Of the studies reported, including that of nosocomial lower respiratory tract infections in which a higher dose of piperacillin and tazobactam injection was used in combination with an aminoglycoside, changes in laboratory parameters, without regard to drug relationship, include:
Hematological: decreases in hemoglobin and hematocrit, thrombocytopenia, increases in platelet count, eosinophilia, leucopenia, neutropenia. The leukopenia/neutropenia associated with Piperacillin/Tazobactam sodium injection administration appears to be reversible and most frequently associated with prolonged administration, i.e., ≥21 days of therapy.
Coagulation: positive direct Coombs' test, prolonged prothrombin time, prolonged partial thromboplastin time.
Hepatic: transient elevations of AST (SGOT), ALT (SGPT), alkaline phosphatase, bilirubin.
Renal: increases in serum creatinine, blood urea nitrogen.
Urinalysis: proteinuria, hematuria, pyuria.
Additional laboratory events include abnormalities in electrolytes (i.e., increases and decreases in sodium, potassium, and calcium), hyperglycemia, decreases in total protein or albumin, blood glucose decreased, gamma-glutamyltransferase increased, hypokalemia, and bleeding time prolonged.
The following adverse reaction has also been reported for sterile piperacillin sodium: Skeletal: prolonged muscle relaxation.
Piperacillin therapy has been associated with an increased incidence of fever and rash in cystic fibrosis patients.
Additional adverse events reported: Gastrointestinal: hepatitis, cholestatic jaundice.
Hematological: hemolytic anemia, anemia, thrombocytosis, agranulocytosis, pancytopenia.
Immune: hypersensitivity reactions, anaphylactic/anaphylactoid reactions (including shock).
Infections: candidal superinfections.
Renal: interstitial nephritis, renal failure.
Skin and Appendages: erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis.