STUDY OBJECTIVE: To evaluate the steady-state pharmacokinetic and pharmacodynamic parameters of piperacillin in morbidly obese, surgical intensive care patients. DESIGN: Open-label single-center prospective study. SETTING: Level I trauma center and university-affiliated teaching institution. PATIENTS: Nine morbidly obese (body mass index [BMI] 40.0 kg/m² or higher) hospitalized patients admitted to the trauma and surgical intensive care service who were treated with piperacillin-tazobactam between December 15, 2010, and April 18, 2012. INTERVENTION: Patients received intravenous piperacillin-tazobactam 4.5 g every 6 hours, administered as a 30-minute infusion. MEASUREMENTS AND MAIN RESULTS: Patients' blood samples were collected after the administration of the fourth, fifth, or sixth dose (i.e., at steady state). Serum piperacillin concentrations were determined by using a validated high-performance liquid chromatography assay; these concentrations were used to estimate pharmacokinetic parameters, and 5000-patient Monte Carlo simulations were performed. The probability of target attainment for 50% or higher of the dosing interval during which free (unbound) drug concentrations exceeded the minimum inhibitory concentration (%fT > MIC) of likely pathogens was calculated for piperacillin at various MICs. Patient demographic and clinical characteristics included a mean ± SD total body weight of 164 ± 50 kg, BMI of 57 ± 15.3 kg/m², and age 57 ± 11 years, and a median Acute Physiology and Chronic Health Evaluation II score of 22 (interquartile range 21-26). Compared with values previously reported in other populations, the volume of distribution was increased in the study patients, and total system clearance was decreased. The net result was a mean ± SD half-life of 3.7 ± 1.2 hours compared with ~1 hour reported in other populations. This contributed to an extended %fT > MIC for likely pathogens. Results from all nine patients showed %fT > MIC of 100% at the susceptibility breakpoint MIC of 16 mg/L and 85% or higher at an MIC of 32 mg/L. CONCLUSION: The pharmacokinetics of piperacillin is altered in morbidly obese, surgical intensive care patients. The use of standard-dosage piperacillin-tazobactam 4.5 g intravenously every 6 hours was shown to be an appropriate dosage for this study population.
STUDY OBJECTIVE: To evaluate the steady-state pharmacokinetic and pharmacodynamic parameters of piperacillin in morbidly obese, surgical intensive care patients. DESIGN: Open-label single-center prospective study. SETTING: Level I trauma center and university-affiliated teaching institution. PATIENTS: Nine morbidly obese (body mass index [BMI] 40.0 kg/m² or higher) hospitalized patients admitted to the trauma and surgical intensive care service who were treated with piperacillin-tazobactam between December 15, 2010, and April 18, 2012. INTERVENTION: Patients received intravenous piperacillin-tazobactam 4.5 g every 6 hours, administered as a 30-minute infusion. MEASUREMENTS AND MAIN RESULTS:Patients' blood samples were collected after the administration of the fourth, fifth, or sixth dose (i.e., at steady state). Serum piperacillin concentrations were determined by using a validated high-performance liquid chromatography assay; these concentrations were used to estimate pharmacokinetic parameters, and 5000-patient Monte Carlo simulations were performed. The probability of target attainment for 50% or higher of the dosing interval during which free (unbound) drug concentrations exceeded the minimum inhibitory concentration (%fT > MIC) of likely pathogens was calculated for piperacillin at various MICs. Patient demographic and clinical characteristics included a mean ± SD total body weight of 164 ± 50 kg, BMI of 57 ± 15.3 kg/m², and age 57 ± 11 years, and a median Acute Physiology and Chronic Health Evaluation II score of 22 (interquartile range 21-26). Compared with values previously reported in other populations, the volume of distribution was increased in the study patients, and total system clearance was decreased. The net result was a mean ± SD half-life of 3.7 ± 1.2 hours compared with ~1 hour reported in other populations. This contributed to an extended %fT > MIC for likely pathogens. Results from all nine patients showed %fT > MIC of 100% at the susceptibility breakpoint MIC of 16 mg/L and 85% or higher at an MIC of 32 mg/L. CONCLUSION: The pharmacokinetics of piperacillin is altered in morbidly obese, surgical intensive care patients. The use of standard-dosage piperacillin-tazobactam 4.5 g intravenously every 6 hours was shown to be an appropriate dosage for this study population.
Authors: Dagan O Lonsdale; Emma H Baker; Karin Kipper; Charlotte Barker; Barbara Philips; Andrew Rhodes; Mike Sharland; Joseph F Standing Journal: Br J Clin Pharmacol Date: 2018-11-26 Impact factor: 4.335
Authors: Abdulaziz S Alobaid; Steven C Wallis; Paul Jarrett; Therese Starr; Janine Stuart; Melissa Lassig-Smith; Jenny Lisette Ordóñez Mejia; Michael S Roberts; Claire Roger; Andrew A Udy; Jeffrey Lipman; Jason A Roberts Journal: Antimicrob Agents Chemother Date: 2017-02-23 Impact factor: 5.191
Authors: John J Veillette; S Alexander Winans; Victoria K Maskiewicz; James Truong; Ronald N Jones; Steven C Forland Journal: Eur J Drug Metab Pharmacokinet Date: 2021-03-20 Impact factor: 2.569
Authors: M Hites; F S Taccone; F Wolff; E Maillart; M Beumier; R Surin; F Cotton; F Jacobs Journal: Nutr Diabetes Date: 2014-06-23 Impact factor: 5.097
Authors: Benoit Pilmis; Vincent Jullien; Alexis Tabah; Jean-Ralph Zahar; Christian Brun-Buisson Journal: Ann Intensive Care Date: 2017-11-10 Impact factor: 6.925