Adult outpatient parenteral antimicrobial therapy (OPAT) good practice prescribing guide

Piperacillin/tazobactam multiple daily dosing regimen (30 minute IV infusions)

Piperacillin/tazobactam is a penicillin and beta-lactamase combination with broad spectrum activity against Gram-positive and Gram-negative bacteria.  It is licensed for severe pneumonia (including hospital and ventilator associated), intra-abdominal infections, complicated urinary tract infections, complicated skin and soft tissue infections (including diabetic foot infections), bacteraemia associated with these indications and bacterial infections associated with neutropenic sepsis and fever.

This guide shares practical experience on the use of piperacillin/tazobactam in an OPAT setting. To create the guidance, we took an evidence based approach. We also used expert consensus and practical experience from across NHS Scotland.

This drug summary does not provide specific treatment guidelines. Individual patient treatment should take into account the core principles of antimicrobial stewardship. This includes selection of the appropriate antimicrobial for the shortest duration with oral therapy being preferred, whenever possible.

For information on Route and method of administration, Contraindications, Cautions and adverse effects and Drug interactions please refer to the following approved resources:

These resources also have more information on licensed indication, use in pregnancy and use in breast feeding. When using unlicensed medicines, and/or off-label doses or indications, follow local health board governance processes.   

The use of broad spectrum antibiotics is associated with an increased risk of Clostridioides difficile infection (CDI).  Please monitor patient for new loose stools.  If suspicion of CDI send stool sample to microbiology for analysis.

It is strongly recommended that OPAT services in Scotland adhere to the Key performance indicators for the management of patients in an outpatient parenteral antimicrobial therapy (OPAT) setting.

Piperacillin/tazobactam multiple daily dosing regimen (30 minute IV infusions)

1. Indication and dose

Licensed indication(s) in the OPAT setting Dose
Complicated intra-abdominal infections
Complicated skin and soft tissue infections (including diabetic foot infection)		 4.5g 8 hourly
If Pseudomonas sp isolated/suspected with above indications 4.5g 6 hourly

 

Off-label indications in the OPAT setting Dose
Infective exacerbation of bronchiectasis
Deep seated Gram negative infection including bacteraemia
Malignant otitis externa		 4.5g 8 hourly
If Pseudomonas sp isolated/ suspected with above indications 4.5g 6 hourly


2. Dose adjustments

2a. Renal impairment

Renal function (Creatinine Clearance CrCl) Dosage adjustment
20 – 40ml/min 4.5g 8 hourly
Less than 20 ml/min 4.5g 12 hourly


2b. Other dosage adjustments

Patient characteristic Dose advice
Hepatic impairment No dose adjustment necessary
Obesity No dose adjustment necessary


3. Monitoring requirements

Frequency Recommended monitoring
Baseline Urea and Electrolytes (U&Es), liver function tests (LFTs), C-reactive protein (CRP) and full blood count (FBC)
Weekly monitoring
(Note this may be more frequent if clinically necessary)		 U&Es, LFTs, CRP and FBC
Therapeutic drug monitoring No therapeutic drug monitoring required
Follow up Ensure follow up arranged with referring speciality and/or completed with an infection specialist


For the use of other antibiotics in an OPAT setting please refer to the SAPG website

 

 Scottish Antimicrobial Prescribing Group (SAPG) | January 2024 for review January 2027

Content updated: April 2024