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Influence of Renal Function on the Pharmacokinetics of Piperacillin/Tazobactam in Intensive Care Unit Patients During Continuous Venovenous Hemofiltration
Author(s) -
Arzuaga Alazne,
Maynar Javier,
Gascón Alicia R.,
Isla Arantxazu,
Corral Esther,
Fonseca Fernando,
SánchezIzquierdo José Ángel,
Rello Jordi,
Canut Andrés,
Pedraz José Luis
Publication year - 2005
Publication title -
the journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.92
H-Index - 116
eISSN - 1552-4604
pISSN - 0091-2700
DOI - 10.1177/0091270004269796
Subject(s) - piperacillin/tazobactam , medicine , piperacillin , pharmacokinetics , tazobactam , hemofiltration , intensive care unit , renal function , pharmacodynamics , anesthesia , pharmacology , hemodialysis , genetics , bacteria , pseudomonas aeruginosa , biology
The pharmacokinetics of piperacillin/tazobactam (4 g/0.5 g every 6 or 8 hours, by 20‐minute intravenous infusion) were studied in 14 patients with acute renal failure who underwent continuous venovenous hemofiltration with AN69 membranes. Patients were grouped according to severity (CL CR 10 mL/min, 10 < CL CR 50 mL/min, and CL CR > 50 mL/min). A noncompartmental analysis was performed. The sieving coefficient (0.78 ± 0.28) was similar to the unbound fraction (0.65 ± 0.24) for tazobactam, but it was significantly different (0.34 ± 0.25) from the unbound fraction (0.78 ± 0.14) for piperacillin. Extracorporeal clearance was 37.0% ± 28.8%, 12.7% ± 12.6%, and 2.8% ± 3.2% for piperacillin in each group and 62.5% ± 44.9%, 35.4% ± 17.0%, and 13.1% ± 8.0% for tazobactam. No patients presented tazobactam accumulation. In patients with CL CR < 50 mL/min, t ss (%) > MIC 90 values were 100% for a panel of 19 pathogens, but in those with CL CR > 50 mL/min, t ss (%) > MIC 90 indexes were 55.5% and 16.6% for pathogens with MIC90 values of 32 and 64. The extracorporeal clearance of piperacillin/tazobactam is clinically significant in patients with CL CR > 50 mL/min, in which the risk of underdosing and clinical failure is important and extra doses are required.