Piperacillin/Tazobactam - Zosyn ® - Renal dosing

Usual Dosing (Adults)

3.375gm q4-6h or 4.5 grams q6-8h.

Zosyn should be administered by intravenous infusion over 30 minutes.
The usual daily dose of Zosyn for adults is 3.375 g every six hours.

Nosocomial Pneumonia
Initial presumptive treatment of patients with nosocomial pneumonia should start with Zosyn at a dosage of 4.5 g every six hours plus an aminoglycoside, totaling 18.0 g (16.0 g piperacillin/2.0 g tazobactam). Treatment with the aminoglycoside should be continued in patients from whom Pseudomonas aeruginosa is isolated. If Pseudomonas aeruginosa is not isolated, the aminoglycoside may be discontinued at the discretion of the treating physician.

Due to the in vitro inactivation of the aminoglycoside by beta-lactam antibiotics, Zosyn and the aminoglycoside are recommended for separate administration. Zosyn and the aminoglycoside should be reconstituted, diluted, and administered separately when concomitant therapy with aminoglycosides is indicated.

Renal Dosing

dialysis [40-90 ml/min]: 3.375 grams q6h

[20-40]: 2.25 gm q6h.
 (3.375g q6h for nosocomial pneumonia)

[<20]: 2.25 grams q8h.
  (2.25 gm q6h for nosocomial pneumonia)

Renal Insufficiency
In patients with renal insufficiency (Creatinine Clearance = 40 mL/min), the intravenous dose of Zosyn (piperacillin and tazobactam for injection) should be adjusted to the degree of actual renal function impairment. In patients with nosocomial pneumonia receiving concomitant aminoglycoside therapy, the aminoglycoside dosage should be adjusted according to the recommendations of the manufacturer. The recommended daily doses of Zosyn for patients with renal insufficiency are as follows:

Recommended Dosing of Zosyn in Patients with Normal Renal Function and Renal Insufficiency (As total grams piperacillin/tazobactam)

Renal Function
(Creatinine Clearance, mL/min)
All Indications (except nosocomial pneumonia) Nosocomial Pneumonia
* Creatinine clearance for patients not receiving hemodialysis
** 0.75 g should be administered following each hemodialysis session on hemodialysis days
>40 mL/min 3.375 q 6 h 4.5 q 6 h
20-40 mL/min* 2.25 q 6 h 3.375 q 6 h
<20 mL/min* 2.25 q 8 h 2.25 q 6 h
Hemodialysis** 2.25 q 12 h 2.25 q 8 h
CAPD 2.25 q 12 h 2.25 q 8 h

For patients on hemodialysis, the maximum dose is 2.25 g every twelve hours for all indications other than nosocomial pneumonia and 2.25 g every eight hours for nosocomial pneumonia. Since hemodialysis removes 30% to 40% of the administered dose, an additional dose of 0.75 g Zosyn should be administered following each dialysis period on hemodialysis days. No additional dosage of Zosyn is necessary for CAPD patients.


dialysis Hemo: 
2.25 grams q12h  (q8h for nosocomial pneumonia)
Plus 0.75 g Zosyn should be administered following each dialysis period

PD: 2.25 grams q8h.


The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer
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