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Variability of piperacillin concentrations in relation to tazobactam concentrations in critically ill patients.

Abstract：

:Therapeutic drug monitoring for critically ill patients receiving piperacillin/tazobactam is described as a useful tool. However, the minimum inhibitory concentration of piperacillin depends on a sufficiently high concentration of tazobactam in case of β-lactamase-producing strains. Therefore, the relationship between piperacillin and tazobactam concentrations was assessed in a heterogeneous group of critically ill patients. Sixty patients with severe infections receiving 4.5 g of piperacillin/tazobactam 2-3 times daily by intermittent infusion were included in this prospective observational study (NCT01793012). Over 4 days, multiple serum samples were obtained to determine the total piperacillin and tazobactam concentrations. The target ranges were defined as trough levels >16 mg/L (>22.5 mg/L) and >4 mg/L (>5.7 mg/L) for the calculated unbound concentrations (measured total concentrations) of piperacillin and tazobactam, respectively. Despite a high correlation coefficient (r = 0.93) comparing piperacillin and tazobactam trough levels, the piperacillin/tazobactam quotients varied between ca. 1 and 10. From linear regression analysis of piperacillin versus tazobactam values, it follows that a piperacillin trough level of 22.5 mg/L might be associated with tazobactam trough levels ranging from 1.5 mg/L to 10.1 mg/L. A 70 mg/L threshold for total piperacillin trough levels would be necessary to ensure that tazobactam concentrations are >5.7 mg/L. Because of the observed variability of piperacillin/tazobactam quotients, defining the total piperacillin target range ≥70 mg/L might be useful to ensure that tazobactam concentrations do not fall below 5.7 mg/L. Further studies are necessary to confirm that the used therapeutic ranges are associated with optimal outcomes in critically ill patients.

journal_name

Int J Antimicrob Agents

journal_title

International journal of antimicrobial agents

authors

Zander J,Döbbeler G,Nagel D,Scharf C,Huseyn-Zada M,Jung J,Frey L,Vogeser M,Zoller M

doi

10.1016/j.ijantimicag.2016.06.013

subject

Has Abstract

pub_date

2016-10-01 00:00:00

pages

435-9

issue

eissn

0924-8579

issn

1872-7913

pii

S0924-8579(16)30182-0

journal_volume

pub_type

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Variability of piperacillin concentrations in relation to tazobactam concentrations in critically ill patients.