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Antibiotic — Extended-Spectrum Penicillin + Beta-Lactamase Inhibitor Pregnancy: Use with caution — limited data; use only if clearly indicated

Piperacillin-Tazobactam (Burns — Sepsis)

Brand names: Tazocin

Adult dose

Dose: 4.5 g IV every 6–8 hours (standard); 4.5 g IV every 6 hours (severe burns sepsis)
Route: IV infusion over 30 min (or extended infusion 4h for resistant organisms)
Frequency: Every 6–8 hours
Max: 18 g/day
Broad-spectrum cover including Pseudomonas aeruginosa — first-line empirical treatment for burns sepsis after day 5 (when Gram-negatives predominate). Extended 4-hour infusion optimises pharmacodynamic target attainment for resistant Pseudomonas. Dose increased in burns due to augmented renal clearance (ARC).

Paediatric dose

Dose: 90 mg/kg
Route: IV infusion
Frequency: Every 6–8 hours
Max: 4.5 g/dose
90 mg/kg (piperacillin component) every 6–8 hours (max 4.5 g/dose).

Dose adjustments

Renal

Reduce frequency if eGFR <20 mL/min: 2.25–4.5 g every 8–12 hours.

Hepatic

No specific adjustment required.

Paediatric weight-based calculator

90 mg/kg (piperacillin component) every 6–8 hours (max 4.5 g/dose).

Clinical pearls

  • Augmented renal clearance (ARC) in burns patients — hypermetabolic state significantly increases drug clearance; standard doses may be subtherapeutic. Consider extended infusion or increased frequency.
  • Pseudomonas cover is essential after day 5 of burns — Tazocin is gold-standard empirical agent
  • NEVER mix piperacillin-tazobactam with aminoglycosides in the same IV line — chemical inactivation

Contraindications

  • Penicillin allergy (immediate — anaphylaxis; 10% cross-reactivity with cephalosporins)
  • Hypersensitivity to beta-lactamase inhibitors

Side effects

  • Diarrhoea (including C. difficile)
  • Nausea
  • Hypokalaemia (with prolonged use)
  • Thrombocytopenia
  • Anaphylaxis
  • Raised LFTs

Interactions

  • Aminoglycosides (synergistic — but inactivate each other if mixed in same line)
  • Methotrexate (reduced excretion — toxicity risk)
  • Warfarin (increases INR)

Monitoring

  • Renal function (dose adjustment and ARC monitoring)
  • Culture and sensitivity results
  • K+ levels (hypokalaemia risk)
  • Clinical response at 48–72 hours

Reference: BNFc; BNF 90; BBA Burns Infection Guidelines; IDSA Guidelines on Pseudomonas; BNFc. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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