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- Title
Pharmacokinetics of piperacillin in critically ill patients with acute kidney injury receiving sustained low-efficiency diafiltration.
- Authors
Sinnollareddy, Mahipal G; Roberts, Michael S; Lipman, Jeffrey; Peake, Sandra L; Roberts, Jason A
- Abstract
<bold>Background: </bold>Piperacillin is a β-lactam penicillin antibiotic commonly used for the empirical therapy of sepsis and other hospital-acquired infections. However, knowledge regarding the effect of sustained low-efficiency diafiltration (SLED-f), a technique increasingly being used in ICUs, on piperacillin pharmacokinetics (PK) and dosing in critically ill patients is lacking.<bold>Objectives: </bold>To describe the PK of piperacillin during SLED-f and compare the results with those reported for other forms of renal replacement therapies.<bold>Methods: </bold>Serial blood samples were collected at pre- and post-filter ports within the SLED-f circuit during SLED-f in one session and from an arterial catheter during sampling without SLED-f. Piperacillin concentrations were measured using a validated chromatography method. Non-compartmental PK analysis of the data was performed.<bold>Results: </bold>The median clearance and area under the concentration-time curve during SLED-f were 6 L/h and 532 mg·h/L, respectively. Fifty-eight percent of piperacillin was cleared by a single SLED-f session (6 h) compared with previous reports of 30%-45% clearance by a 3.5 h intermittent haemodialysis session. Clearance, half-life and area under the concentration-time curve during SLED-f obtained from this study were comparable with those reported in the post-dilution mode of continuous veno-venous haemodiafiltration studies.<bold>Conclusions: </bold>As it can be challenging to accurately predict when SLED-f will be initiated in the critically ill, a maintenance dose of at least 4 g every 12 h with at least a 2 g replacement dose post-SLED-f would be a practical approach to piperacillin dosing in ICU patients with anuria receiving SLED-f with a duration similar to the current study.
- Publication
Journal of Antimicrobial Chemotherapy (JAC), 2018, Vol 73, Issue 3, pN.PAG
- ISSN
0305-7453
- Publication type
journal article
- DOI
10.1093/jac/dky057