Extracorporeal Elimination of Piperacillin/Tazobactam during Molecular Adsorbent Recirculating System Therapy.
Use of the Molecular Adsorbent Recirculating System (MARS) as a liver support device continues to grow worldwide. Various components of the MARS circuit remove both protein-bound and water-soluble molecules. Little is known about the extent of the enhanced clearance mechanisms used in MARS therapy on drug elimination. Of particular interest to acute care practitioners is the impact of MARS on antibiotic clearance, as suboptimal concentrations of such drugs can negatively impact patient outcomes. The properties of piperacillin/tazobactam suggest that elimination may be enhanced in the setting of MARS therapy. We describe two cases in which this was studied. Piperacillin concentrations were determined at various points within the MARS circuit, and patient serum concentrations were reported throughout the dosing interval while receiving MARS therapy. Piperacillin concentrations in both cases were in excess of the desired goal minimum inhibitory concentrations for treatment of gram-negative infections. Use of an extended-infusion strategy of piperacillin/tazobactam 3.375 or 4.5 g given every 8 hours maintained desired serum levels throughout the dosing interval. To our knowledge, this is the second published report on the use of piperacillin/tazobactam during MARS therapy. These case reports reveal successful dosing strategies for patients requiring piperacillin/tazobactam while receiving MARS therapy, as well as quantify the influence of individual MARS elements on drug extraction.
Pharmacy Services, Mayo Clinic Hospital, Rochester, Minnesota.
Heather A
HA
Personett
Pharmacy Services, Mayo Clinic Hospital, Rochester, Minnesota.
Scott L
SL
Larson
Pharmacy Services, Mayo Clinic Hospital, Rochester, Minnesota.|Transplantation Surgery, Mayo Clinic Hospital, Rochester, Minnesota.|Nephrology and Hypertension, Mayo Clinic Hospital, Rochester, Minnesota.
Erin N
EN
Frazee
Transplantation Surgery, Mayo Clinic Hospital, Rochester, Minnesota.
Scott L
SL
Nyberg
Nephrology and Hypertension, Mayo Clinic Hospital, Rochester, Minnesota.
Ziad M
ZM
El-Zoghby
D000328:Adult; D000900:Anti-Bacterial Agents / Q000097:blood* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D010397:Penicillanic Acid / Q000031:analogs & derivatives* / Q000097:blood / Q000627:therapeutic use; D010878:Piperacillin / Q000097:blood / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D016060:Sorption Detoxification
D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin
Molecular Adsorbent Recirculating System; acute liver failure; albumin dialysis; molecular adsorbent recirculating system therapy; pharmacokinetics