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Piperacillin/tazobactam, renal replacement

Soo Min Jang, Katherine N Gharibian, Susan J Lewis, William H Fissell, Ashita J Tolwani, Bruce A Mueller
Cefepime, ceftazidime, and piperacillin/tazobactam are commonly used beta-lactam antibiotics in the critical care setting. For critically ill patients receiving prolonged intermittent renal replacement therapy (PIRRT), limited pharmacokinetic data are available to inform clinicians on the dosing of these agents. Monte Carlo simulations (MCS) can be used to guide drug dosing when pharmacokinetic trials are not feasible. For each antibiotic, MCS using previously published pharmacokinetic data derived from critically ill patients was used to evaluate multiple dosing regimens in 4 different prolonged intermittent renal replacement therapy effluent rates and prolonged intermittent renal replacement therapy duration combinations (4 L/h × 10 hours or 5 L/h × 8 hours in hemodialysis and hemofiltration modes)...
May 10, 2018: Journal of Clinical Pharmacology
Saiyuri Naicker, Yarmarly C Guerra Valero, Jenny L Ordenez Meija, Jeffrey Lipman, Jason A Roberts, Steven C Wallis, Suzanne L Parker
Piperacillin-tazobactam is a beta-lactam/beta-lactamase combination antibiotic used in patients with moderate to severe infection. Dosing of piperacillin-tazobactam requires an understanding of this patient group to maximise the effectiveness of this antibiotic and limit a further emergence of resistant pathogens. This is the first method that measures piperacillin and tazobactam simultaneously, across this range of clinically-relevant biological matrices. The calibration line was linear across the concentration range of 0...
January 30, 2018: Journal of Pharmaceutical and Biomedical Analysis
Claire Roger, Menino O Cotta, Laurent Muller, Steven C Wallis, Jeffrey Lipman, Jean-Yves Lefrant, Jason A Roberts
This prospective pharmacokinetic study aimed to compare the clearance of piperacillin-tazobactam administered as a 24-h continuous infusion between continuous venovenous haemodiafiltration (CVVHDF) and continuous venovenous haemofiltration (CVVH) applied at equal dose in critically ill patients. A loading dose of 4.5 g of piperacillin-tazobactam followed by a continuous infusion (500 mg/h) was administered to patients randomized to receive CVVHDF or CVVH. Serial pre- and postfilter blood samples were drawn during an 8-h sampling interval...
August 2017: International Journal of Antimicrobial Agents
Hanako Kohama, Takeshi Ide, Kazuro Ikawa, Norifumi Morikawa, Shinichi Nishi
BACKGROUND: Tazobactam/piperacillin (TAZ/PIPC), which is often combined with continuous renal replacement therapy (CRRT), induces renal excretion and is thought to have a high component removal rate for blood purification. CRRT procedures vary depending on the country, region, and institution. It is not clear whether the dose of TAZ/PIPC for use in Japan can be determined based on studies conducted in other countries. Therefore, in this study, we examined the suitability of recommended dose in Japan...
2017: Clinical Pharmacology: Advances and Applications
Bhagyashri Navalkele, Jason M Pogue, Shigehiko Karino, Bakht Nishan, Madiha Salim, Shantanu Solanki, Amina Pervaiz, Nader Tashtoush, Hamadullah Shaikh, Sunitha Koppula, Jonathan Koons, Tanveer Hussain, William Perry, Richard Evans, Emily T Martin, Ryan P Mynatt, Kyle P Murray, Michael J Rybak, Keith S Kaye
BACKGROUND: Recent evidence suggests that among patients receiving vancomycin, receipt of concomitant piperacillin-tazobactam increases the risk of nephrotoxicity. Well-controlled, adequately powered studies comparing rates of acute kidney injury (AKI) among patients receiving vancomycin + piperacillin-tazobactam (VPT) compared to similar patients receiving vancomycin + cefepime (VC) are lacking. In this study we compared the incidence of AKI among patients receiving combination therapy with VPT to a matched group receiving VC...
January 15, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Joseph P Rindone, Chadwick Mellen, Jennifer Ryba
BACKGROUND: Observational studies have suggested an increased risk of nephrotoxicity when piperacillin-tazobactam is added to vancomycin, although the data are confliciting. OBJECTIVE: To perform a meta-analysis of identified studies to assess if adding piperacillin-tazobactam to vancomycin increases the incidence of nephrotoxicity. METHOD: A systematic review of PubMed, EMBASE, Cochrane Central, and Google Scholar was conducted to identify studies...
October 24, 2016: Current Drug Safety
Craig McDonald, Menino O Cotta, Peter J Little, Brett McWhinney, Jacobus P Ungerer, Jeffrey Lipman, Jason A Roberts
BACKGROUND: β-lactam antibiotics may necessitate higher than licensed drug doses to achieve therapeutic exposures in critically ill patients. Therapeutic drug monitoring can be used to guide dosing so as to maximise therapeutic effect whilst reducing the likelihood of exposure-related toxicity. METHODS: A retrospective review of critically ill patients identified those that received higher than licensed doses of either meropenem (3-6 g/day) or piperacillin-tazobactam (16 g-2 g/day) (i...
September 2016: Minerva Anestesiologica
Johannes Zander, Gundula Döbbeler, Dorothea Nagel, Barbara Maier, Christina Scharf, Mikayil Huseyn-Zada, Jette Jung, Lorenz Frey, Michael Vogeser, Michael Zoller
BACKGROUND: Piperacillin levels after standard dosing have been shown frequently to be subtherapeutic, especially when renal clearance was augmented. Here, we aimed to determine if piperacillin was in its therapeutic range in a typically heterogeneous intensive care unit patient group, and also to describe target attainment dependent on daily dosage, creatinine clearance, and renal replacement therapy (RRT). METHODS: Sixty patients with severe infections were included in this monocentric prospective observational study...
April 4, 2016: Critical Care: the Official Journal of the Critical Care Forum
Drayton A Hammond, Melanie N Smith, Jacob T Painter, Nikhil K Meena, Katherine Lusardi
STUDY OBJECTIVE: The combination of vancomycin and piperacillin-tazobactam has been associated with an increased risk of acute kidney injury (AKI) in non-critically ill patient populations, but it is still unknown if this association exists in critically ill patients. The objective of this study was to compare the incidence of AKI development during therapy or within 72 hours after completion of therapy in adult critically ill patients who received vancomycin with concomitant piperacillin-tazobactam or cefepime...
May 2016: Pharmacotherapy
Jason A Roberts, Gordon Y S Choi, Gavin M Joynt, Sanjoy K Paul, Renae Deans, Sandra Peake, Louise Cole, Dianne Stephens, Rinaldo Bellomo, John Turnidge, Steven C Wallis, Michael S Roberts, Darren M Roberts, Melissa Lassig-Smith, Therese Starr, Jeffrey Lipman
BACKGROUND: Optimal antibiotic dosing is key to maximising patient survival, and minimising the emergence of bacterial resistance. Evidence-based antibiotic dosing guidelines for critically ill patients receiving RRT are currently not available, as RRT techniques and settings vary greatly between ICUs and even individual patients. We aim to develop a robust, evidence-based antibiotic dosing guideline for critically ill patients receiving various forms of RRT. We further aim to observe whether therapeutic antibiotic concentrations are associated with reduced 28-day mortality...
March 1, 2016: BMC Infectious Diseases
H J Heppner, F Yapan, A Wiedemann
Due to the demographic shift, increasing numbers of geriatric patients are admitted to acute care hospitals of all levels of care. This means that special challenges must be met in the medical care and management of these patients.Immunosenescence and multimorbidity make elderly patients vulnerable to infectious diseases. Urinary tract infections range from "simple" cystitis to pyelonephritis and urosepsis and, at 25%, are the second most common form of infection in geriatric patients. It is often difficult to make a diagnosis because typical symptoms do not always occur...
February 2016: Aktuelle Urologie
Jian P Mei, Azadeh Ali-Moghaddam, Bruce A Mueller
BACKGROUND: The use of hybrid renal replacement therapies like sustained low efficiency dialysis (SLED) is increasing in ICUs worldwide. However, pharmacokinetic studies designed to inform therapeutic antibiotic dosing in critically ill patients receiving SLED are limited. SLED operational characteristics vary across institutions. Pharmacists in institutions that utilize SLED are challenged to recommend therapeutic doses for antibiotics. OBJECTIVE: To characterize pharmacist-recommended antibiotic regimens for SLED...
February 2016: International Journal of Clinical Pharmacy
Estrella Martín-Mazuelos, Ana Loza, Carmen Castro, Desirée Macías, Ismail Zakariya, Pedro Saavedra, Sergio Ruiz-Santana, Elena Marín, Cristóbal León
PURPOSE: To assess the performance of (1→3)-β-D-glucan (BDG) and Candida albicans germ tube antibody (CAGTA) for the diagnosis of invasive candidiasis (IC) in a prospective cohort of 107 unselected, non-neutropenic ICU patients. METHODS: BDG (cutoff positivity ≥80 pg/mL) and CAGTA (cutoff positivity ≥1/160) assays were performed twice a week. Confounding factors included amoxicillin-clavulanate and piperacillin-tazobactam treatments, recent surgery, Gram-positive bloodstream infection, renal replacement therapy, and enteral nutrition...
August 2015: Intensive Care Medicine
Don-Kelena Awissi, Annie Beauchamp, Elisabeth Hébert, Viviane Lavigne, Danya Lucia Munoz, Geneviève Lebrun, Michel Savoie, Mylène Fagnan, Julie Amyot, Nicolas Tétreault, Robert Robitaille, France Varin, Christian Lavallée, Vincent Pichette, Martine Leblanc
STUDY OBJECTIVE: To evaluate the pharmacokinetic and pharmacodynamic profiles of piperacillin-tazobactam administered as a 4-hour infusion in critically ill patients undergoing continuous renal replacement therapy (CRRT). DESIGN: Prospective, observational, pharmacokinetic study. SETTING: Intensive care unit of a tertiary care hospital in Montréal, Canada. PATIENTS: Twenty critically ill adults who were undergoing continuous venovenous hemodiafiltration and receiving a 4-hour infusion of piperacillin 4 g-tazobactam 0...
June 2015: Pharmacotherapy
H Habayeb, B Sajin, K Patel, C Grundy, A Al-Dujaili, S Van de Velde
A formulary decision was made at a large provider of acute hospital services in Surrey to replace piperacillin/tazobactam with amoxicillin+temocillin for the empiric treatment of severe hospital-acquired pneumonia. This decision was made because the use of broad-spectrum-β-lactam antibiotics is a known risk factor for Clostridium difficile infection (CDI) and for the selection of resistance. After the antibiotic formulary was changed, a retrospective audit was conducted to assess the effect of this change...
August 2015: European Journal of Clinical Microbiology & Infectious Diseases
Eleanor C Murray, Aleksandra Marek, Peter C Thomson, John E Coia
BACKGROUND: Patients on renal replacement therapy experience higher rates of morbidity and mortality, infection being the second commonest cause of death. In our haemodialysis population, we identify the pathogens, sensitivity patterns, sources of infection and outcomes of Gram-negative bacteraemia. METHODS: Data from the NHS Greater Glasgow & Clyde and NHS Forth Valley haemodialysis population were collected July 2011 to April 2014 through an interrogation of the renal unit electronic patient record, and confirmed by an independent search of the Microbiology database...
July 2015: Nephrology, Dialysis, Transplantation
Darren M Roberts, Xin Liu, Jason A Roberts, Priya Nair, Louise Cole, Michael S Roberts, Jeffrey Lipman, Rinaldo Bellomo
INTRODUCTION: Continuous renal replacement therapy (CRRT) may alter antibiotic pharmacokinetics and increase the risk of incorrect dosing. In a nested cohort within a large randomized controlled trial, we assessed the effect of higher (40 mL/kg per hour) and lower (25 mL/kg per hour) intensity CRRT on antibiotic pharmacokinetics. METHODS: We collected serial blood samples to measure ciprofloxacin, meropenem, piperacillin-tazobactam, and vancomycin levels. We calculated extracorporeal clearance (CL), systemic CL, and volume of distribution (Vd) by non-linear mixed-effects modelling...
March 13, 2015: Critical Care: the Official Journal of the Critical Care Forum
Darren M Roberts, Xin Liu, Jason A Roberts, Priya Nair, Louise Cole, Michael S Roberts, Jeffrey Lipman, Rinaldo Bellomo
INTRODUCTION: Continuous renal replacement therapy (CRRT) may alter antibiotic pharmacokinetics and increase the risk of incorrect dosing. In a nested cohort within a large randomized controlled trial, we assessed the effect of higher (40 mL/kg/hour) and lower (25 mL/kg/hour) intensity CRRT on antibiotic pharmacokinetics. METHODS: We collected serial blood samples to measure ciprofloxacin, meropenem, piperacillin-tazobactam and vancomycin levels. We calculated extracorporeal clearance (CL), systemic CL and volume of distribution (Vd) by nonlinear mixed effects modelling...
December 2015: Critical Care: the Official Journal of the Critical Care Forum
Andrew A Udy, Jeffrey Lipman, Paul Jarrett, Kerenaftali Klein, Steven C Wallis, Kashyap Patel, Carl M J Kirkpatrick, Peter S Kruger, David L Paterson, Michael S Roberts, Jason A Roberts
INTRODUCTION: The aim of this study was to explore the impact of augmented creatinine clearance and differing minimum inhibitory concentrations (MIC) on piperacillin pharmacokinetic/pharmacodynamic (PK/PD) target attainment (time above MIC (fT>MIC)) in critically ill patients with sepsis receiving intermittent dosing. METHODS: To be eligible for enrolment, critically ill patients with sepsis had to be receiving piperacillin-tazobactam 4.5 g intravenously (IV) by intermittent infusion every 6 hours for presumed or confirmed nosocomial infection without significant renal impairment (defined by a plasma creatinine concentration greater than 171 μmol/L or the need for renal replacement therapy)...
2015: Critical Care: the Official Journal of the Critical Care Forum
Precil Diego M M Neves, Fernanda M Freitas, Christiane A Kojima, Beatriz L Carmello, Rodrigo Bazan, Pasqual Barretti, Luis C Martin
Antibiotics are potentially a cause of neurotoxicity in dialysis patients, the most common are the beta-lactams as ceftazidime and cefepime, and few cases have been reported after piperacillin/tazobactam use. This report presents a case of a hypertensive and diabetic 67-year-old woman in regular hemodialysis, which previously had a stroke. She was hospitalized presenting pneumonia, which was initially treated with cefepime. Two days after treatment, she presented dysarthria, left hemiparesis, ataxia, and IX and X cranial nerves paresis...
January 2015: Hemodialysis International
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