Piperacillin/Tazobactam
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| ID | DRUG-PIPERACILLIN-TAZOBACTAM |
|---|---|
| Тип | Препарат |
| Синоніми | PTZPip/TazoTazobacTazocinZosynpip-tazoПіперацилін/Тазобактам |
| Статус | переглянуто 2026-04-27 | очікує клінічного підпису |
| Хвороби | Не вказано |
| Джерела | SRC-NCCN-BCELL-2025 SRC-NCCN-MM-2025 |
Дані про препарат
| Клас | Extended-spectrum penicillin + β-lactamase inhibitor combination |
|---|---|
| Механізм дії | Piperacillin is a ureidopenicillin that binds penicillin-binding proteins (PBPs) and inhibits bacterial cell-wall synthesis, producing rapid bactericidal activity against most Gram-negative bacilli including Pseudomonas aeruginosa, most Enterobacterales, many anaerobes, and selected Gram-positive cocci. Tazobactam is an irreversible β-lactamase inhibitor (penicillanic acid sulfone) that binds and inactivates plasmid-mediated and chromosomal class A β-lactamases (TEM, SHV, CTX-M ESBLs partially), restoring piperacillin activity against many β-lactamase-producing organisms. First-line empiric monotherapy for febrile neutropenia (FN) at most centers per IDSA, ECIL-4, and NCCN guidelines because of pseudomonal coverage, anaerobic activity, and good safety profile. |
| Типове дозування | Febrile neutropenia (adult): 4.5 g IV every 6-8 hours via 30-min bolus OR (preferred for severe sepsis / pseudomonal infection) prolonged 4-hour infusion to optimize time-above-MIC. Standard empiric: 4.5 g IV q8h. Pediatric (≥9 months): 100 mg piperacillin/ kg IV q8h, max 4 g per dose. Renal adjustment required: CrCl 20-40 → 3.375 g q6h or 4.5 g q8h; CrCl <20 → 2.25 g q6h or 4.5 g q12h; hemodialysis → 2.25 g q8h with extra 0.75 g after each session; CRRT → 3.375 g q6h. Hepatic: no adjustment. Duration in FN: until ANC recovery (>500/µL) and afebrile ≥48 h, typically 5-14 days; de-escalate based on cultures + clinical course. CAUTION: prolonged-infusion administration improves PK/PD but requ... |
| Зареєстровано в Україні | True |
| Відшкодовується НСЗУ | True |
| Остання перевірка для України | 2026-04-27 |
Нотатки
Standard first-line empirical antibiotic for febrile neutropenia (FN) per IDSA 2010 (Freifeld), ECIL-4, and NCCN — combines pseudomonal coverage, broad anaerobic activity, and acceptable toxicity profile. De-escalate after 48-72 h based on cultures (pip-tazo continued or narrowed to a directed agent). Add vancomycin if MRSA suspected (line infection, skin/soft-tissue source, prior MRSA colonization, hemodynamic instability) — but the pip-tazo + vanco combination has a debated AKI signal in adults (no signal in pediatrics or in CRRT). Common errors: under-dosing in CrCl 40-60 (still use 4.5 g q8h, not q12h), failure to extend infusion in critically ill patients (4-h infusion improves T>MIC), missing the rash → DRESS / SJS conversion early. Sodium load matters in heart failure — 4.5 g q6h delivers ~3 g sodium/ day. Ukraine: widely available; first-line FN empirical agent in hematology centers per local protocols aligned with NCCN/IDSA.
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