapy. Closely assess for signs of anaphylaxis (during initial dose), bleeding, skin rash, and CNS effects.

Significant: Bone marrow suppression (e.g. neutropenia, leucopenia, non-immune, agranulocytosis, pancytopenia), drug-induced thrombocytopenia, bleeding events, nephrotoxicity, piperacillin-induced encephalopathy, bacterial or fungal superinfection. Gastrointestinal disorders: Diarrhoea, constipation, nausea, vomiting, dyspepsia, abdominal pain. General disorders and administration site conditions: Inj site reactions, chills, fever. Hepatobiliary disorders: Jaundice, hepatitis. Infections and infestations: Candidiasis. Investigations: Increased AST/ALT, blood alkaline phosphatase, blood creatinine, BUN; prolonged aPTT, decreased blood albumin and total protein. Metabolism and nutrition disorders: Hypoglycaemia, hypokalaemia. Musculoskeletal and connective tissue disorders: Arthralgia, myalgia. Nervous system disorders: Headache. Psychiatric disorders: Insomnia. Respiratory, thoracic and mediastinal disorders: Eosinophilic pneumonia. Rarely, epistaxis. Skin and subcutaneous tissue disorders: Rash, pruritus. Vascular disorders: Hypotension, flushing, phlebitis, thrombophlebitis.
Potentially Fatal: Hypersensitivity reactions including anaphylaxis, anaphylactic shock, and severe cutaneous adverse reactions (e.g. Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalised exanthematous pustulosis, drug reaction with eosinophilia and systemic symptoms); Clostridioides difficile-associated diarrhoea, Clostridioides difficile colitis; haemophagocytic lymphohistiocytosis.

Increased incidence of nephrotoxicity or acute kidney injury when given with vancomycin. Prolonged half-life and decreased renal clearance with probenecid. Piperacillin: May prolong the neuromuscular blockade of vecuronium. May reduce the excretion and increase the serum levels of methotrexate. May enhance the anticoagulant effects of heparin and oral anticoagulants.

Penicillins

J01CA12 - piperacillin ; Belongs to the class of penicillins with extended spectrum. Used in the systemic treatment of infections.
J01CG02 - tazobactam ; Belongs to the class of beta-lactamase inhibitors. Used in the systemic treatment of infections.