Pharmacokinetics and pharmacodynamics of extended-infusion piperacillin/tazobactam in adult patients with cystic fibrosis-related acute pulmonary exacerbations

Abstract

Intensive prolonged infusion regimens are the best option to ensure optimal exposures against most susceptible isolates in adult patients with CF.

Scaling beta‐lactam antimicrobial pharmacokinetics from early life to old age

“…A flowchart of study selection for each drug is provided in Figure . A total of 2082 articles were identified and screened, with 130 studies included in the final analysis . Some studies provided PK parameters for two drugs (e.g.…”

Clinical Outcomes with Alternative Dosing Strategies for Piperacillin/Tazobactam: A Systematic Review and Meta-Analysis

“…Higher clinical cure rate for the extended infusion approach was found in our study, which is an important result, indicating the merit of using the extended or continuous infusion instead of the conventional intermittent infusion approach in clinical practice. The reason for which the extended or continuous infusion leads to increased clinical cure rate may be related to the increase in the time that the drug concentrations exceed the MIC since piperacillin/tazobactam is a time-dependent antimicrobial [ 1 ], [ 12 – 14 ], [ 17 ], [ 19 ], [ 24 ], [ 30 ], [ 33 ], [ 34 ]. However, Falagas et al concluded no difference in clinical cure rate between extended and conventional intermittent infusion strategy after their meta-analysis [ 15 ].…”

“…Conventional dosing of piperacillin/tazobactam is an intermittent 30-minute infusion, potentially resulting in serum concentrations below minimum inhibitory concentration (MIC) for a prolonged period of time [ 11 ]. Numerous studies have investigated alternative dosing strategies that increase the drug’s fT>MIC, of which the extended or continuous infusion strategy (>3 hours) was an option [ 12 – 14 ], but no consistent conclusions were obtained. Therefore, a definitive recommendation is necessary because of its significant meaning for clinical practice.…”

Implementing an Inpatient Pediatric Prospective Audit and Feedback Antimicrobial Stewardship Program Within a Larger Medical Center

“…The most common piperacillintazobactam recommendation was to use an extended infusion protocol to maximize time-dependent bacterial killing. [16][17][18][19] We often made the suggestion to discontinue therapy for vancomycin when cultures were revealed to be negative during the 48-to 72hour feedback period. Another common vancomycin recommendation was dose modification, most commonly to increase the dose or frequency because of subtherapeutic troughs.…”