Extended versus bolus infusion of meropenem and piperacillin: a pharmacolcinetic analysis

De Waele, J., Carlier, M., Hoste, E., Depuydt, P., Decruyenaere, J., Wallis, S. C., Lipman, J. and Roberts, J. A. (2014) Extended versus bolus infusion of meropenem and piperacillin: a pharmacolcinetic analysis. Minerva Anestesiologica, 80 12: 1302-1309.

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Name Description MIMEType Size Downloads
Author De Waele, J.
Carlier, M.
Hoste, E.
Depuydt, P.
Decruyenaere, J.
Wallis, S. C.
Lipman, J.
Roberts, J. A.
Title Extended versus bolus infusion of meropenem and piperacillin: a pharmacolcinetic analysis
Journal name Minerva Anestesiologica   Check publisher's open access policy
ISSN 0375-9393
1827-1596
Publication date 2014-12
Sub-type Article (original research)
Open Access Status
Volume 80
Issue 12
Start page 1302
End page 1309
Total pages 8
Place of publication Turin, Italy
Publisher Edizioni Minerva Medica
Collection year 2015
Language eng
Formatted abstract
BACKGROUND: Extended infusion of beta-lactam antibiotics has been advocated as a method for optimizing antibiotic exposure in critically ill patients. The objective of this study was to compare the pharmacokinetics/pharmacodynamics of extended infusion versus bolus infusion of piperacillin and meropenem in critically ill patients with normal renal function.

METHODS: A prospective study of 3 hours extended infusion of meropenem and piperacillin in critically ill patients without renal dysfunction. Results from the extended infusion cohort were compared to previously published bolus infusion data in critically ill patients.

RESULTS: Twenty extended infusion patients (15 piperacillin, 5 meropenem) were compared with 13 bolus infusion patients (8 piperacillin, 5 meropenem). The demographic and clinical characteristics between both groups were not statistically different. Significant pharmacokinetic differences were observed in median (interquartile range) Cmax for both meropenem (extended infusion 17 [12.6-21.9] vs. bolus 85.2 [66.7-140.3]; P=0.01) and piperacillin (extended infusion 76.2 [57.7-92.6] vs. bolus 240.2 [168.5-275.4]; P=0.001). Considerable pharmacokinetic variability existed in each group for both drugs. Compared to bolus infusion, fT>MIC using extended infusion was higher for both drugs: 96% (IQR 71-100%) compared to 77% (IQR 41-93%) for piperacillin (P=0.05) and 82% (IQR 63-89%) compared to 51% (IQR 48-63%) for meropenem (P=0.095); assuming a MIC of 16 mg/L and 2 mg/L respectively.

CONCLUSION: This study confirms that extended infusion in critically ill patients result in advantageous pharmacokinetic profiles by increasing the fT>MIC for piperacillin and meropenem. In a significant subpopulation of critically ill patients with normal renal function, a 100% fT>MIC target is not reached, even with 3-hour extended infusions.
language: English
Keyword Anti Bacterial Agents
Pharmacokinetics
Intensive care unit
Critically Ill Patients
Augmented Renal Clearance
Beta lactam antibiotics
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
 
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