Pharmacokinetics of piperacillin in critically ill patients receiving continuous venovenous haemofiltration: a randomised controlled trial of continuous infusion versus intermittent bolus administration

Here we describe the pharmacokinetics of piperacillin administered by continuous infusion (CI) versus intermittent bolus (IB) dosing in critically ill patients receiving continuous venovenous haemofiltration (CVVH) and compare the frequency of pharmacodynamic/pharmacokin...

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Main Authors:	Jamal, Janattul-Ain, Roberts, Darren M., Udy, Andrew A, Mat Nor, Mohd Basri, Mohamad Nor, Fariz Safhan, Wallis, Steven C, Lipman, Jeffrey, Roberts, Jason A.
Format:	Article
Language:	English English
Published:	Elsevier 2015
Subjects:	RS Pharmacy and materia medica
Online Access:	http://irep.iium.edu.my/43883/ http://irep.iium.edu.my/43883/ http://irep.iium.edu.my/43883/ http://irep.iium.edu.my/43883/1/Pharmacokinetics_of_piperacillin_in_critically_ill_patients_receiving_continuous_venovenous_haemofiltration_A_randomised_controlled_trial_of_continuous_infusion_versus_intermi.pdf http://irep.iium.edu.my/43883/4/43883_Pharmacokinetics%20of%20piperacillin%20in%20critically%20ill%20patients%20receiving%20continuous%20venovenous%20haemofiltration_SCOPUS.pdf

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spelling	iium-438832017-11-15T03:52:51Z http://irep.iium.edu.my/43883/ Pharmacokinetics of piperacillin in critically ill patients receiving continuous venovenous haemofiltration: a randomised controlled trial of continuous infusion versus intermittent bolus administration Jamal, Janattul-Ain Roberts, Darren M. Udy, Andrew A Mat Nor, Mohd Basri Mohamad Nor, Fariz Safhan Wallis, Steven C Lipman, Jeffrey Roberts, Jason A. RS Pharmacy and materia medica Here we describe the pharmacokinetics of piperacillin administered by continuous infusion (CI) versus intermittent bolus (IB) dosing in critically ill patients receiving continuous venovenous haemofiltration (CVVH) and compare the frequency of pharmacodynamic/pharmacokinetic (PK/PD) target attainment with each dosing strategy. This was a prospective pharmacokinetic trial in 16 critically ill patients with severe sepsis or septic shock undergoing CVVH and randomised to receive either CI or IB administration of a standard daily dose of piperacillin/tazobactam (11.25 g/day on Day 1 followed by 9 g/day). Serial blood samples were measured on two occasions. Piperacillin pharmacokinetics were calculated using a non-compartmental approach. Blood concentrations were compared with established PK/PD targets. On occasion 1 (Days 1–3 of therapy), IB administration resulted in significantly higher piperacillin peak concentrations (169 vs. 89 mg/L; P = 0.002), whereas significantly higher steady-state concentrations were observed in CI patients (83 vs. 57 mg/L; P = 0.04). Total clearance and clearance not mediated by CVVH were significantly higher with CI administration [median (interquartile range), 1.0 (0.7–1.1) and 0.8 (0.6–1.0) mL/kg/min; P = 0.001 and 0.001, respectively]. The estimated unbound piperacillin conncentrations were four times above the target susceptibility breakpoint (16 mg/L) for the entire dosing interval (100%fT>4xMIC) in 87.5% of patients receiving CI administration (sampling occasion 1), compared with 62.5% of IB patients achieving the desired target (50%fT>4xMIC). Compared with IB dosing, and despite similar CVVH settings, CI administration of piperacillin results in a pharmacokinetic profile that may optimise outcomes for less susceptible pathogens. Elsevier 2015-07-01 Article PeerReviewed application/pdf en http://irep.iium.edu.my/43883/1/Pharmacokinetics_of_piperacillin_in_critically_ill_patients_receiving_continuous_venovenous_haemofiltration_A_randomised_controlled_trial_of_continuous_infusion_versus_intermi.pdf application/pdf en http://irep.iium.edu.my/43883/4/43883_Pharmacokinetics%20of%20piperacillin%20in%20critically%20ill%20patients%20receiving%20continuous%20venovenous%20haemofiltration_SCOPUS.pdf Jamal, Janattul-Ain and Roberts, Darren M. and Udy, Andrew A and Mat Nor, Mohd Basri and Mohamad Nor, Fariz Safhan and Wallis, Steven C and Lipman, Jeffrey and Roberts, Jason A. (2015) Pharmacokinetics of piperacillin in critically ill patients receiving continuous venovenous haemofiltration: a randomised controlled trial of continuous infusion versus intermittent bolus administration. International Journal of Antimicrobial Agents, 46 (1). pp. 39-44. ISSN 0924-8579 http://www.sciencedirect.com/science/article/pii/S0924857915001089 10.1016/j.ijantimicag.2015.02.014
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English English
topic	RS Pharmacy and materia medica
spellingShingle	RS Pharmacy and materia medica Jamal, Janattul-Ain Roberts, Darren M. Udy, Andrew A Mat Nor, Mohd Basri Mohamad Nor, Fariz Safhan Wallis, Steven C Lipman, Jeffrey Roberts, Jason A. Pharmacokinetics of piperacillin in critically ill patients receiving continuous venovenous haemofiltration: a randomised controlled trial of continuous infusion versus intermittent bolus administration
description	Here we describe the pharmacokinetics of piperacillin administered by continuous infusion (CI) versus intermittent bolus (IB) dosing in critically ill patients receiving continuous venovenous haemofiltration (CVVH) and compare the frequency of pharmacodynamic/pharmacokinetic (PK/PD) target attainment with each dosing strategy. This was a prospective pharmacokinetic trial in 16 critically ill patients with severe sepsis or septic shock undergoing CVVH and randomised to receive either CI or IB administration of a standard daily dose of piperacillin/tazobactam (11.25 g/day on Day 1 followed by 9 g/day). Serial blood samples were measured on two occasions. Piperacillin pharmacokinetics were calculated using a non-compartmental approach. Blood concentrations were compared with established PK/PD targets. On occasion 1 (Days 1–3 of therapy), IB administration resulted in significantly higher piperacillin peak concentrations (169 vs. 89 mg/L; P = 0.002), whereas significantly higher steady-state concentrations were observed in CI patients (83 vs. 57 mg/L; P = 0.04). Total clearance and clearance not mediated by CVVH were significantly higher with CI administration [median (interquartile range), 1.0 (0.7–1.1) and 0.8 (0.6–1.0) mL/kg/min; P = 0.001 and 0.001, respectively]. The estimated unbound piperacillin conncentrations were four times above the target susceptibility breakpoint (16 mg/L) for the entire dosing interval (100%fT>4xMIC) in 87.5% of patients receiving CI administration (sampling occasion 1), compared with 62.5% of IB patients achieving the desired target (50%fT>4xMIC). Compared with IB dosing, and despite similar CVVH settings, CI administration of piperacillin results in a pharmacokinetic profile that may optimise outcomes for less susceptible pathogens.
format	Article
author	Jamal, Janattul-Ain Roberts, Darren M. Udy, Andrew A Mat Nor, Mohd Basri Mohamad Nor, Fariz Safhan Wallis, Steven C Lipman, Jeffrey Roberts, Jason A.
author_facet	Jamal, Janattul-Ain Roberts, Darren M. Udy, Andrew A Mat Nor, Mohd Basri Mohamad Nor, Fariz Safhan Wallis, Steven C Lipman, Jeffrey Roberts, Jason A.
author_sort	Jamal, Janattul-Ain
title	Pharmacokinetics of piperacillin in critically ill patients receiving continuous venovenous haemofiltration: a randomised controlled trial of continuous infusion versus intermittent bolus administration
title_short	Pharmacokinetics of piperacillin in critically ill patients receiving continuous venovenous haemofiltration: a randomised controlled trial of continuous infusion versus intermittent bolus administration
title_full	Pharmacokinetics of piperacillin in critically ill patients receiving continuous venovenous haemofiltration: a randomised controlled trial of continuous infusion versus intermittent bolus administration
title_fullStr	Pharmacokinetics of piperacillin in critically ill patients receiving continuous venovenous haemofiltration: a randomised controlled trial of continuous infusion versus intermittent bolus administration
title_full_unstemmed	Pharmacokinetics of piperacillin in critically ill patients receiving continuous venovenous haemofiltration: a randomised controlled trial of continuous infusion versus intermittent bolus administration
title_sort	pharmacokinetics of piperacillin in critically ill patients receiving continuous venovenous haemofiltration: a randomised controlled trial of continuous infusion versus intermittent bolus administration
publisher	Elsevier
publishDate	2015
url	http://irep.iium.edu.my/43883/ http://irep.iium.edu.my/43883/ http://irep.iium.edu.my/43883/ http://irep.iium.edu.my/43883/1/Pharmacokinetics_of_piperacillin_in_critically_ill_patients_receiving_continuous_venovenous_haemofiltration_A_randomised_controlled_trial_of_continuous_infusion_versus_intermi.pdf http://irep.iium.edu.my/43883/4/43883_Pharmacokinetics%20of%20piperacillin%20in%20critically%20ill%20patients%20receiving%20continuous%20venovenous%20haemofiltration_SCOPUS.pdf
first_indexed	2023-09-18T21:02:27Z
last_indexed	2023-09-18T21:02:27Z
_version_	1777410713607733248

Pharmacokinetics of piperacillin in critically ill patients receiving continuous venovenous haemofiltration: a randomised controlled trial of continuous infusion versus intermittent bolus administration

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