Daily serum piperacillin monitoring is advisable in critically ill patients

Blondiaux, Nicolas; Wallet, Frédéric; Favory, Raphaël; Onimus, Thierry; Nseir, Saad; Courcol, René; Durocher, A; Roussel-Delvallez, M.

doi:10.1016/j.ijantimicag.2010.01.018

Cited by 52 publications

(38 citation statements)

References 14 publications

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“…No patients received an increased dosage. Dr. Blondiaux and colleagues reported that TDMguided dose adjustment was required in 50% of patients for the continuous infusion of PIPC in combination with tazobactam [23]. Similarly, in this study, the patients required a correction of their initial regimens following TDM and the most of them were successful in decrease beta-lactam dosages in the present study.…”

Section: Dose Individualizationsupporting

confidence: 66%

Application of Beta-lactam Therapeutic Drug Monitoring in Clinical Practice Using HPLC

Aoki¹

2013

JBABM

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In beta-lactam therapy, investigation of the pharmacokinetic-pharmacodynamic (PK-PD) relationship has provided surrogate makers to predict clinical outcome. This study was designed to verify the therapeutic efficacy and clinical utility of beta-lactam therapeutic drug monitoring (TDM) in critically ill patients using high-performance liquid chromatography (HPLC). This cohort study included 13 patients who were intravenously administered ceftazidime (n = 6), cefepime (n = 1), imipenem (n = 1), meropenem (n = 1), or piperacillin (n = 4). Blood samples were collected at 3 time points fitted to a 1-compartment model, and concentrations were determined using HPLC. The PK-PD target was the percentage of the dosing interval during which the antibiotic concentration exceeded the minimum inhibitory concentration for the pathogens (%T > MIC), which is 50% for penicillins (piperacillin), 60% for cephalosporins (ceftazidime and cefepime), and 40% for carbapenems (imipenem and meropenem). Our process using HPLC enables the analytical results of TDM to be available within half a day. The results revealed significant inter-patient pharmacokinetic variability. During the initial regimen, beta-lactam concentrations reached the target %T > MIC in all patients, and dosage reduction was required for 5 patients (38%). Of the 13 evaluable patients, clinical improvement was observed in 11 (85%), and microbiological success was observed in 10 (77%). In summary, beta-lactam TDM achieved the treatment goals and might also allow for the personalization to prevent overdosing for variable pharmacokinetic changes in critically ill patients. These findings indicate that beta-lactam TDM using HPLC can be used in the standard pharmacy clinical practice for critically ill patients.

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Section: Dose Individualizationsupporting

confidence: 66%

Application of Beta-lactam Therapeutic Drug Monitoring in Clinical Practice Using HPLC

Aoki¹

2013

JBABM

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“…Recent retrospective studies support this optimized dosing in critically-ill patients, 26,27 with relevant data available for piperacillin-tazobactam, ceftazidime, cefepime and meropenem. 23 The choice of continuous versus extended infusion of beta-lactams should be guided by the stability of the drug at room temperature.…”

Section: This Issue Of Haematologica 21mentioning

confidence: 79%

The role of antibiotic stewardship in limiting antibacterial resistance among hematology patients

Gyssens¹,

Kern

Livermore

2013

Haematologica

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“…has not yet been a standard practice across the world, studies have demonstrated the clinical utility of this methodology in critically ill patients [12,[36][37][38][39][40]. The level of evidence supporting TDM program for these antibiotics is strong with increasing interest in further demonstrating its impact on clinical outcomes [41].…”

Section: Page 8 Of 48mentioning

confidence: 99%

Simultaneous determination of seven β-lactam antibiotics in human plasma for therapeutic drug monitoring and pharmacokinetic studies

Sime

Roberts

et al. 2014

Journal of Chromatography B

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This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. AbstractThere is strong evidence in literature supporting the benefit of monitoring plasma concentrations of -lactam antibiotics in the critically ill to ensure appropriateness of dosing.The objective of this work was to develop a method for the simultaneous determination of total concentrations piperacillin, benzylpenicillin, flucloxacillin, meropenem, ertapenem, cephazolin and ceftazidime in human plasma. Sample preparation involved protein precipitation with acetonitrile containing 0.1% formic acid and subsequent dilution of supernatant with 0.1% formic acid in water. Chromatographic separation was achieved on a reversed phase column (C18, 2.6µm, 2.1* 50 mm) via gradient elution using water and acetonitrile, each containing 0.1% formic acid, as mobile phase. Tandem mass spectrometry (MSMS) analysis was performed, after electrospray ionization in the positive mode, with multiple reaction monitoring (MRM). The method is accurate with the inter-day and intra-day accuracies of quality control samples (QCs) ranging from 95%-107% and 95%-108%, respectively. It is also precise with intra-day and inter-day coefficient of variations ranging from 4 to 12 % and 5-14% respectively. The lower limit of quantification was 0.1g/mL for each antibiotic except flucloxacillin (0.25g/mL). Recovery was greater than 96% for all analytes except for ertapenem (78%). Coefficients of variation for the matrix effect were less than 10% over the six batches of plasma. Analytes were stable over three freeze-thaw cycles, and for reasonable hours on the bench top as well as post-preparation. This novel liquid chromatography tandem mass spectrometry method proved accurate, precise and applicable for therapeutic drug monitoring and pharmacokinetic studies of the selected -lactam antibiotics.Page 5 Highlights  We present a method for simultaneous determination of seven beta-lactams in plasma  The selected antibiotics are those commonly used in critically ill patients  The method is accurate, precise and meets validation requirements by guidelines  It proved applicable for therapeutic drug monitoring and pharmacokinetic studies

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Daily serum piperacillin monitoring is advisable in critically ill patients

Cited by 52 publications

References 14 publications

Application of Beta-lactam Therapeutic Drug Monitoring in Clinical Practice Using HPLC

Application of Beta-lactam Therapeutic Drug Monitoring in Clinical Practice Using HPLC

The role of antibiotic stewardship in limiting antibacterial resistance among hematology patients

Simultaneous determination of seven β-lactam antibiotics in human plasma for therapeutic drug monitoring and pharmacokinetic studies

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