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Simplifying Piperacillin/Tazobactam Dosing: Pharmacodynamics of Utilizing Only 4.5 or 3.375 g Doses for Patients With Normal and Impaired Renal Function.
- Source :
-
Journal of pharmacy practice [J Pharm Pract] 2017 Dec; Vol. 30 (6), pp. 593-599. Date of Electronic Publication: 2016 Dec 21. - Publication Year :
- 2017
-
Abstract
- Objectives: To evaluate the pharmacodynamic exposure of piperacillin/tazobactam across the renal function range using 4.5 or 3.375 g dosing regimens.<br />Methods: A 5000-patient Monte Carlo simulation was conducted to determine the probability of achieving 50% free time above the minimum inhibitory concentration ( fT > MIC) for piperacillin. Proposed regimens, using solely 4.5 or 3.375 g strengths, were compared with regimens listed in piperacillin/tazobactam prescribing information over creatinine clearance (CrCl) ranges of 120 mL/min to hemodialysis. The probability of target attainment (PTA) at MICs ≤ 16 μg/mL was compared between proposed and standard regimens.<br />Results: At CrCl 41 to 120 mL/min, prolonged infusions of 4.5 g (3 hours) and 3.375 g (4 hours) every 6 hours resulted in ≥95% PTA versus ≥76% for standard regimens (0.5 hour). At CrCl 20 to 40 mL/min, 4.5 and 3.375 g every 8 hours as prolonged infusions achieved slightly higher PTA (≥98%) versus standard regimens (≥93%). Similarly, PTA achieved with prolonged infusions of 4.5 and 3.375 g every 12 hours (≥93%) was comparable with those of standard regimens (≥91%) at CrCl 1 to 19 mL/min. In hemodialysis, 100% PTA was achieved with prolonged infusion regimens.<br />Conclusion: Piperacillin/tazobactam regimens designed around the 4.5 or 3.375 g dose and prolonged infusions provided similar or better PTA at MICs ≤ 16 μg/mL compared with standard regimens. These observations may support the stocking and use of a single piperacillin/tazobactam strength to simplify dosing.
- Subjects :
- Anti-Bacterial Agents pharmacokinetics
Dose-Response Relationship, Drug
Enterobacteriaceae drug effects
Enterobacteriaceae physiology
Humans
Infusions, Intravenous
Kidney metabolism
Microbial Sensitivity Tests methods
Penicillanic Acid administration & dosage
Penicillanic Acid pharmacokinetics
Piperacillin administration & dosage
Piperacillin pharmacokinetics
Piperacillin, Tazobactam Drug Combination
Pseudomonas aeruginosa drug effects
Pseudomonas aeruginosa physiology
Renal Insufficiency metabolism
Anti-Bacterial Agents administration & dosage
Kidney drug effects
Monte Carlo Method
Penicillanic Acid analogs & derivatives
Renal Insufficiency drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1531-1937
- Volume :
- 30
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Journal of pharmacy practice
- Publication Type :
- Academic Journal
- Accession number :
- 29121839
- Full Text :
- https://doi.org/10.1177/0897190016684453