Pharmacokinetics of meropenem and piperacillin in critically ill patients with indwelling surgical drains

Adnan, Syamhanin, Li, Janice Xuanhui, Wallis, Steven C., Rudd, Michael, Jarrett, Paul, Paterson, David L., Lipman, Jeffrey, Udy, Andrew A. and Roberts, Jason A. (2013) Pharmacokinetics of meropenem and piperacillin in critically ill patients with indwelling surgical drains. International Journal of Antimicrobial Agents, 42 1: 90-93. doi:10.1016/j.ijantimicag.2013.02.023


Author Adnan, Syamhanin
Li, Janice Xuanhui
Wallis, Steven C.
Rudd, Michael
Jarrett, Paul
Paterson, David L.
Lipman, Jeffrey
Udy, Andrew A.
Roberts, Jason A.
Title Pharmacokinetics of meropenem and piperacillin in critically ill patients with indwelling surgical drains
Journal name International Journal of Antimicrobial Agents   Check publisher's open access policy
ISSN 0924-8579
1872-7913
Publication date 2013-07
Year available 2013
Sub-type Article (original research)
DOI 10.1016/j.ijantimicag.2013.02.023
Volume 42
Issue 1
Start page 90
End page 93
Total pages 4
Place of publication Amsterdam, Netherlands
Publisher Elsevier
Collection year 2014
Language eng
Formatted abstract
Meropenem and piperacillin are two commonly prescribed antibiotics in critically ill surgical patients. To date, the pharmacokinetics of these antibiotics in the presence of indwelling abdominal surgical drains is poorly defined. This was a prospective pharmacokinetic study of meropenem and piperacillin. Serial plasma, urine and surgical drain fluid samples were collected over one dosing interval of antibiotic treatment in ten patients (meropenem, n = 5; piperacillin n = 5). Drug concentrations were measured using a validated high-performance liquid chromatography assay. Median (interquartile range) pharmacokinetic parameter estimates for meropenem were as follows: area under concentration–time curve (AUC), 128.7 mg h/L (95.3–176.7 mg h/L); clearance (CL), 5.7 L/h (5.1–10.5 L/h); volume of distribution (Vd), 0.41 L/kg (0.35–0.56 L/kg); AUC ratio (drain:plasma), 0.2 (0.1–0.2); and calculated antibiotic clearance via surgical drain, 3.8% (2.8–5.4%). For piperacillin, unbound pharmacokinetic results were as follows; AUC, 344.3 mg h/L (341.1–348.4 mg h/L); CL, 13.1 L/h (12.9–13.2 L/h); Vd, 0.63 L/kg (0.38–1.28 L/kg); AUC ratio (drain:plasma), 0.2 (0.2–0.3); and calculated antibiotic clearance via surgical drain 8.2% (3.3–14.0%). A linear correlation was present between the percentage of antibiotic cleared through the drain and the volume of surgical drain fluid output for meropenem (r2 = 0.89; P = 0.05) and piperacillin (r2 = 0.63; P = 0.20). Meropenem and piperacillin have altered pharmacokinetics in critically ill patients with indwelling surgical drains. We propose that only when very high drain fluid output is present (>1000 mL/day) would an additional dose of antibiotic be necessary.
Keyword Pharmacokinetic
Meropenem
Piperacillin
Critically ill
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
Official 2014 Collection
School of Medicine Publications
School of Pharmacy Publications
 
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