Disclosed herein are tethered cap and spout combinations. The tethered cap and spout combinations prevent loss of the cap after opening. In an implementation, the tethered cap and spout combinations may provide mechanisms for puncturing or opening a seal that may be present at a throat or neck of the container which provides both an anti-tampering and freshness function. In an implementation, the tethered cap and spout combinations may provide anti-tampering mechanisms. In an implementation, the tethered cap and spout combinations may provide mechanisms to hold an opened and tethered cap away from the container opening during use.