Extended Infusion Piperacillin/Tazobactam

These materials are intended for general clinical education and guidance. They are not a substitute for a clinician’s knowledge, skill or judgment in treating patients.

Background

Piperacillin/tazobactam is a beta-lactam antibiotic, traditionally dosed at intermittent 30-minute infusions. However, its bactericidal activity correlates with the amount of time its serum concentration remains above the minimum inhibitory concentration of the pathogen (fT > MIC), providing a rationale for longer infusion times. In addition, the rising incidence of resistant bacteria requires higher antibiotic doses and longer infusions to improve microbiological and clinical success. Recent data from a randomized controlled trial and a meta-analysis demonstrate reduced mortality and improved clinical cure with prolonged piperacillin/tazobactam infusions in patients with sepsis or septic shock.

New policy

Starting in November 2025, Sinai Health will implement a new infusion policy for piperacillin/tazobactam, defaulting to an initial dose infused over 30 minutes, followed three hours later by subsequent doses, each infused over three hours.

Intervals should continue to be adjusted to renal function (see dosing table below).

The updated PowerChart order set for piperacillin/tazobactam now reflects this move to an extended infusion regimen.

Extended piperacillin/tazobactam infusions require a smart infusion pump. All pumps are programmed with both the 30-minute and three-hour infusion approaches.

Note: If the Emergency Department initiated piperacillin/tazobactam for the patient, please check the timing of administered doses to determine subsequent dose intervals.

Eligibility

This new infusion regimen applies to all hospitalized adult inpatients, including those in the Emergency Department, Intensive Care Unit, General Internal Medicine, Women’s and Infants' Health, Surgery and Cardiology.

Exceptions

The following are indications to use intermittent infusions:

• One-time or first doses
• Medication scheduling and/or drug compatibility conflicts that cannot be resolved with available IV lines
• Medical interventions that cannot be performed during infusion, only if administration times cannot be modified
• Consultation by the Antimicrobial Stewardship Program (ASP), Infectious Disease (ID) or Pharmacy recommending an intermittent infusion protocol

Changes to infusion duration

Following the initial phase of extended infusions, patients who require continued piperacillin/tazobactam may be changed to intermittent infusion if their clinical condition has stabilized and newly acquired microbiological data support bacterial antibiotic susceptibility (with Pharmacy, ASP or ID consultation). All changes to infusion duration require a new order.

Inquiries

For inquiries about drug compatibility issues, consult Lexicomp. For questions regarding infusion duration or process, consult your nursing team lead, pharmacist or physician. For further questions, email [email protected].