Piperacillin + Tazobactam (Piperacillinum + Tazobactamum)

Pharmacodynamics Pharmacokinetics Indications Carefully Contraindications Dosing and Administration Side effects
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Clinical and pharmacological group: & nbsp

Penicillins

Included in the formulation
  • Piperacillin + Tazobactam
    powder in / in 
    ARS, LLC     Russia
  • Piperacillin + Tazobactam Kabi
    powder in / in 
    Fresenius Kabi Deutschland GmbH     Germany
  • Piperacillin + Tazobactam-Alkem
    powder in / in 
    Alkem Laboratories Ltd     India
  • Santa's
    powder in / in 
    SP.INKOMED, ​​LLC     Russia
  • Tazocin®
    lyophilizate d / infusion in / in 
    Pfizer Inc.     USA
  • Tazrobid®
    lyophilizate in / in 
    GlaxoSmithKline Trading, ZAO     Russia
  • Tacillin J
    powder in / in 
    Jodas Expo Pvt.Ltd     India
    • АТХ:

    J.01.C.R.05   Piperacillin in combination with enzyme inhibitors

    Pharmacodynamics:

    Combined drug

    Piperacillin - a semisynthetic bactericidal antibiotic with a broad spectrum of action. The mechanism of action is based on inhibiting the synthesis of the membrane of the bacterial cell wall.

    Tazobactam - sulfonate derivative of triazolmethylpenicillic acid. The mechanism of action is the inhibition of many beta-lactamases, including plasmid and chromosomal beta-lactamases, which cause bacterial resistance to penicillins and cephalosporins. Tazobactam significantly enhances antimicrobial activity and broadens the spectrum of antibiotic action.

    The drug is active against the following Gram-negative bacteria:

    Escherichia coli, Citrobacter spp. (at Tom number of Citrobacter freundii, Citrobacter diversus), Klebsiella spp. (at Tom number of Klebsiella oxytoca, Klebsiella pneumoniae), Enterobacter spp. (at Tom number of Enterobacter cloaca, Enterobacter aerogenes), Proteus vulgaris, Proteus mirabilis, Providencia rettgery, Providencia stuartii, Plesiomonas shigelloides, Morganella morganii, Serratia spp. (at Tom number of Serratia marcescens, Serratia liquifaciens), Salmonella spp., Shigella spp., Pseudomonas aeruginosa and others Pseudomonas spp. (at Tom number of Pseudomonas cepacia, Pseudomonas fluorescens), Xanthamonas maltophilia, Neisseria gonorrhoeae, Neisseria meningitidis, Moraxella spp. (at Tom number of Branhamella catarrhalis), Acinetobacter spp., Haemophilus influenzae, Haemophilus parainfluenza, Pasteurella multocida, Yersinia spp., Campylobacter spp., Gardnerella vaginalis.

    The drug effectively affects the following strains of Gram-positive bacteria:

    Streptococcus spp. (including Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus bovis, Streptococcus agalactiae, Streptococcus spp., viridans of subgroup C and G), Enterococcus spp. (Enterococcus faecalis, Enterococcus faecium), Staphylococcus aureus (susceptible to methicillin), Staphylococcus saprophyticus, Staphylococcus epidermidis (coagulase negative), Listeria monocytogenes, Nocardia spp.

    The drug is also active against anaerobic bacteria:

    Bacteroides spp. (Bacteroides bivius, Bacteroides disiens, Bacteroides capillosus, Bacteroides melaninogenicus, Bacteroides oralis), subgroups Bacteroides fragilis (Bacteroides fragilis, Bacteroides vulgatus, Bacteroides distasonis, Bacteroides ovatus, Bacteroides thetaiotaomicronron), Bacteroides uniformis, Bacteroides asaccharolyticus), Peptostreptococcus spp., Fusobacterium spp., Eubacterium spp., Clostridium spp. (at t.h. Clostridium difficile, Clostridium perfringens), Veilonella spp. and Actynomyces spp.

    Pharmacokinetics:

    With intravenous administration of the drug, the maximum concentration is achieved immediately. The connection with plasma proteins piperacillin and tazobactam is the same - 30%, the distribution in tissues is 50-100% of the concentration in the plasma. The drug is found in many liquids and tissues of the body: the intestinal mucosa, gall bladder, bile, lungs, uterus, ovaries, fallopian tubes, bones.

    Piperacillin is metabolized to a low-activity desmethyl metabolite, tazobactam - to an inactive metabolite.

    The drug is excreted mainly by the kidneys.The half-life is 0.7-1.2 hours, with a decrease in creatinine clearance it increases.

    Indications:Infections of the lower respiratory tract, urinary tract, skin and soft tissues, bones and joints, intra-abdominal, gynecological, mixed infections, septicemia, bacterial infections with neutropenia (in combination with aminoglycosides).
    ICD-10

    I.A30-A49.A39   Meningococcal infection

    I.A30-A49.A40   Streptococcal septicemia

    I.A30-A49.A41   Other septicemia

    I.A50-A64.A54   Gonococcal infection

    VI.G00-G09.G00   Bacterial meningitis, not elsewhere classified

    IX.I80-I89.I83.2   Varicose veins of the lower extremities with ulcer and inflammation

    X.J10-J18.J15   Bacterial pneumonia, not elsewhere classified

    X.J40-J47.J47   Bronchoectasia

    X.J85-J86.J85   Abscess of the lung and mediastinum

    X.J85-J86.J86   Pythothrace

    X.J90-J94.J90   Pleural effusion, not elsewhere classified

    XI.K65-K67.K65.0   Acute peritonitis

    XI.K70-K77.K75.0   Abscess of liver

    XI.K80-K87.K81.0   Acute cholecystitis

    XI.K80-K87.K81.1   Chronic cholecystitis

    XI.K80-K87.K83.0   Cholangitis

    XII.L00-L08.L01   Impetigo

    XII.L00-L08.L02   Abscess of skin, boil and carbuncle

    XII.L00-L08.L03   Phlegmon

    XII.L00-L08.L08.0   Pyoderma

    XIII.M00-M03.M00   Pyogenic arthritis

    XIII.M86-M90.M86   Osteomyelitis

    XIV.N10-N16.N10   Acute tubulointerstitial nephritis

    XIV.N10-N16.N11   Chronic tubulointerstitial nephritis

    XIV.N30-N39.N30   Cystitis

    XIV.N30-N39.N34   Urethritis and urethral syndrome

    XIV.N40-N51.N41   Inflammatory diseases of the prostate

    XIV.N40-N51.N45   Orchitis and epididymitis

    XIV.N70-N77.N70   Salpingitis and oophoritis

    XIV.N70-N77.N71.9   Inflammatory disease of uterus, unspecified

    XIV.N70-N77.N72   Inflammatory disease of the cervix

    XIV.N70-N77.N73.0   Acute parametritis and pelvic cellulite

    XIX.T79.T79.3   Post-traumatic wound infection, not elsewhere classified

    XXI.Z20-Z29.Z29.2   Another type of preventive chemotherapy

    Contraindications:
    • Hypersensitivity to beta-lactam antibiotics
    • Hypersensitivity to beta-lactamase inhibitors
    • Children under 2 years old
    • Lactation period
    Carefully:
    • Childhood
    • Pregnancy
    • Bleeding, including in the anamnesis
    • Cystic fibrosis (risk of hyperthermia)
    • Pseudomembranous colitis
    • Chronic Renal Failure
    • Simultaneous use of anticoagulants
    • Hypokalemia
    Pregnancy and lactation:

    Piperacillin and tazobactam penetrate the placental barrier, so the drug is prescribed only if the expected benefit for the mother exceeds the possible risk to the fetus.

    Piperacillin is secreted with breast milk, so it is necessary to stop breastfeeding for the period of treatment with the drug.

    Dosing and Administration:

    The drug is injected intravenously for 3-4 minutes or drip for 30 minutes.

    For adults and children older than 12 years with normal renal function, the dose of the drug is 4.5 g (4 g piperacillin / 0.5 g tazobactam) every 8 hours.

    For treatment of children from 2 to 12 years with neutropenia, the dose is calculated based on body weight: 90 mg (80 mg piperacillin / 10 mg tazobactam) per 1 kg of body weight. The drug is administered every 6 hours in combination with a suitable dose of aminoglycoside.

    For patients on hemodialysis, the daily dose of the drug should not exceed 8 g of piperacillin / 1 g of tazobactam.

    Treatment should be conducted for at least 5 days, but not more than 14 days.

    Side effects:
    • Allergic reactions, including anaphylactic shock
    • Abdominal pain, nausea, vomiting, indigestion
    • Hepatitis, jaundice
    • Stomatitis
    • Bleeding
    • Interstitial nephritis, kidney failure
    • Headache, insomnia, cramps
    • Reduction of blood pressure, "hot flashes"
    • From the laboratory indicators: hypokalemia, transient leukopenia, eosinophilia, thrombocytopenia, Coombs positive reaction, transient increase in hepatic transaminase and alkaline phosphatase activity.
    • Local reactions (phlebitis, thrombophlebitis, reddening and condensation at the site of injection)
    • Fungal superinfections
    Overdose:

    Symptoms: nausea, vomiting, diarrhea, convulsions.

    Treatment: symptomatic, in severe cases, hemodialysis is indicated.

    Interaction:

    Simultaneous application with probenecid increases the half-life of piperacillin and tazobactam.

    A joint application with vecuronium bromide may result in a longer neuromuscular blockade.

    Application together with high doses of heparin, indirect anticoagulants increases the risk of bleeding.

    Piperacillin delays excretion of methotrexate from the body, which can increase its toxic effect.

    The drug should not be mixed in one syringe or dropper with other medicines.

    The drug should not be added to a solution of sodium bicarbonate, as well as in blood or serum preparations.

    Special instructions:Before starting treatment with the drug it is necessary to identify the patient's hypersensitivity to beta-lactam antibiotics (penicillins, cephalosporins) and beta-lactamase inhibitors in order to avoid anaphylactic shock.

    With prolonged treatment, it is necessary to periodically monitor the function of the kidneys, liver, blood counts.

    It should be borne in mind the possibility of the emergence of microorganisms resistant to the effects of the drug, and the occurrence of superinfection, especially with prolonged treatment.

    During treatment with the drug should be careful when driving vehicles and working with potentially dangerous mechanisms due to the possible development of side effects from the central nervous system.

    Instructions
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