Piperacillin population pharmacokinetics in critically ill patients with multiple organ dysfunction syndrome receiving continuous venovenous haemodiafiltration: Effect of type of dialysis membrane on dosing requirements

M Ulldemolins, I Martín-Loeches, M Llauradó-Serra, J Fernández, S Vaquer, A Rodríguez, C Pontes, G Calvo, A Torres, D. Soy

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Abstract

© The Author 2016. Objectives: Thismulticentre study aimed to describe the pharmacokinetics (PK) of piperacillin in critically ill patients with multiple organ dysfunction syndrome (MODS) receiving continuous venovenous haemodiafiltration (CVVHDF), to identify the sources of PK variability and evaluate different dosing regimens to develop recommendations based on clinical parameters. Patients and methods: Nineteen patients with MODS and CVVHDF receiving piperacillin/tazobactamwere enrolled from three tertiary hospitals (95 plasma samples). Population PK modelling and Monte Carlo simulations were performed using NONMEM v7.3w. Results: Patients'median agewas 70 years (range 39-82),medianweightwas 80 kg (45-129),median APACHE II score at admissionwas 21 (13-33) andmedian SOFA score on the day of studywas 11 (8-21). The final population PK model was characterized by CL (L/h)=6.11* [weight (kg)/80]1.39*CLMEMB. If membrane=1.5 m2 AN69ST, CLMEMB=1; if membrane=0.9 m2 AN69, CLMEMB=0.51. Monte Carlo simulations showed that: (i) to maintain unbound piperacillin concentrations above the MIC for the bacteria for 100% of dosing interval T (100%fuT>MIC), patients receiving CVVHDF with 1.5 m2 AN69ST membranes required doses of 4000 mg q8h for the treatment of bacteria with a susceptibility to piperacillin close to the clinical breakpoint (MIC=8-16 mg/L) (2000 mg q8h was sufficient for patients with CVVHDF using 0.9 m2 AN69membranes); and (ii) for the treatment of bacteriawith high susceptibility to piperacillin (MIC ,4 mg/L) or for the attainment of a more traditional pharmacodynamic target (50%fuT>MIC), 2000 mg q8h sufficed regardless of type of membrane and body weight. Conclusions: Our results suggest that type ofmembrane and bodyweight should be considered for piperacillin dose titration in critically ill patients with MODS and CVVHDF requirement.
Original languageEnglish
Pages (from-to)1651-1659
JournalJ Antimicrob Chemother
Volume71
Issue number6
DOIs
Publication statusPublished - 13 Jun 2016

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