Simplifying Piperacillin/Tazobactam Dosing: Pharmacodynamics of Utilizing Only 4.5 or 3.375 g Doses for Patients With Normal and Impaired Renal Function
| Autor: | Abrar K. Thabit, Joseph L. Kuti, Mordechai Grupper, David P. Nicolau |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty medicine.medical_treatment 030106 microbiology Urology Renal function Penicillanic Acid Microbial Sensitivity Tests Pharmacology Kidney Tazobactam 03 medical and health sciences 0302 clinical medicine Pharmacokinetics Enterobacteriaceae medicine Humans Pharmacology (medical) 030212 general & internal medicine Dosing Renal Insufficiency Infusions Intravenous Piperacillin Dose-Response Relationship Drug business.industry Anti-Bacterial Agents Piperacillin Tazobactam Drug Combination Pharmacodynamics Piperacillin/tazobactam Pseudomonas aeruginosa Hemodialysis business Monte Carlo Method medicine.drug |
| Zdroj: | Journal of pharmacy practice. 30(6) |
| ISSN: | 1531-1937 |
| Popis: | Objectives: To evaluate the pharmacodynamic exposure of piperacillin/tazobactam across the renal function range using 4.5 or 3.375 g dosing regimens. 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. 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. 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. |
| Databáze: | OpenAIRE |
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