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Population Pharmacokinetics of Piperacillin in Sepsis Patients: Should Alternative Dosing Strategies Be Considered?
Aarhus Univ Hosp, Dept Infect Dis, Aarhus, Denmark.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
Aarhus Univ Hosp, Dept Infect Dis, Aarhus, Denmark.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.ORCID iD: 0000-0003-3166-9981
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2018 (English)In: Antimicrobial Agents and Chemotherapy, ISSN 0066-4804, E-ISSN 1098-6596, Vol. 62, no 5, article id e02306Article in journal (Refereed) Published
Abstract [en]

Sufficient antibiotic dosing in septic patients is essential for reducing mortality. Piperacillin-tazobactam is often used for empirical treatment, but due to the pharmacokinetic (PK) variability seen in septic patients, optimal dosing may be a challenge. We determined the PK profile for piperacillin given at 4 g every 8 h in 22 septic patients admitted to a medical ward. Piperacillin concentrations were compared to the clinical breakpoint MIC for Pseudomonas aeruginosa (16 mg/liter), and the following PK/pharmacodynamic (PD) targets were evaluated: the percentage of the dosing interval that the free drug concentration is maintained above the MIC (fTMIC) of 50% and 100%. A two-compartment population PK model described the data well, with clearance being divided into renal and nonrenal components. The renal component was proportional to the estimated creatinine clearance (eCLCR) and constituted 74% of the total clearance in a typical individual (eCLCR, 83.9 ml/min). Patients with a high eCLCR (>130 ml/min) were at risk of subtherapeutic concentrations for the current regimen, with a 90% probability of target attainment being reached at MICs of 2.0 (50% fTMIC) and 0.125 mg/liter (100% fTMIC). Simulations of alternative dosing regimens and modes of administration showed that dose increment and prolonged infusion increased the chance of achieving predefined PK/PD targets. Alternative dosing strategies may therefore be needed to optimize piperacillin exposure in septic patients. (This study has been registered at ClinicalTrials.gov under identifier NCT02569086.)

Place, publisher, year, edition, pages
AMER SOC MICROBIOLOGY , 2018. Vol. 62, no 5, article id e02306
Keywords [en]
augmented renal clearance, dosage optimization, piperacillin, population pharmacokinetics, sepsis
National Category
Infectious Medicine Pharmaceutical Sciences
Identifiers
URN: urn:nbn:se:uu:diva-356077DOI: 10.1128/AAC.02306-17ISI: 000431341200054PubMedID: 29507062OAI: oai:DiVA.org:uu-356077DiVA, id: diva2:1233000
Available from: 2018-07-13 Created: 2018-07-13 Last updated: 2018-07-13Bibliographically approved

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Thorsted, AndersKristoffersson, Anders N.Friberg, Lena E

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