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:
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.
positive direct Coombs' test, prolonged prothrombin time, prolonged partial thromboplastin time.
transient elevations of AST (SGOT), ALT (SGPT), alkaline phosphatase, bilirubin.
increases in serum creatinine, blood urea nitrogen.
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.
hemolytic anemia, anemia, thrombocytosis, agranulocytosis, pancytopenia.
hypersensitivity reactions, anaphylactic/anaphylactoid reactions (including shock).
interstitial nephritis, renal failure.
Skin and Appendages:
erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis.