We need to optimize piperacillin-tazobactam dosing in critically ill patients-but how?

Menino Osbert Cotta,Jason A Roberts,Jeffrey Lipman

doi:10.1186/s13054-016-1348-8

Menino Osbert Cotta, Jason A Roberts + Show 1 more

Open Access

https://doi.org/10.1186/s13054-016-1348-8

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Abstract

We need to optimize piperacillin-tazobactam dosing in critically ill patients-but how?

Highlights

Zander et al [1] have recently conducted a prospective observational study to describe the variability of piperacillin (PIP) concentrations and target attainment in a heterogeneous cohort of 60 critically ill patients
These results are consistent with previous data showing that ‘augmented renal clearance’ (ARC), defined as a creatinine clearance (CrCl) ≥130 mL/min [2], is frequently being associated with subtherapeutic PIP concentrations, even when dosing PIP-TAZ four times daily (QID) [2, 3]
This is a very important finding as it highlights that initiating times daily (TID) PIP-TAZ dosing as a blanket strategy in critically ill patients with ‘normal’ renal function or even mild to moderate renal impairment will not reliably attain PK/PD targets

Summary

Introduction

Zander et al [1] have recently conducted a prospective observational study to describe the variability of piperacillin (PIP) concentrations and target attainment in a heterogeneous cohort of 60 critically ill patients. These results are consistent with previous data showing that ‘augmented renal clearance’ (ARC), defined as a CrCl ≥130 mL/min [2], is frequently being associated with subtherapeutic PIP concentrations, even when dosing PIP-TAZ four times daily (QID) [2, 3].

Results

Conclusion