Piperacillin-Tazobactam (Burns — Sepsis)

How it works

Piperacillin inhibits bacterial cell-wall synthesis by binding penicillin-binding proteins, while tazobactam inactivates many bacterial beta-lactamases, extending cover to organisms that would otherwise be resistant.

Prescribing in practice

• It is a penicillin, so confirm there is no significant penicillin or beta-lactam allergy before administration and follow local burns sepsis and antimicrobial-stewardship protocols.
• Burns patients have markedly altered, often augmented, drug clearance and large volumes of distribution, so dosing should follow critical-care burns guidance and may need adjustment, with extended infusions sometimes used.
• It can cause hypokalaemia and, with concomitant nephrotoxins, raises acute kidney injury risk, which is pertinent in resuscitated, multi-drug burns patients.

Monitoring

Monitor clinical response, inflammatory markers, renal function and electrolytes, and review cultures to de-escalate antimicrobial therapy.

Counselling the patient

• Team: confirm penicillin/beta-lactam allergy status before giving.
• Team: dose per burns critical-care guidance given altered clearance, and review against cultures for de-escalation.
• Report any rash, swelling or breathing difficulty suggesting an allergic reaction.

Evidence & guidelines

Empirical broad-spectrum antipseudomonal cover such as piperacillin-tazobactam aligns with sepsis and burns infection guidance, with prompt de-escalation once cultures return.