Drastic Reduction of Piperacillin-Tazobactam Concentrations in an in-vitro Model of Continuous Venovenous Hemofiltration: Proposal of An Innovative Modality of Administration to Maintain them at Constant Concentration

Author(s): Michele Ferrannini, Pasquale Niscola, Clorinda Falcone, Annalisa Noce, Anna Pastore, Gianna Di Giovamberardino, Andrea Tendas, Laura Scaramucci, Nicola Di Daniele, Roberto Palumbo.

Journal Name:Cardiovascular & Hematological Agents in Medicinal Chemistry

Volume 11 , Issue 3 , 2013

Abstract:

Background/Aims: Critically-ill patients often undergo continuous renal replacement therapy (CRRT) and need antimicrobial therapy. Piperacillin and tazobactam (Pip-Tzb) are cleared by CRRT. Our aim is to evaluate Pip-Tzb removal in an in-vitro-single-pool-model of continuous-veno-venous-hemofiltration (CVVH); we test a new method of Pip-Tzb administration during CRRT assuring constant levels of concentrations above the minimum inhibitory concentration (MIC).

Methods: In an in-vitro-single-pool-model of CVVH, two solutions (Protein-Free-Solution, PFS and Fresh-Frozen- Plasma, FFP) added with Pip-Tzb were tested for Pip-Tzb removal and adsorption. Then, to keep concentrations constantly above the MIC during CVVH, we add Pip-Tzb in the reinfusion bags.

Results: Pip-Tzb rapidly decreased than the MIC during CVVH. The adsorption was irrelevant in the test with FPS. Adding Pip-Tzb in the reinfusion bags of the CVVH system, we observed constant concentrations of Pip-Tzb over time.

Conclusion: The association of Pip-Tzb is rapidly cleared with a real risk of inadequate dosages in patients undergoing CRRT. Adding Pip-Tzb in the reinfusion bags above the MIC, we obtained stability of concentrations during CVVH.

Keywords: Antibiotic, antimicrobial therapy, continuous renal replacement therapy, continuous venovenous hemofiltration, drug clearance, dyalisis, in vitro investigation, infection, minimum inhibitory concentration (MIC), piperacillin, sepsis, tazobactam.

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Article Details

VOLUME: 11
ISSUE: 3
Year: 2013
Page: [187 - 193]
Pages: 7
DOI: 10.2174/187152571103140120102359
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