Piperacillin / Tazobactam Qilu 4 g / 0.5 g powder for solution for infusion – Summary of Product Characteristics (SmPC) for healthcare professionals

1 NAME OF THE MEDICINAL PRODUCT

Piperacillin / Tazobactam Qilu 4 g / 0.5 g powder for solution for infusion

2 QUALITATIVE AND QUANTITATIVE COMPOSITION

Each vial contains 4 g piperacillin (as piperacillin sodium) and 0.5 g tazobactam (as tazobactam sodium).

Excipient with known effect

9.39 mmol (216 mg) of sodium per vial

For the full list of excipients, see section 6.1.

3 PHARMACEUTICAL FORM

Powder for solution for infusion

Off-white to white cake or powder.

4 CLINICAL PARTICULARS

4.1 Therapeutic indications

Piperacillin / Tazobactam Qilu is indicated for the treatment of the following infections in adults, adolescents and children over 2 years of age (see sections 4.2 and 5.1):

Adults and adolescents

• Severe pneumonia including hospital-acquired and ventilator-associated pneumonia
• Complicated urinary tract infections (including pyelonephritis)
• Complicated intra-abdominal infections
• Complicated skin and soft tissue infections (including diabetic foot infections)

Treatment of patients with bacteraemia that occurs in association with, or is suspected to be associated with, any of the infections listed above.

Piperacillin / Tazobactam Qilu may be used in the management of neutropenic patients with fever suspected to be due to a bacterial infection.

Note: Use for bacteraemia due to extended-beta-lactamase (ESBL) producing E. coli and K. pneumoniae (ceftriaxone non-susceptible), is not recommended in adult patients, see section 5.1.

Children 2 to 12 years of age

• Complicated intra-abdominal infections

Piperacillin / Tazobactam Qilu may be used in the management of neutropenic children with fever suspected to be due to a bacterial infection.

Consideration should be given to official guidance on the appropriate use of antibacterial agents.

4.2 Posology and method of administration

Posology

The dose and frequency of Piperacillin / Tazobactam Qilu depends on the severity and localisation of the infection and expected pathogens.

Adult and adolescent patients

Infections

The usual dose is 4 g piperacillin / 0.5 g tazobactam given every 8 hours.

For nosocomial pneumonia and bacterial infections in neutropenic patients, the recommended dose is 4 g piperacillin / 0.5 g tazobactam administered every 6 hours. This regimen may also be applicable to treat patients with other indicated infections when particularly severe.

The following table summarises the treatment frequency and the recommended dose for adult and adolescent patients by indication or condition:

Patients with renal impairment

The intravenous dose should be adjusted to the degree of actual renal impairment as follows (each patient must be monitored closely for signs of substance toxicity; medicinal product dose and interval should be adjusted accordingly):

For patients on haemodialysis, one additional dose of piperacillin/tazobactam 2 g / 0.25 g should be administered following each dialysis period, because haemodialysis removes 30%-50% of piperacillin in 4 hours.

Patients with hepatic impairment

No dose adjustment is necessary (see section 5.2).

Elderly patients

No dose adjustment is required for the elderly with normal renal function or creatinine clearance values above 40 ml/min.

Paediatric population (2-12 years of age)

Infections

The following table summarises the treatment frequency and the dose per body weight for paediatric patients 2-12 years of age by indication or condition:

* Not to exceed the maximum 4 g / 0.5 g per dose over 30 minutes

Patients with renal impairment

The intravenous dose should be adjusted to the degree of actual renal impairment as follows (each patient must be monitored closely for signs of substance toxicity; medicinal product dose and interval should be adjusted accordingly):

For children on haemodialysis, one additional dose of 40 mg piperacillin / 5 mg tazobactam / kg should be administered following each dialysis period.

Use in children aged below 2 years

The safety and efficacy of piperacillin/tazobactam in children 0- 2 years of age has not been established.

No data from controlled clinical studies are available.

Treatment duration

The usual duration of treatment for most indications is in the range of 5-14 days. However, the duration of treatment should be guided by the severity of the infection, the pathogen(s) and the patient's clinical and bacteriological progress.

Method of administration

For intravenous use after reconstitution/dilution.

Piperacillin / Tazobactam Qilu 4 g / 0.5 g is administered by intravenous infusion (over 30 minutes).

For instructions on reconstitution/dilution of the medicinal product before administration, see section 6.6.

4.3 Contraindications

Hypersensitivity to the active substances and any other penicillin-antibacterial agent.

History of acute severe allergic reaction to any other beta-lactam active substances (e.g.cephalosporin, monobactam or carbapenem).

4.4 Special warnings and precautions for use

The selection of piperacillin/tazobactam to treat an individual patient should take into account the appropriateness of using a broad-spectrum semi-synthetic penicillin based on factors such as the severity of the infection and the prevalence of resistance to other suitable antibacterial agents.

Before initiating therapy with piperacillin/tazobactam careful inquiry should be made concerning previous hypersensitivity reactions to penicillins, other beta-lactam agents (e.g. cephalosporin, monobactam or carbapenem) and other allergens. Serious and occasionally fatal hypersensitivity (anaphylactic/anaphylactoid [including shock]) reactions have been reported in patients receiving therapy with penicillins, including piperacillin/tazobactam. These reactions are more likely to occur in persons with a history of sensitivity to multiple allergens. Serious hypersensitivity reactions require the discontinuation of the antibiotic, and may require administration of epinephrine and other emergency measures.

There have been reports of hypersensitivity reactions which progressed to Kounis syndrome (acute allergic coronary arteriospasm that can result in myocardial infarction, see section 4.8).

Piperacillin/Tazobactam may cause severe cutaneous adverse reactions, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, and acute generalised exanthematous pustulosis (see section 4.8). If patients develop a skin rash they should be monitored closely and piperacillin/tazobactam discontinued if lesions progress.

Rhabdomyolysis has been reported with the use of piperacillin/tazobactam. If signs or symptoms of rhabdomyolysis are observed, piperacillin/tazobactam should be discontinued and appropriate therapy initiated.

Antibiotic-induced pseudomembranous colitis may be manifested by severe, persistent diarrhoea which may be life-threatening. The onset of pseudomembranous colitis symptoms may occur during or after antibacterial treatment. In these cases piperacillin/tazobactam should be discontinued.

Therapy with piperacillin/tazobactam may result in the emergence of resistant organisms, which might cause super-infections.

Bleeding manifestations have occurred in some patients receiving beta-lactam antibiotics. These reactions sometimes have been associated with abnormalities of coagulation tests, such as clotting time, platelet aggregation and prothrombin time, and are more likely to occur in patients with renal failure. If bleeding manifestations occur, the antibiotic should be discontinued and appropriate therapy instituted.

Leukopenia and neutropenia may occur, especially during prolonged therapy; therefore, periodic assessment of haematopoietic function should be performed.

As with treatment with other penicillins, neurological complications in the form of convulsions (seizures) may occur when high doses are administered, especially in patients with impaired renal function (see section 4.8).

Hypokalaemia may occur in patients with low potassium reserves or those receiving concomitant medicinal products that may lower potassium levels; periodic electrolyte determinations may be advisable in such patients.

Haemophagocytic lymphohistiocytosis (HLH)

Cases of HLH have been reported in patients treated with piperacillin/tazobactam, often following treatment longer than 10 days. HLH is a life-threatening syndrome of pathologic immune activation characterised by clinical signs and symptoms of an excessive systemic inflammation (e.g. fever, hepatosplenomegaly, hypertriglyceridaemia, hypofibrinogenaemia, high serum ferritin, cytopenias and haemophagocytosis). Patients who develop early manifestations of pathologic immune activation should be evaluated immediately. If diagnosis of HLH is established, piperacillin/tazobactam treatment should be discontinued.

Renal Impairment

Due to its potential nephrotoxicity (see section 4.8), piperacillin/tazobactam should be used with care in patients with renal impairment or in haemodialysis patients.

Intravenous dosages and administration intervals should be adjusted to the degree of renal function impairment (see section 4.2).

In a secondary analysis using data from a large multicenter, randomized-controlled trial when glomerular filtration rate (GFR) was examined after administration of frequently used antibiotics in critically ill patients, the use of piperacillin/tazobactam was associated with a lower rate of reversible GFR improvement compared with the other antibiotics. This secondary analysis concluded that piperacillin/tazobactam was a cause of delayed renal recovery in these patients.

Combined use of piperacillin/tazobactam and vancomycin may be associated with an increased incidence of acute kidney injury (see section 4.5).

This medicinal product contains 108 mg sodium per vial, equivalent to 5.4 % of the WHO recommended maximum daily intake of 2 g sodium for an adult.

This should be taken into consideration for patients who are on a controlled sodium diet.

4.5 Interaction with other medicinal products and other forms of interaction

Non-depolarising muscle relaxants

Piperacillin when used concomitantly with vecuronium has been implicated in the prolongation of the neuromuscular blockade of vecuronium. Due to their similar mechanisms of action, it is expected that the neuromuscular blockade produced by any of the non-depolarising muscle relaxants could be prolonged in the presence of piperacillin.

Anticoagulants

During simultaneous administration of heparin, oral anticoagulants and other substances that may affect the blood coagulation system including thrombocyte function, appropriate coagulation tests should be performed more frequently and monitored regularly.

Methotrexate

Piperacillin may reduce the excretion of methotrexate; therefore, serum levels of methotrexate should be monitored in patients to avoid substance toxicity.

Probenecid

As with other penicillins, concurrent administration of probenecid and piperacillin/tazobactam produces a longer half-life and lower renal clearance for both piperacillin and tazobactam; however, peak plasma concentrations of either substance are unaffected.

Aminoglycosides

Piperacillin, either alone or with tazobactam, did not significantly alter the pharmacokinetics of tobramycin in subjects with normal renal function and with mild or moderate renal impairment. The pharmacokinetics of piperacillin, tazobactam, and the M1 metabolite were also not significantly altered by tobramycin administration. The inactivation of tobramycin and gentamicin by piperacillin has been demonstrated in patients with severe renal impairment.

For information related to the administration of piperacillin/tazobactam with aminoglycosides please refer to sections 6.2 and 6.6.

Vancomycin

Studies have detected an increased incidence of acute kidney injury in patients concomitantly administered piperacillin/tazobactam and vancomycin as compared to vancomycin alone (see section 4.4). Some of these studies have reported that the interaction is vancomycin dose-dependent. No pharmacokinetic interactions have been noted between piperacillin/tazobactam and vancomycin.

Effects on laboratory tests

Non-enzymatic methods of measuring urinary glucose may lead to false-positive results, as with other penicillins. Therefore, enzymatic urinary glucose measurement is required under piperacillin/tazobactam therapy.

A number of chemical urine protein measurement methods may lead to false-positive results. Protein measurement with dip sticks is not affected.

The direct Coombs test may be positive.

Bio-Rad Laboratories Platelia Aspergillus EIA tests may lead to false-positive results for patients receiving piperacillin/tazobactam.

Cross-reactions with non-Aspergillus polysaccharides and polyfuranoses with Bio-Rad Laboratories Platelia Aspergillus EIA test have been reported.

Positive test results for the assays listed above in patients receiving piperacillin/tazobactam should be confirmed by other diagnostic methods.

4.6 Fertility, pregnancy and lactation

Pregnancy

There are no or a limited amount of data from the use of piperacillin/tazobactam in pregnant women.

Studies in animals have shown developmental toxicity, but no evidence of teratogenicity, at doses that are maternally toxic (see section 5.3).

Piperacillin and tazobactam cross the placenta. Piperacillin/tazobactam should only be used during pregnancy if clearly indicated, i.e. only if the expected benefit outweighs the possible risks to the pregnant woman and foetus.

Breast-feeding

Piperacillin is excreted in low concentrations in human milk; tazobactam concentrations in human milk have not been studied. Women who are breast- feeding should be treated only if the expected benefit outweighs the possible risks to the woman and child.

Fertility

A fertility study in rats showed no effect on fertility and mating after intraperitoneal administration of tazobactam or the combination piperacillin/tazobactam (see section 5.3).

4.7 Effects on ability to drive and use machines

No studies on the effect on the ability to drive and use machines have been performed.

4.8 Undesirable effects

The most commonly reported adverse reaction is diarrhoea (occurring in 1 patient out of 10).

Among the most serious adverse reactions pseudo-membranous colitis and toxic epidermal necrolysis occur in 1 to 10 patients in 10,000. The frequencies for pancytopenia, anaphylactic shock and Stevens-Johnson syndrome cannot be estimated from the currently available data.

In the following table, adverse reactions are listed by system organ class and MedDRA-preferred term. Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness.

≥

*ADR identified post marketing

**Acute coronary syndrome associated with an allergic reaction.

Piperacillin therapy has been associated with an increased incidence of fever and rash in cystic fibrosis patients.

Beta-lactam antibiotic class effects

Beta-lactam antibiotics, including piperacillin tazobactam, may lead to manifestations of encephalopathy and convulsions (see section 4.4).

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

4.9 Overdose

Symptoms

There have been post-marketing reports of overdose with piperacillin/tazobactam. The majority of those events experienced, including nausea, vomiting, and diarrhoea, have also been reported with the usual recommended dose. Patients may experience neuromuscular excitability or convulsions if higher than recommended doses are given intravenously (particularly in the presence of renal failure).

Treatment

In the event of an overdose, piperacillin/tazobactam treatment should be discontinued. No specific antidote is known.

Treatment should be supportive and symptomatic according to the patient’s clinical presentation.

Excessive serum concentrations of either piperacillin or tazobactam may be reduced by haemodialysis (see section 4.4).

5 PHARMACOLOGICAL PROPERTIES

5.1 Pharmacodynamic properties

Pharmacotherapeutic group: Antibacterials for systemic use; Combinations of penicillins incl. beta-lactamase inhibitors;

ATC code: J01C R05

Mechanism of action

Piperacillin, a broad-spectrum, semisynthetic penicillin exerts bactericidal activity by inhibition of both septum and cell-wall synthesis.

Tazobactam, a beta-lactam structurally related to penicillins, is an inhibitor of many beta-lactamases, which commonly cause resistance to penicillins and cephalosporins but it does not inhibit AmpC enzymes or metallo beta-lactamases. Tazobactam extends the antibiotic spectrum of piperacillin to include many beta-lactamase-producing bacteria that have acquired resistance to piperacillin alone.

Pharmacokinetic / Pharmacodynamic effects

The time above the minimum inhibitory concentration (T > MIC) is considered to be the major pharmacodynamic determinant of efficacy for piperacillin.

Mechanism of resistance

The two main mechanisms of resistance to piperacillin/tazobactam are:

• Inactivation of the piperacillin component by those beta-lactamases that are not inhibited by tazobactam: beta-lactamases in the Molecular class B, C and D.
• Alteration of penicillin-binding proteins (PBPs), which results in the reduction of the affinity of piperacillin for the molecular target in bacteria.

Additionally, alterations in bacterial membrane permeability, as well as expression of multi-drug efflux pumps, may cause or contribute to bacterial resistance to piperacillin/tazobactam, especially in Gram-negative bacteria.

Susceptibility testing breakpoints

MIC (minimum inhibitory concentration) interpretive criteria for susceptibility testing have been established by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) for piperacillin/tazobactam and are listed here: https://www.ema.europa.eu/documents/other/minimum-inhibitory-concentration-mic-breakpoints_en.xlsx.

Susceptibility

The prevalence of acquired resistance may vary geographically and with time for selected species, and local information on resistance is desirable, particularly when treating severe infections. As necessary, expert advice should be sought when the local prevalence of resistance is such that the utility of the agent in at least some types of infections is questionable.

Groupings of relevant species according to piperacillin/tazobactam susceptibility

COMMONLY SUSCEPTIBLE SPECIES

Aerobic Gram-positive micro-organisms

Enterococcus faecalis (ampicillin- or penicillin-susceptible isolates only) Listeria monocytogenes

Staphylococcus aureus (methicillin-susceptible isolates only) Staphylococcus species, coagulase negative (methicillin-susceptible isolates only) Streptococcus agalactiae (Group B streptococci)^† Streptococcus pyogenes (Group A streptococci)^†

Aerobic Gram-negative micro-organisms

Citrobacter koseri

Haemophilus influenzae

Moraxella catarrhalis

Proteus mirabilis

Anaerobic Gram-positive micro-organisms

Clostridioides species

Eubacterium species

Anaerobic gram-positive cocci^††

Anaerobic Gram-negative micro-organisms

Bacteroides fragilis group

Fusobacterium species

Porphyromonas species

Prevotella species

SPECIES FOR WHICH ACQUIRED RESISTANCE MAY BE A PROBLEM

Aerobic Gram-positive micro-organisms

Enterococcus faecium

Streptococcus pneumoniae^†

Streptococcus viridans group^†

Aerobic Gram-negative micro-organisms

Acinetobacter baumannii

Citrobacter freundii

Enterobacter species

Escherichia coli

Klebsiella pneumoniae

Morganella morganii

Proteus vulgaris

Providencia ssp.

Pseudomonas aeruginosa

Serratia species

INHERENTLY RESISTANT ORGANISMS

Aerobic Gram-positive micro-organisms

Corynebacterium jeikeium

Aerobic Gram-negative micro-organisms

Burkholderia cepacia

Legionella species

Ochrobactrum anthropi

Stenotrophomonas maltophilia

Other micro-organisms

Chlamydophila pneumoniae

Mycoplasma pneumoniae

^† Streptococci are not β

-lactamase producing bacteria; resistance in these organisms is due to alterations in penicillin-binding proteins (PBPs) and, therefore, susceptible isolates are susceptible to piperacillin alone. Penicillin resistance has not been reported in S. pyogenes. ^†† Including Anaerococcus, Finegoldia, Parvimonas, Peptoniphilus, and Peptostreptococcus spp.

Merino Trial (blood stream infections due to ESBL producers)

In a prospective, non-inferiority, parallel-group, published randomized clinical trial, definitive (i.e. based on susceptibility confirmed in-vitro) treatment with piperacillin/tazobactam, compared with meropenem, did not result in a non-inferior 30-day mortality in adult patients with ceftriaxone-non-susceptible E. coli or K. pneumoniae blood stream infections.

A total of 23 of 187 patients (12.3%) randomized to piperacillin/tazobactam met the primary outcome of mortality at 30 days compared with 7 of 191 (3.7%) randomized to meropenem (risk difference, 8.6% [1-sided 97.5% CI − ∞ to 14.5%]; P = 0.90 for non-inferiority). The difference did not meet the non-inferiority margin of 5%. Effects were consistent in an analysis of the per-protocol population, with 18 of 170 patients (10.6%) meeting the primary outcome in a piperacillin/tazobactam group compared with 7 of 186 (3.8%) in the meropenem group (risk difference, 6.8% [one-sided 97.5% CI, - ∞ to 12.8%]; P = 0.76 for non-inferiority).

Clinical and microbiological resolution (secondary outcomes) by day 4 occurred in 121 of 177 patients (68.4%) in the piperacillin/tazobactam group compared with 138 of 185 (74.6%), randomized to meropenem (risk difference, 6.2% [95% CI − 15.5 to 3.1%]; P = 0.19). For secondary outcomes, statistical tests were 2-sided, with a P <0.05 considered significant.

In this trial, a mortality imbalance between study groups was found. It was supposed that deaths occurred in piperacillin/tazobactam group were related to underlying diseases rather than to the concomitant infection.

5.2 Pharmacokinetic properties

Absorption

The peak piperacillin and tazobactam concentrations after 4 g / 0.5 g administered over 30 minutes by intravenous infusion are 298 µg/ml and 34 µg/ml respectively.

Distribution

Both piperacillin and tazobactam are approximately 30% bound to plasma proteins. The protein binding of either piperacillin or tazobactam is unaffected by the presence of the other compound. Protein binding of the tazobactam metabolite is negligible.

Piperacillin/tazobactam is widely distributed in tissues and body fluids including intestinal mucosa, gallbladder, lung, bile, and bone. Mean tissue concentrations are generally 50 to 100% of those in plasma. Distribution into cerebrospinal fluid is low in subjects with non-inflamed meninges, as with other penicillins.

Biotransformation

Piperacillin is metabolised to a minor microbiologically active desethyl metabolite. Tazobactam is metabolised to a single metabolite that has been found to be microbiologically inactive.

Elimination

Piperacillin and tazobactam are eliminated via the kidney by glomerular filtration and tubular secretion.

Piperacillin is excreted rapidly as unchanged substance, with 68% of the administered dose appearing in the urine. Tazobactam and its metabolite are eliminated primarily by renal excretion, with 80% of the administered dose appearing as unchanged substance and the remainder as the single metabolite.

Piperacillin, tazobactam, and desethyl piperacillin are also secreted into the bile.

Following single or multiple doses of piperacillin/tazobactam to healthy subjects, the plasma half-life of piperacillin and tazobactam ranged from 0.7 to 1.2 hours and was unaffected by dose or duration of infusion. The elimination half-lives of both piperacillin and tazobactam are increased with decreasing renal clearance.

There are no significant changes in piperacillin pharmacokinetics due to tazobactam. Piperacillin appears to slightly reduce the clearance of tazobactam.

Special populations

The half-life of piperacillin and of tazobactam increases by approximately 25% and 18%, respectively, in patients with hepatic cirrhosis compared to healthy subjects.

The half-life of piperacillin and tazobactam increases with decreasing creatinine clearance. The increase in half-life is two-fold and four-fold for piperacillin and tazobactam, respectively, at creatinine clearance below 20 ml/min compared to patients with normal renal function.

Haemodialysis removes 30% to 50% of piperacillin/tazobactam, with an additional 5% of the tazobactam dose removed as the tazobactam metabolite. Peritoneal dialysis removes approximately 6% and 21% of the piperacillin and tazobactam doses, respectively, with up to 18% of the tazobactam dose removed as the tazobactam metabolite.

Paediatric population

In a population PK analysis, estimated clearance for 9 month-old to 12 year-old patients was comparable to adults, with a population mean (SE) value of 5.64 (0.34) ml/min/kg. The piperacillin clearance estimate is 80% of this value for paediatric patients 2-9 months of age. The population mean (SE) for piperacillin volume of distribution is 0.243 (0.011) l/kg and is independent of age.

Elderly patients

The mean half-life for piperacillin and tazobactam were 32% and 55% longer, respectively, in the elderly compared with younger subjects. This difference may be due to age-related changes in creatinine clearance.

Race

No difference in piperacillin or tazobactam pharmacokinetics was observed between Asian (n=9) and Caucasian (n=9) healthy volunteers who received single 4 g / 0.5 g doses.

5.3 Preclinical safety data

Non-clinical data reveal no special hazard for humans based on conventional studies of repeated dose toxicity and genotoxicity. Carcinogenicity studies have not been conducted with piperacillin/ tazobactam.

A fertility and general reproduction study in rats using intraperitoneal administration of tazobactam or the combination piperacillin/tazobactam reported a decrease in litter size and an increase in fetuses with ossification delays and variations of ribs, concurrent with maternal toxicity. Fertility of the F1 generation and embryonic development of F2 generation were not impaired.

Teratogenicity studies using intravenous administration of tazobactam or the combination piperacillin/tazobactam in mice and rats resulted in slight reductions in rat fetal weights at maternally toxic doses but did not show teratogenic effects.

Peri/postnatal development was impaired (reduced pup weights, increase in stillbirths, increase in pup mortality) concurrent with maternal toxicity after intraperitoneal administration of tazobactam or the combination piperacillin/tazobactam in the rat.

6 PHARMACEUTICAL PARTICULARS

6.1 List of excipients

None.

6.2 Incompatibilities

This medicinal product must not be mixed with other medicinal products except those mentioned in section 6.6.

Whenever Piperacillin / Tazobactam Qilu is used concurrently with another antibiotic (e.g. aminoglycosides), the substances must be administered separately. The mixing of beta-lactam antibiotics with an aminoglycoside in vitro can result in substantial inactivation of the aminoglycoside.

Piperacillin / Tazobactam Qilu should not be mixed with other substances in a syringe or infusion bottle since compatibility has not been established.

Due to chemical instability, Piperacillin / Tazobactam Qilu should not be used in solutions containing only sodium bicarbonate.

Piperacillin / Tazobactam Qilu is not compatible with lactated Ringer’s solution, Ringer’s acetate solution, Ringer’s acetate/malate solution, and Hartmann solution.

Piperacillin / Tazobactam Qilu should not be added to blood products or albumin hydrolysates.

6.3 Shelf life

2 years

Reconstituted solution in vial

Chemical and physical in-use stability has been demonstrated for up to 48 hours when stored in a refrigerator at 2-8°C and for 5 hours when stored at 20 - 25°C, when reconstituted with one of the compatible solvents for reconstitution (see section 6.6).

Diluted solution for infusion

Chemical and physical in-use stability has been demonstrated for up to 48 hours when stored in a refrigerator at 2-8°C and for 6 hours when stored at 20 - 25°C, when diluted with one of the compatible solvents for dilution at the suggested dilution volume (see section 6.6).

From a microbiological point of view, the product should be used immediately. If not used immediately, in-use storage times and conditions prior to use are the responsibility of the user and would normally not be longer than 24 hours at 2-8°C, unless reconstitution / dilution (etc) has taken place in controlled and validated aseptic conditions.

6.4 Special precautions for storage

This medicinal product does not require any special storage condition.

For storage conditions of the reconstituted and diluted medicinal product, see section 6.3.

6.5 Nature and contents of container

50 ml glass vial with bromobutyl rubber stoppers and aluminium plastic combined cap.

Pack sizes: 1, 5, 10, 12, 25 or 50 vials per carton.

Not all pack sizes may be marketed.

6.6 Special precautions for disposal

The reconstitution and dilution is to be made under aseptic conditions. The solution is to be inspected visually for particulate matter and discolouration prior to administration. The solution should only be used if the solution is clear and free from particles.

Preparation of the solution for infusion

The powder of each vial should be reconstituted with the volume of solvent shown in the table below, using one of the compatible solvents for reconstitution. It should be swirled until dissolved. When swirled constantly, reconstitution generally occurs within 5 to 10 minutes (for details on handling, please see below).

* Compatible solvents for reconstitution:

• Sodium chloride 9 mg/ml (0.9%) solution for injection
• Sterile water for injections ⁽¹⁾
• Glucose 50 mg/ml (5 %) solution for infusion

⁽¹⁾ Maximum recommended volume of sterile water for injection per dose is 50 ml.

The reconstituted solutions should be withdrawn from the vial by syringe. When reconstituted as directed, the vial contents withdrawn by syringe will provide the labelled amount of piperacillin and tazobactam.

The reconstituted solutions may be further diluted to the desired volume (e.g. 50 ml to 150 ml) with one of the following compatible solvents:

• Sodium chloride 9 mg/ml (0.9 %) solution for injection
• Glucose 50 mg/ml (5 %) solution for infusion
• Dextran 60 mg/ml (6 %) in sodium chloride 9 mg/ml (0.9 %) solution for injection

Co-administration with aminoglycosides

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

See section 6.2 for incompatibilities.

Any unused medicinal product or waste material should be disposed of in accordance with local requirements.

For single use only. Discard any unused solution.

7 MARKETING AUTHORISATION HOLDER

QILU PHARMA SPAIN S.L.

Paseo de la Castellana 40, planta 8,

28046 Madrid,

Spain

8 MARKETING AUTHORISATION NUMBER(S)

PL 44570/0031

9 DATE OF FIRST AUTHORISATION/RENEWAL OF THE

AUTHORISATION

06/11/2023

10 DATE OF REVISION OF THE TEXT

14/07/2026