Antibiotic Case No 17.Broad Spectrum Penicillins Antibiotic.

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Antibiotic Case No 17.Broad Spectrum Penicillins Antibiotic.

Thera are 3 Component Preparation in this group Broad Spectrum Penicillins Antibiotic.

They are :-

1.Amoxicillin +Clavulanic Acid.

2. Amoxicillin Trihydrate.

3.Piperacillin +Tazobactam. :-(Only IV Infusion)

1.Amoxicillin +Clavulanic Acid:-

Descriptition:-

Indications of (Amoxicillin +Clavulanic Acid):-

Co-amoxiclav is indicated for short-term treatment of bacterial infections at the following sites:

Upper respiratory tract infections (including ENT) e.g.tonsillitis,sinusitis,otitis media.
Lower respiratory tract infections e.g.acute and chronic bronchitis, lobar and bronchopneumonia.
Genito-urinary tract infections e.g.cystitis,urethritis,pyelonephritis.
Skin and soft tissue infections.
Bone and joint infections e.g.osteomyelitis.
Other infections e.g.septic abortion,puerperal sepsis,intra-abdominal sepsis etc.

Composition of (Amoxicillin +Clavulanic Acid):-

375 mg tablet: Each film coated tablet contains Amoxicillin 250 mg as Amoxicillin Trihydrate BP and Clavulanic Acid 125 mg as Diluted Potassium Clavulanate BP.
625 mg tablet: Each film coated tablet contains Amoxicillin 500 mg as Amoxicillin Trihydrate BP and Clavulanic Acid 125 mg as Diluted Potassium Clavulanate BP.
1 gm tablet: Each film coated tablet contains Amoxicillin 875 mg as Amoxicillin Trihydrate BP and Clavulanic Acid 125 mg Diluted Potassium Clavulanate BP.
Powder for Suspension: Each 5 ml reconstituted suspension contains Amoxicillin 125 mg as Amoxicillin Trihydrate BP and Clavulanic Acid 31.25 mg as Diluted Potassium Clavulanate BP.
Powder for Suspension (Forte): Each 5 ml reconstituted suspension contains Amoxicillin 400 mg as Amoxicillin Trihydrate BP and Clavulanic Acid 57.5 mg as Diluted Potassium Clavulanate BP.
1.2 gm Injection: Each vial contains sterile mixture of Amoxicillin Sodium BP (equivalent to Amoxicillin 1 gm) and Clavulanate Potassium USP (equivalent to Clavulanic Acid 200 mg).
0.6 gm injection: Each vial contains sterile mixture of Amoxicillin Sodium BP (equivalent to Amoxicillin 500) and Clavulanate Potassium USP (equivalent to Clavulanic Acid 100 mg).

Pharmacology of (Amoxicillin +Clavulanic Acid):-

Pharmacodynamic properties: Co-amoxiclav is an antibacterial combination consisting of the antibiotic Amoxicillin and the (3-lactamase inhibitor Clavulanic Acid. Amoxicillin has a broad spectrum of bactericidal activity against many Gram-positive & Gram-negative microorganisms but it is susceptible to degradation by (3-lactamases and therefore the spectrum of activity does not include microorganisms, which produce these enzymes. Clavulanic acid possesses the ability to inactivate a wide range of beta-lactamase enzymes commonly found in microorganisms resistant to penicillins and cephalosporins. Thus Clavulanic acid in this preparation protects Amoxicillin from degradation by (3-lactamase enzymes and effectively extends the antibiotic spectrum to embrace a wide range of microorganisms.

Pharmacokinetic properties: The pharmacokinetics of the two components of Co-amoxiclav is closely matched. Peak serum levels of both occur about one hour after oral administration. Absorption of Co-amoxiclav is optimized at the start of a meal. Both clavulanate and Amoxicillin have low levels of serum binding; about 70% remains free in the serum. Doubling the dosage of Co-amoxiclav approximately doubles the serum levels achieved.

Dosage of (Amoxicillin +Clavulanic Acid):-

Adults and children over 12 years:

Tablet:

The usual adult dose is one 625 mg Tablet every 12 hours or one 375 mg Tablet every 8 hours.
For more severe infections and infections of the respiratory tract, the dose should be one 1 gm Tablet every 12 hours or one 625 mg Tablet every 8 hours.

Suspension:

Children 6-12 years: 2 teaspoonful every 8 hours.
Children 1-6years: 1 teaspoonful every 8 hours.
Children below 1 year: 25 mg/kg/day in divided doses every 8 hours, for example a 7.5 kg child would require 2 ml suspension t.i.d, Treatment should not be extended beyond 14 days without review.

Forte suspension:

The usual recommended daily dosage: 25/3.6 mg/kg/day in mild to moderate infections (upper respiratory tract infections e.g. recurrent tonsilitis, lower respiratory infections, and skin and soft tissue infections)।
For serious infections: 45/6.4 mg/kg/day for the treatment of more serious infections (upper respiratory tract infections, e.g. otitis media and sinusitis, lower respiratory infections e.g. bronchopneumonia, and urinary tract infections).

Children of 2 to 12 years:
Mild to moderate infections:

25/3.6 mg/kg/day (Suspension)
2-6 years (13-21 kg) 2.5 ml suspension b.i.d
7-12years (22-40kg) 5 ml suspension b.i.d

Serious infections:

45/6.4 mg/kg/day (Forte Suspension)
2-6 years (13-21 kg) 5 ml suspension b.i.d
7-12 years (22-40 kg) 10 ml suspension b.i.d

IV Injection

Adults-

Usually, 1.2 gm every 8 hours
Increased in more serious infections to 1.2 gm every 6 hours
For surgical prophylaxis: The usual dose is 1.2 gm at induction, for high risk procedures (eg. colorectal surgery) up to 2-3 gm may be given every 8 hours.

Children-

0 to 3 months: 30 mg/kg every 8 hours. (every 12 hours in the perinatal period and in premature infants.
3 months to 12 years: Usually 30 mg/kg every 8 hours increased in more serious infection to 30 mg/kg every 6 hours.

Administration of (Amoxicillin +Clavulanic Acid):-

Oral dosage form: This may be taken without regard to meals; however, absorption of clavulanate potassium is enhanced when Amoxicillin and Clavulanic acid are administered at the start of a meal. To minimize the potential for gastrointestinal intolerance, Amoxicillin and Clavulanic acid should be taken at the start of the meal.

IV injection is not suitable for intramuscular or subcutaneous administration. The reconstituted vial can be administered intravenously by injection (over 2 minutes) or slow intravenous infusion (30 minutes). The contents of the content of the vial must be used within 20 minutes and thereafter any unused material should be discarded.

Interaction of (Amoxicillin +Clavulanic Acid):-

Prolongation of bleeding time and prothrombin time have been reported in some patients receiving Co-amoxiclav. In common with other broad-spectrum antibiotics, Co-amoxiclav may reduce the efficacy of oral contraceptives and patients should be warned accordingly. Concomitant use of allopurinol during treatment with amoxicillin can increase the likelihood of allergic skin reactions. There are no data on the concomitant use of Co-amoxiclav and allopurinol.

Contraindications of (Amoxicillin +Clavulanic Acid):-

History of Penicillin hypersensitivity. Attention should be paid to possible cross-sensitivity with other beta-lactam antibiotics e.g. cephalosporins. Also contraindicated for patients with a previous history of Co-amoxiclav or Penicillin-associated cholestatic jaundice.

Side Effects of (Amoxicillin +Clavulanic Acid):-

Side effects, as with Amoxicillin, are uncommon and mainly of a mild and transitory nature. Diarrhoea, pseudomembranous colitis, indigestion, nausea, vomiting and candidiasis have been reported, if gastrointestinal side effects occur with oral therapy, that may be reduced by taking Co-amoxiclav at the start of meals. Hepatitis and cholestatic jaundice have been reported rarely but are usually reversible. Urticarial and erythematous rashes sometimes occur. Rarely erythema multiforme, Stevens-Johnson Syndrome and exfoliative dermatitis have been reported. In common with other beta-lactam antibiotics, angioedema and anaphylaxis have been reported.

Pregnancy & Lactation of (Amoxicillin +Clavulanic Acid):-

Animal studies with orally and parenterally administered Co-amoxiclav have shown no teratogenic effect. The drug has been used orally in human pregnancy in a limited number of cases with no untoward effect; however, the use of Co-amoxiclav in pregnancy is not recommended unless considered essential by the physician. During lactation, trace quantities of Amoxicillin can be detected in breast milk.

Precautions & Warnings of (Amoxicillin +Clavulanic Acid):-

Co-amoxiclav should be used with care in patients on anticoagulation therapy or with severe hepatic dysfunction. In patients with moderate or severe renal impairment, dosage should be adjusted. During the administration of a high dose of Co-amoxiclav adequate fluid intake and urinary output should be maintained to minimize the possibility of crystalluria.

Use in Special Populations of (Amoxicillin +Clavulanic Acid):-

The dose should be adjusted in case of patients with renal impairment

Adult:

Mild impairment (Creatinine clearance> 30ml/minute): No changein dosage.
Moderate impairment (Creatinine clearance 10-30 ml/minute): One 375 Tablet or one 625 Tablet 12 hourly or 1.2 gm IV followed by 0.6 gm IV 12 hourly.
Severe impairment (Creatinine clearance <10 ml/minute): Not more than one 375 mg tablet 12 hourly or 1.2 gm IV followed by 0.6 gm IV 24 hourly. Dialysis decreases serum concentrations of this preparation and an additional 0.6 gm IV dose may need to be given during dialysis and at the end of dialysis.

Children:

A similar reduction in dosage should be made for children.
Administration hepatic impairment: Dose with caution; monitor hepatic function at regular intervals.

Overdose Effects of (Amoxicillin +Clavulanic Acid):-

Problems of overdose with Co-amoxiclav are unlikely to occur, if encountered gastrointestinal symptoms and disturbance of the fluid and electrolyte balances may be evident. Co-amoxiclav may be removed from the circulation by haemodialysis.

Therapeutic Class of (Amoxicillin +Clavulanic Acid):-

Broad spectrum penicillins

1.Amoxicillin +Clavulanic Acid:-

Tablet 1.Moxaclav (250mg+125mg) (AS A (Amoxicillin +Clavulanic Acid) AS A (Broad spectrum penicillins))

Tablet 2.Moxaclav (500 mg+125mg) (AS A (Amoxicillin +Clavulanic Acid) AS A (Broad spectrum penicillins))

Tablet 3.Moxaclav (875 mg+125mg) (AS A (Amoxicillin +Clavulanic Acid) AS A (Broad spectrum penicillins))

Syrup 4.Moxaclav Forte (400 mg+57.50 mg)/5ml 50 ml Bottle (AS A (Amoxicillin +Clavulanic Acid) AS A (Broad spectrum penicillins))

Syrup 5.Moxaclav (125 mg+31.25 mg)/5ml 100 ml Bottle (AS A (Amoxicillin +Clavulanic Acid) AS A (Broad spectrum penicillins))

Injection 6.Moxaclav IV (1gm+200 mg)/20ml 1.2 gm vial (AS A (Amoxicillin +Clavulanic Acid) AS A (Broad spectrum penicillins))

Injection 7.Avloclav IV (500mg+100mg )/10ml 600mg Vial (AS A (Amoxicillin +Clavulanic Acid) AS A (Broad spectrum penicillins))

2. Amoxicillin Trihydrate:-

Descriptition:-

Indications of Amoxicillin Trihydrate:-

Amoxicillin Trihydrate is indicated in the treatment of infections due to susceptible ß-lactamase negative strains of microorganisms. These infections include

Ear, nose and throat infections (i.e. otitis media, sinusitis, tonsillitis, pharyngitis, laryngitis)
Lower respiratory tract infections (i.e. pneumonia, acute and chronic bronchitis lung abscess, empyema, bronchiectasis)
Skin and soft tissue infections (i.e. cellulitis, carbuncles, furunculosis, infected wounds, abscess)
Genito-urinary tract infections (i.e. pyelonephritis, cystitis and urethritis)
Venereal disease (i.e. acute uncomplicated gonorrhoea)
In dental abscess, it is used as short-term therapy.
It is also indicated in combination with Clarithromycin and Lansoprazole (as triple therapy), for the treatment of patients with H. pylori infection and duodenal ulcer disease and to reduce the risk of duodenal ulcer recurrence.

Pharmacology of Amoxicillin Trihydrate:-

Amoxicillin is a broad spectrum penicillin. It is effective against a wide range of Gram-positive and Gram-negative bacteria. It acts through the inhibition of biosynthesis of cell wall. Amoxicillin is stable in the presence of gastric acid and is rapidly absorbed after oral administration. After an oral dose, peak plasma concentration of Amoxicillin is reached within 1 to 2 hours. Amoxicillin is widely distributed at varying concentration in body tissues and fluids.

Dosage of Amoxicillin Trihydrate:-

Adult: 250 mg three times daily, increasing up to 500 mg three times daily for severe infections.

Children (up to 10 years of age) : 125 mg three times daily, increasing up to 250 mg three times daily for severe infections.

Severe or recurrent purulent respiratory infection: 3 gm every 12 hours.
Otitis media: Recommended dose is 1 g three times daily for adult and 40 mg/kg body weight daily in 3 divided doses for children (max. 3 g daily).
Pneumonia: Recommended dose is 500-1000 mg three times daily.
Dental abscess: Recommended dose is 3 gm, repeated after 10-12 hours.
Urinary tract infections: Recommended dose is 3 gm, repeated after 10-12 hours.
Gonorrhoea: Single dose of 2-3 gm with Probenecid 1 gm is recommended (Probenecid is contraindicated in children under 2 years).
In renal impairment: it may be necessary to reduce the total daily dosage.

Administration of Amoxicillin Trihydrate:-

Reconstituted suspension can be administered by adding the required amount of suspension to milk, fruit juice, water. These preparations should then be taken immediately.

Interaction of Amoxicillin Trihydrate:-

Concurrent use of Amoxicillin and Probenecid may result in increased and prolonged blood levels of Amoxicillin. Amoxicillin may affect the gut flora, leading to lower estrogen reabsorption and reduced efficacy of combined oral estrogen/progesterone contraceptives.

Contraindications of Amoxicillin Trihydrate:-

Amoxicillin is contraindicated in penicillin hypersensitive patients.

Side Effects of Amoxicillin Trihydrate:-

Side effects are mild and transient in nature. This may include diarrhoea, indigestion or occasionally rash. Pseudo-membranous colitis has been reported rarely.

Pregnancy & Lactation of Amoxicillin Trihydrate:-

US FDA pregnancy category of Amoxicillin is B. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Amoxicillin has been shown to be excreted in human milk. So, caution should be exercised when Amoxicillin is administered to a lactating mother.

Precautions & Warnings of Amoxicillin Trihydrate:-

The possibility of superinfections with mycotic or bacterial pathogens should be kept in mind during therapy. If superinfections occur, Amoxicillin should be discontinued and appropriate therapy should be instituted.

Therapeutic Class of Amoxicillin Trihydrate:-

Broad spectrum penicillins

2. Amoxicillin Trihydrate:-

Capsule 1.Moxacil 250mg AS A (Amoxicillin Trihydrate) AS A (Broad spectrum penicillins).

Capsule 2.Moxacil 500 mg AS A (Amoxicillin Trihydrate) AS A (Broad spectrum penicillins).

Syrup 3. Moxacil 125mg/5ml 100ml Bottle AS A (Amoxicillin Trihydrate) AS A (Broad spectrum penicillins).

Syrup 4. Moxacil 125mg/1.25 ml 15 ml Bottle AS A (Amoxicillin Trihydrate) AS A (Broad spectrum penicillins).

Pediatric Drops 5.Avlomox 125mg/1.25ml 15 ml Bottle AS A (Amoxicillin Trihydrate) AS A (Broad spectrum penicillins).

Injection 6.Avlomox IM/IV 500mg/vial 500mg vial AS A (Amoxicillin Trihydrate) AS A (Broad spectrum penicillins).

3.Piperacillin +Tazobactam:- :-(Only IV Infusion)

Descriptition:-

Indications of (Piperacillin +Tazobactam):-

Piperacillin and tazobactam is a combination product consisting of a penicillin-class antibacterial, piperacillin, and a β-lactamase inhibitor, tazobactam, indicated for the treatment of patients with moderate to severe infections caused by susceptible isolates of the designated bacteria in the conditions listed below.

Intra-abdominal Infections: Appendicitis (complicated by rupture or abscess) and peritonitis caused by β-lactamase producing isolates of Escherichia coli or the following members of the Bacteroides fragilis group: B. fragilis, B. ovatus, B. thetaiotaomicron, or B. vulgatus.

Skin and Skin Structure Infections: Uncomplicated and complicated skin and skin structure infections, including Cellulites, cutaneous abscesses and ischemic/diabetic foot infections caused by β-lactamase producing isolates of Staphylococcus aureus.

Female Pelvic Infections: Postpartum endometritis or pelvic inflammatory disease caused by β-lactamase producing isolates of Escherichia coli.

Community-acquired pneumonia: Community-acquired pneumonia (moderate severity only) caused by β lactamase producing isolates of Haemophilus influenzae.

Nosocomial pneumonia: Nosocomial pneumonia (moderate to severe) caused by β-lactamase producing isolates of Staphylococcus aureus and by piperacillin/tazobactam-susceptible Acinetobacter baumanii, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa (Nosocomial pneumonia caused by P. aeruginosa should be treated in combination with an aminoglycoside).

Pharmacology of (Piperacillin +Tazobactam):-

Piperacillin, a broad spectrum, semi-synthetic penicillin active against many gram-positive and gram-negative aerobic and anaerobic bacteria, exerts bactericidal activity by inhibition of both septum and cell wall synthesis. Tazobactam is a potent inhibitor of many beta-lactamases, including the plasmid and chromosomally mediated enzymes that commonly cause resistance to penicillins. Tazobactam enhances and extends the antibiotic spectrum of Piperacillin to include many beta-lactamase-producing bacteria normally resistant to it. Thus, this infusion combines the properties of a broad-spectrum antibiotic and a beta-lactamase inhibitor.

Dosage & Administration of (Piperacillin +Tazobactam):-

Piperacillin and tazobactam should be administered by intravenous infusion over 30 minutes.

Adult Patients: The usual total daily dose of Piperacillin and tazobactam for adults is 3.375 g every six hours totaling 13.5 g (12.0 g piperacillin/1.5 g tazobactam). The usual duration of treatment is from 7 to 10 days.

Nosocomial Pneumonia: Initial presumptive treatment of patients with nosocomial pneumonia should start with piperacillin and tazobactam at a dosage of 4.5 g every six hours plus an aminoglycoside, totaling 18.0 g (16.0 g piperacillin/2.0 g tazobactam). The recommended duration of the treatment for nosocomial pneumonia is 7 to 14 days. Treatment with the aminoglycoside should be continued in patients from whom Pseudomonas aeroginosa is isolated.

Pediatric Patients: For children with appendicitis and/or peritonitis 9 months of age or older, weighing up to 40 kg, and with normal renal function, the recommended piperacillin and tazobactam dosage is 100 mg piperacillin/12.5 mg tazobactam per kilogram of body weight, every 8 hours. For pediatric patients between 2 months and 9 months of age, the recommended dosage based on Pharmacokinetic modeling, is 80 mg piperacillin/10 mg tazobactam per kilogram of body weight, every 8 hours. Pediatric patients weighing over 40 kg and with normal renal function should receive the adult dose. It has not been determined how to adjust piperacillin and tazobactam dosage in pediatric patients with renal impairment.

Interaction of (Piperacillin +Tazobactam):-

Aminoglycosides: Piperacillin may inactivate aminoglycosides by converting them to microbiologically inert amides. When aminoglycosides are administered in conjunction with piperacillin to patients with end-stage renal disease requiring hemodialysis, the concentrations of the aminoglycosides (especially tobramycin) may be significantly reduced and should be monitored.

Sequential administration of pipercillin and tazobactam and tobramycin to patients with either normal renal function or mild to moderate renal impairment has been shown to modestly decrease serum concentrations of tobramycin but no dosage adjustment is considered necessary.

Probenecid: Probenecid administered concomitantly with piperacillin and tazobactam prolongs the half-life of piperacillin by 21% and that of tazobactam by 71% because probenecid inhibits tubular renal secretion of both piperacillin and tazobactam. Probenecid should not be co-administered with Pipercillin and tazobactam unless the benefit outweighs the risk.

Anticoagulants: Coagulation parameters should be tested more frequently and monitored regularly during simultaneous administration of high doses of heparin, oral anticoagulants, or other drugs that may affect the blood coagulation system or the thrombocyte function.

Vecuronium: Piperacillin when used concomitantly with vecuronium has been implicated in the prolongation of the neuromuscular blockade of vacuronium, piperacillin and tazobactam could produce the same phenomenon if given along with vecuronium. Due to their similar mechanism of action, it is expected that the neuromuscular blockade produced by any of the non-depolarizing muscle relaxants could be prolonged in the presence of piperacillin.

Methotrexate: Limited data suggests that co-administration of methotrexate and piperacillin may reduce the clearance of methotrexate due to competition for renal secretion. The impact of tazobactam on the elimination of methotrexate has not been evaluated. If concurrent therapy is necessary, serum concentrations of methotrexate as well as the signs and symptoms of methotrexate toxicity should be frequently monitored.

Contraindications of (Piperacillin +Tazobactam):-

Piperacillin and tazobactam is contraindicated in patients with a history of allergic reactions to any of the penicillins, cephalosporins, or β -lactamase inhibitors.

Side Effects of (Piperacillin +Tazobactam):-

Adverse events primarily involving the skin, including rash, pruritus and Purpura; the gastrointestinal system including diarrhea, Constipation, nausea, vomiting, Dyspepsia and Abdominal Pain; General disorders and administration site conditions including Fever, Injection site reaction (≤1%) and Rigors. (≤1%), Immune hypersensitivity reactions, anaphylactic/anaphylactoid reactions (including shock) (≤1%), Infections-Candidiasis and Pseudomembranous colitis (≤1%), Metabolism and nutrition disorders- Hypoglycemia (≤1%), Musculoskeletal and connective tissue disorders- Myalgia and Arthralgia (≤1%), Psychiatric disorders Insomnia, Vascular disorders- Phlebitis Thrombophlebitis(≤1%), Hypotension(≤1%), Flushing(≤1%), Respiratory, thoracic and mediastinal disorders- Epistaxis (≤1%).

Pregnancy & Lactation of (Piperacillin +Tazobactam):-

Piperacillin and tazobactam cross the placenta in humans. However, there are insufficient data with piperacillin and/or tazobactam in pregnant women to inform a drug-associated risk for major birth defects and miscarriage. Piperacillin is excreted in human milk; tazobactam concentrations in human milk have not been studied. No information is available on the effects of piperacillin and tazobactam on the breastfed child or on milk production.

Precautions & Warnings of (Piperacillin +Tazobactam):-

Serious hypersensitivity reactions (anaphylactic/anaphylactoid) reactions have been reported in patients receiving Piperacillin and tazobactam. Discontinue Piperacillin and tazobactam if a reaction occurs.

Piperacillin and tazobactam may cause severe cutaneous adverse reactions, such as Stevens- Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, and acute generalized exanthematous pustulosis. Discontinue Piperacillin and tazobactam for progressive rashes.

Hematological effects (including bleeding, leukopenia and neutropenia) have occurred. Monitor hematologic tests during prolonged therapy.

Nephrotoxicity in critically ill patients has been observed; the use of Piperacillin and tazobactam was found to be an independent risk factor for renal failure and was associated with delayed recovery of renal function as compared to other beta-lactam antibacterial drugs in a randomized, multicenter, controlled trial in critically ill patients. Based on this study, alternative treatment options should be considered in the critically ill population. If alternative treatment options are inadequate or unavailable, monitor renal function during treatment with Piperacillin and tazobactam.

Clostridium difficile associated diarrhea: Evaluate patients if diarrhea occurs.

Use in Special Populations of (Piperacillin +Tazobactam):-

Pediatric Use: Use of Piperacillin and tazobactam in pediatric patients 2 months of age or older with appendicitis and/or peritonitis is supported by evidence from well-controlled studies and pharmacokinetic studies in adults and in pediatric patients. It has not been determined how to adjust Piperacillin and tazobactam dosage in pediatric patients with renal impairment.

Geriatric Use: Patients over 65 years are not at an increased risk of developing adverse effects solely because of age. However, dosage should be adjusted in the presence of renal impairment. This may be clinically important with regard to such diseases as congestive heart failure.

Renal Impairment: In patients with creatinine clearance ≤40 mL/min and dialysis patients (hemodialysis and CAPD), the intravenous dose of Piperacillin and tazobactam should be reduced to the degree of renal function impairment.

Hepatic Impairment: Dosage adjustment of Piperacillin and tazobactam is not warranted in patients with hepatic cirrhosis.

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

Overdose Effects of (Piperacillin +Tazobactam):-

There have been post marketing reports of overdose with piperacillin/tazobactam. The majority of those events experienced, including nausea, vomiting, and diarrhea, have also been reported with the usual recommended dosages. Patients may experience neuromuscular excitability or convulsions if higher than recommended doses are given intravenously (particularly in the presence of renal failure). Treatment should be supportive and symptomatic according the patient’s clinical presentation.

Therapeutic Class of (Piperacillin +Tazobactam):-

Broad spectrum penicillins, Other beta-lactam Antibiotics

3.Piperacillin +Tazobactam:-(Only IV Infusion)

IV Infusion 1.Tazocilin (4gm+0.5gm)/vial 4.5gm vial (AS A (Piperacillin +Tazobactam) AS A Broad spectrum penicillins, Other beta-lactam Antibiotics).

IV Infusion 2.Tazocilin (2gm+0.25gm)/vial 2.25 gm vial (AS A (Piperacillin +Tazobactam) AS A Broad spectrum penicillins, Other beta-lactam Antibiotics).

Raiyyan Tahsan Date:31-01-2025 Friday Time:3-01-45 Pm

Raiyyan Tahsan

Raiyyan Tahsan