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Why it's used

Topiz Injection is a prescription medicine that is used to treat certain infections including skin and soft tissue infections such as diabetic foot infection, female reproductive organs infection, community and hospital-acquired lung infection and severe lung infection. It also treats complicated urinary tract infections (pyelonephritis), complicated stomach cavity infection, low levels of neutrophils with fever and inflamed appendix or peritoneum. It works by eliminating bacteria that begin infection and preventing bacteria from damaging piperacillin. Topiz Injection is also used to treat patients with the presence of bacteria in the bloodstream that occurs in association with any of these infections.
Topiz Injection may also be used along with other medicines in the treatment of certain conditions as recommended by the doctor. It is used with an aminoglycoside, or Topiz to treat hospital-acquired lung infection caused by P. aeruginosa.
When not to use
Topiz Injection will not work to treat viral infections such as common cold.
Topiz belongs to the Antibacterial class of medicines. Antibacterial.

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How to use

Read the directions on the product label, patient guide, or medicine guide provided by the medicine company or your pharmacist before starting to use Topiz Injection. If you have any questions related to this medicine, ask your doctor or pharmacist. Inject this medicine as recommended by your doctor.

Typical Dosage

The typical dose of Topiz is 3375 mg after every six hours totaled 13500 mg (12000 mg piperacillin/1500 mg tazobactam). The usual dose for children is 100 mg/12.5 mg/kg (45.4/5.69 mg/lb) given after every 8 hours. This medicine is typically used for a period of 7-14 days for a hospital-acquired lung infection, 5-14 days for a stomach infection, and 5-14 days for urinary tract infection. This medicine is not known to be habit-forming.
You should continue to use this medicine as directed by the doctor even if you feel well.
The injection form of the medicine may be used on the vein. Inject slowly, into the vein over 20-30 minutes. Each vial of Topiz reconstituted by adding 50 ml of sterile water or 0.9% sodium chloride solution or 5% glucose for injection under aseptic conditions. Shake vigorously for 1-2 minutes. This solution may be further diluted to the desired volume. Shake well again till it is completely dissolved. Syringes are used for the withdrawn of this solution from the vial. The product should be visually examined for particulate matter, damage to the container or discoloration before use.

Talk to Your Doctor

Talk to your doctor if your condition persists or worsens or if you develop new symptoms. Tell your doctor if watery and bloody stools with or without fever and stomach cramps, skin rashes, and patches or itchy spots on the skin. If you have any kidney disease, adjustment of the dose should be done in kidney patients with creatinine clearance 40 mL/min or less. You should consult with your doctor before stopping the use of Topiz.
Older patients may see an increase in the incidence of side-effects with this medicine. As a result, a lower dose may be recommended for older patients.

Use in Children

If you are giving Topiz Injection to a child, be sure to use a product that is meant for children. Before giving this medicine to a child, use the child's weight or age to find the right dose from the product package. You can also read the dosage section of this page to know the correct dose for your child. Else, consult with your doctor and follow their recommendation.

Lab Tests

Your doctor may request that specific lab tests be performed before you start using Topiz Injection. You may need to have Antibiotic Susceptibility test. This test helps the doctor in selecting a various effective antimicrobial agent.


You should store Topiz Injection store at 20-25°C if solution used within 5 hours and stored at 2-8°C if solution used within 24 hours. Store the medicine away from the reach of children and pets.
Medicines may be prescribed for uses other than those listed in the medicine guide. Do not use Topiz Injection for conditions for which it was not prescribed. Do not give Topiz Injection to other people who might have the same conditions or symptoms that you have. Self-medication may harm them.

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How to take Topiz

Your dose and how often you take Topiz will depend on the following factors:
  • age
  • weight
  • patient's health
  • the health of the patient's liver
  • medicines recommended by the doctor
  • any other medicines being used
  • herbal supplements in use

Topiz Dosage

Dosage for a hospital-acquired lung infection

  • Recommended: 4500 mg every six hours, totaled 18000 mg (16000 mg piperacillin/2000 mg tazobactam)

Dosage for inflamed appendix and peritoneum

Children (9 months with up to 40 kg of body weight)
  • Recommended: 100 mg/12.5 mg/kg (45.4/5.69 mg/lb) given after every 8 hours
Children (2-9 months of age)
  • Recommended: 80 mg/10 mg/kg (36.3/4.54 mg/lb) given after every 8 hours

Dosage for low levels of neutrophils with fever

  • Recommended: 4000 mg/500 mg after every 6 hours
Children (2-12 years)
  • Recommended: 80 mg/10 mg/kg (36.3/4.54 mg/lb) given after every 6 hours

Dosage for complicated stomach cavity infection

  • Recommended: 4000 mg/500 mg after every 8 hours
  • Initial: 100 mg/12.5 mg/kg (45.4/5.69 mg/lb) given after every 8 hours
  • Maximum: 2-12 years

Dosage for complicated urinary tract infection

  • Recommended: 4000 mg/500 mg after every 8 hours

Dosage for skin and skin structure infections

  • Recommended: 4000 mg/500 mg after every 8 hours

Dosage calculation for children

To calculate the dosage for children please use the weight based dose calculator to calculate the appropriate dosage as per the weight of your child.


Powder, for solution
Strength: 4000 mg/500 mg

Special Instructions

Creatinine clearance of greater than 40 ml/min
It is recommended to give 3375 mg every 6 hours, but in hospital-acquired lung infection, it is advised to give 4500 mg every 6 hours.
Creatinine clearance with 20-40 mL/min
Patients with creatinine clearance of 20-40 mL/min while receiving no treatment of blood purification (hemodialysis), it is recommended to give 2250 mg every 6 hours, but in hospital-acquired lung infection, it is advised to give 3375 mg every 6 hours.
Creatinine clearance of <20-40 mL/min
Patients with creatinine clearance of less than 20-40 mL/min while receiving no treatment of blood purification (hemodialysis), it is recommended to give 2250 mg every 8 hours, but in hospital-acquired lung infection, it is advised to give 2250 mg every 6 hours.
Patients on hemodialysis
It is recommended to give 2250 mg every 12 hours, but in hospital-acquired lung infection, it is advised to give 2250 mg every 8 hours. The dose used for each blood purification session on hemodialysis days is 750 mg ( 670 mg/80 mg).
Patients on continuous ambulatory peritoneal dialysis
Patients on therapy which cleans the body, it is recommended to give 2250 mg every 12 hours, but in hospital-acquired lung infection, it is advised to give 2250 mg every 8 hours.

Missed Dose

If you miss a dose of Topiz, inform your doctor immediately.


What to do if you overdose on Topiz?
In the case of an overdose, Topiz treatment should be discontinued. There is no particular antidote is available. Excessive blood levels of Topiz may be decreased by purification of blood.
Symptoms of an overdose of Topiz
If you use too much of this medicine, it could lead to dangerous levels of the medicine in your body. In such cases, symptoms of an overdose may include:
  • irregular movement of the body
  • spasm of nerves and muscles
If you think you have overdosed on Topiz Injection, call a poison control center immediately. You can look up the poison control center information from the Poison Center Finder at

Precautions while using Topiz

Before you use Topiz, tell your doctor of your medical and health history including the following:
  • a genetic disorder affecting lungs and kidneys (cystic fibrosis)
  • kidney disease
  • liver disease
  • patients are on a low salt diet
  • sensitivity to multiple allergens
  • sexually transmitted infection (gonorrhea)
  • syphilis
If you are on gonorrhea therapy, you should be tested for syphilis as well. There is an increased risk of rash or fever in patients with cystic fibrosis.
Before you use Topiz Injection, tell your doctor if you are allergic to it or its ingredients. Your doctor may prescribe an alternative medicine and update your medical records to record this information. Tell your doctor if you are allergic to penicillins, cephalosporins, or beta-lactamase inhibitors.
The use of this medicine may change the bilirubin level. There is an elevation in bilirubin levels.
The use of Topiz Injection may change alkaline phosphatase. The levels of alkaline phosphatase get increased.
The use of this medicine may change aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Elevation in the levels of AST and ALT is seen.
The use of this medicine may change the blood creatinine level. There is an increase in blood creatinine level.
The use of Topiz Injection may change partial thromboplastin time. There is prolongation in the partial thromboplastin time.

Use in Pregnancy

Topiz Injection should be used in pregnancy only when required. There is no or limited data available for Topiz use in pregnant women as Topiz cross the placenta. Topiz should be used only during pregnancy if clearly shown, that means only if the expected benefit exceeds the potential risk to the fetus and pregnant woman.

Use while Breastfeeding

Topiz should be used while breastfeeding only when required. Piperacillin is passed in low amount in human milk, tazobactam levels in human milk have not been investigated. Breastfeeding women should only be treated if the expected benefit exceeds the potential risk to the child and woman.


Topiz Injection may cause seizures in some people. Discuss with your doctor if you perform activities where a loss of consciousness may cause you or others harm.

Side-effects in Older Patients

Topiz Injection may increase side-effects in older patients. Elderly patients may see an increased risk of decreased functioning of kidneys.

Long Term Use

Prolong use of Topiz is associated with low level of neutrophils and leukocytes.

Topiz Side-effects

The following side-effects may commonly occur when using Topiz Injection. If any of these side-effects worsen or last for a long time, you should consult with your doctor:
  • abnormally low levels of thrombocytes
  • anemia
  • candida infection
  • constipation
  • decreased blood albumin
  • decreased total protein
  • diarrhea
  • fever
  • headache
  • increased alanine aminotransferase
  • increased aspartate aminotransferase
  • increased blood alkaline phosphatase
  • increased blood creatinine
  • increased blood urea
  • indigestion
  • injection-site reaction
  • insomnia
  • nausea
  • prolonged activated partial thromboplastin time
  • rash
  • severe itching
  • stomach pain
  • vomiting
The following side-effects may commonly occur in older patients on the use of Topiz Injection. Discuss with your doctor if any of these side-effects last for a long time or are severe:
  • decreased functioning of kidneys
Rarely, the use of Topiz Injection may cause the following side-effects:
  • chills
  • hives
  • inflammation of a vein
  • joint pain
  • muscle pain
  • rapid reddening of the face
  • vein inflammation associated with a blot clot
The following severe side-effects may also occur when using Topiz Injection:
  • Kidney and urinary disorders
    Symptoms: kidney failure swelling in-between the kidney tubules
  • Metabolism and nutrition disorders
    Symptoms: low level of potassium low sugar level
  • Immune system disorders
    Symptoms: severe allergic reaction
    If any allergic reaction arises, Topiz should be discontinued and start suitable therapy.
  • Blood and lymphatic system disorders
    Symptoms: lowered white blood cell count, reduction in the number of red and white blood cells, as well as platelets, low level of neutrophils, abnormal breakdown of red blood cells, an excessive number of platelets in the blood high level of eosinophils in the blood
  • Infections and infestations (it can be life-threatening)
    Symptoms: inflammation of the large intestine due to C. difficile bacteria
    Topiz should be discontinued if signs of the large intestine inflammation may arise throughout the antibacterial therapy.
  • Vascular disorders
  • Respiratory, neck, and lung-related disorders
    Symptoms: nosebleed (epistaxis) accumulation of white blood cells in the lungs
  • Stomach and intestinal disorder
    Symptoms: mouth and lips inflammation diarrhea
  • Liver disorders
  • Skin and skin structure disorders
    Symptoms: flat or raised red bump, severe skin reaction, scaling of the skin (dermatitis exfoliative), inflammation of the skin (dermatitis bullous), red or purple colored spots severe allergic reaction
    Patients should be monitored if they develop skin redness. Discontinuation of Topiz should be done if lesions progress.
Your doctor has prescribed this Topiz because they have judged that the benefits outweigh the risks posed by side-effects. Many people using this medicine do not have serious side-effects. This is not a complete list of possible side-effects for Topiz.
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at


Abnormal Functioning of Kidneys

Patients with abnormal functioning of kidneys are at an increased risk when using this medicine. During the combined therapy with other penicillins when high doses of Topiz are given, irregular movement of the body (seizures) and brain complications can occur.

Development of Drug-Resistant Bacteria

Giving Topiz in the absence of a completely suspected bacterial infection or a preventive indication is unlikely to give an advantage to the patient. Therefore, enhances the risk of the growth of drug-resistant bacteria.

Hospital-Acquired Infection

Clostridium difficile-associated diarrhea has been observed over two months of Topiz use and may vary in severity from moderate diarrhea to life-threatening inflammation of the colon. Treatment with Topiz changes the normal flora of the colon leading to overgrowth of C. difficile, contributing to hospital-acquired diarrhea. These can cause an increased fatality and disease rate. Patients may require the removal of the colon in such condition. If CDAD is suspected or confirmed, Topiz uses against C. difficile needs to be discontinued. Suitable fluid and electrolyte use, protein supplementation, antibacterial therapy of C. difficile, and operational evaluation should be started as indicated.

Electrolyte Effects

Patients requiring restricted salt intake are at an increased risk when using this medicine. Regular checking of electrolyte should be done in patients with low potassium. The possibility of low potassium should be kept in mind with patients having low potassium reserves and who are taking cytotoxic treatment or diuretics.

Kidney Damage in Critically Ill Patients

The use of Topiz was known to be an independent risk factor for kidney failure. It was associated with slowed recovery of the functioning of kidneys as compared to other beta-lactam drugs in critically ill patients. The combined use of Topiz and vancomycin may be related to an increased rate of acute kidney injury. Based on this research, alternative therapy options should be taken into consideration in the critically ill group. If alternative therapy options are unavailable, observe the functioning of kidneys.

Central Nervous System Side Effects

Patients may undergo spasm of nerves and muscles or convulsions if larger than recommended doses are delivered through veins (especially in the presence of kidney failure).

Hematologic Side-Effects

Patients with kidney failure are at a greater risk when using this medicine. Bleeding signs have occurred in some patients taking piperacillin. These reactions sometimes are known to be associated with irregularities in blood clotting tests such as platelet aggregation, clotting time, and prothrombin time. The decreased amount of white blood cells associated with Topiz use appears to be reversible and most often linked with long-term use. Recurrent evaluation of the process of blood cells formation should be performed, particularly with prolonged therapy that is 21 days. If bleeding signs occur, Topiz should be discontinued and began appropriate treatment.

Severe Skin-Related Side Effects

Topiz can cause severe skin side effects, such as severe skin reaction, drug reaction with elevated levels of eosinophils and systemic symptoms, and sudden skin eruptions. If patients acquire a skin rash, close monitoring should be done and discontinue Topiz if lesions progress.

Allergic Reactions

Individuals with a history of cephalosporin, penicillin, or carbapenem allergy or a previous history of sensitivity to various allergens are at an increased risk when using this medicine. Serious and infrequently fatal allergic reactions (including shock) have been seen in patients undergoing therapy with Topiz. Before starting therapy with Topiz, careful analysis should be done concerning previous allergic reactions. If any allergic reaction occurs, Topiz should be discontinued and institute proper treatment.

Interactions with Topiz

When two or more medicines are taken together, it can change how the medicines work and increase the risk of side-effects. In medical terms, this is called as a Drug Interaction.
This page does not contain all the possible interactions of Topiz Injection. Share a list of all medicines that you use with your doctor and pharmacist. Do not start, stop, or change the dose of any medicines without the approval of your doctor.

Glycopeptide Antibiotics

Topiz Injection interacts with glycopeptide antibiotics (vancomycin) which are used to treat colitis. When vancomycin is used in combination with Topiz, there is an increased risk of acute kidney injury. It is necessary to monitor the functioning of kidneys in patients having a combination of vancomycin and Topiz.

Uricosuric Drugs

There may be an interaction of Topiz with uricosuric-drugs (probenecid), which are used to treat severe pain, redness, and tenderness in joints and excess of uric acid. When probenecid is used in combination with Topiz, it prolongs the time taken for elimination of half of the Topiz from the body by blocking the tubular kidney secretion of Topiz. Probenecid should not be used in combination with Topiz unless the benefits are more significant than the risk.


Topiz Injection may interact with aminoglycosides (tobramycin, amikacin and gentamicin) which are used to treat bacterial infections. Decreased aminoglycosides blood level has been seen during combined therapy of Topiz and aminoglycosides given in-vivo to the patients with normal functioning of kidneys, severe kidney disease and having blood purification therapy. When this combined therapy is given in-vitro, piperacillin inactivates aminoglycosides. Topiz is not compatible with tobramycin for a single syringe (Y-site intravenous) infusion. Topiz and aminoglycosides are suggested to be used separately. It is reconstituted, diluted, and used individually when combined therapy with aminoglycosides is given. Topiz which contains EDTA is compatible with amikacin and gentamicin for Y-site intravenous infusion.

Aminosteroid Neuromuscular-Blocker

Your doctor's guidelines may need to be followed while taking this medicine along with aminosteroid neuromuscular-blocker (vecuronium), which is used to relax skeletal muscle during surgery. When piperacillin is used in combination with vecuronium, it prolongs nerve and muscle relaxation of vecuronium. Topiz also shows the same effect if given along with vecuronium. Side effects should be monitor related to nerve and muscle relaxation.


Special instructions need to be followed while taking this medicine along with anticoagulants which are used to prevent or reduce blood coagulation and extend the time of clotting. The combined use of Topiz with high dose heparin, oral anticoagulants, and other substances may alter the system of blood coagulation including platelet function. It is necessary to perform and monitor the coagulation parameters regularly in patients having the combination of Topiz with high dose heparin, oral anticoagulants, and other substances.

Laboratory Tests

There may be an interaction of Topiz with effects on laboratory tests. Positive results have been seen with Platelia Aspergillus EIA tests in patients receiving Topiz injection. Cross-reactions with non-Aspergillus polyfuranoses and polysaccharides with Platelia Aspergillus EIA test have been detected. The combined use of Topiz with other penicillins shows a false-positive result for glucose in urine by using the method of copper-reduction. Positive test results in patients having Topiz therapy should be performed carefully and verified by other diagnostic methods. Based on enzymatic glucose oxidase reactions, it is advised to perform glucose tests.


Topiz Injection may interact with antimetabolites (methotrexate), which is used to treat cancer, autoimmune diseases and for medical abortions. There is insufficient data available for the combined use of methotrexate and piperacillin which may decrease the clearance of methotrexate. There is no evaluation for the impact of tazobactam on methotrexate elimination. The symptoms of methotrexate toxic effects, as well as blood levels of methotrexate, should be regularly monitored if combined treatment is required.

Traveling With Medication

  • Ensure that you carry enough doses of each of your prescription medicines to last the entire trip. The best place to store your medicines is in the carry on baggage. However, while flying, if carrying liquid medicines, make sure you do not go over the limits imposed for carry-on liquids.
  • While traveling overseas, make sure that you can carry each of your prescription medicines legally to your destination country. One way to ensure this is by checking with your destination country's embassy or website.
  • Make sure that you carry each of your medicines in their original packaging, which should typically include your name and address, and the details of the prescribing doctor.
  • If your travel involves crossing time zones, and you are required to take your medicine as per a fixed schedule, make sure that you adjust for the change in time.

Expired Medication

Taking a single dose of expired Topiz is unlikely to cause a side-effect. However, please discuss with your doctor or pharmacist, if you feel unwell or sick. An expired medicine may become ineffective in treating your prescribed conditions. To be on the safe side, it is important not to use an expired drug. You are much safer by always keeping a fresh supply of unexpired medicines.

Safe Disposal of Medication

  • If there are disposal instructions on the package, please follow the instructions.
  • If there are medicine take-back programs in your country, you should contact the respective authority to arrange for the disposal of the medicine. For example, in the USA, the Drug Enforcement Administration regularly hosts National Prescription Drug Take-Back events.
  • If there are no take-back programs, mix the medicine with dirt and place them in a sealed plastic bag. Throw the plastic bag in your household trash. Separately, remove all personal information including the prescription label from the medicine packaging and then dispose off the container.
  • If specifically indicated on the medicine package that it needs to be flushed down the toilet when no longer needed, perform the required step.
This page provides information for Topiz Injection .
Bacterial Infections
Skin Infections
Urinary Tract Infections

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