Daily serum piperacillin monitoring is advisable in critically ill patients.
The aim of the present study was to evaluate the benefit of monitoring serum piperacillin concentrations in critically ill patients. This was an 11-month, prospective, observational study in a 30-bed Intensive Care Unit in a teaching hospital, involving 24 critically ill patients with evidence of bacterial sepsis. All patients received a 66 mg/kg intravenous bolus of piperacillin in combination with tazobactam (ratio 1:0.125) followed by continuous infusion of 200mg/kg/24h. The dosage was adjusted when the serum piperacillin concentration either fell below 4x the drug's minimum inhibitory concentration (MIC) for the causative agent or exceeded the toxic threshold of 150 mg/L. With the initial regimen, serum piperacillin concentrations were within the therapeutic target range in only 50.0% of patients (n=12). This proportion increased to 75.0% (18 patients) (P=0.006) following dosage adjustment. For patients with low initial serum piperacillin concentrations (n=8), the percentage of time during which the concentration remained above 4x MIC (%T>4x MIC) was 7.1+/-5.9% before dosage adjustment and 27.3+/-8.6% afterwards. In conclusion, in critically ill patients, monitoring and adjustment of serum piperacillin levels is required to prevent overdosing and might also help to correct underdosing, an important cause of antibiotic therapy failure.
Blondiaux
Nicolas
N
Pôle de Microbiologie, Centre de Biologie-Pathologie, Centre Hospitalier Régional Universitaire (CHRU) de Lille, Boulevard du Pr. J. Leclercq, F-59037 Lille, France. nicolas.blondiaux@chru-lille.fr
Wallet
Frédéric
F
Favory
Raphaël
R
Onimus
Thierry
T
Nseir
Saad
S
Courcol
René J
RJ
Durocher
Alain
A
Roussel-Delvallez
Micheline
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D016638:Critical Illness; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D005602:France; D006784:Hospitals, Teaching; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D044967:Serum / Q000737:chemistry*; D000078142:Tazobactam; D013997:Time Factors
D000900:Anti-Bacterial Agents; D010397:Penicillanic Acid; D000078142:Tazobactam; D010878:Piperacillin