Document Detail

Piperacillin-tazobactam for Pseudomonas aeruginosa infection: clinical implications of an extended-infusion dosing strategy.
MedLine Citation:
PMID:  17205441     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Piperacillin-tazobactam is frequently used to treat Pseudomonas aeruginosa infections in critically ill patients. In an effort to improve clinical outcomes, an extended-infusion dosing scheme for piperacillin-tazobactam therapy was devised using a Monte Carlo simulation and was adopted into clinical practice at Albany Medical Center (Albany, New York). This study evaluates the clinical implications of extended infusion of piperacillin-tazobactam therapy for critically ill patients with P. aeruginosa infection. METHODS: We performed a cohort study of patients who received piperacillin-tazobactam therapy for a P. aeruginosa infection that was susceptible to piperacillin-tazobactam during the period January 2000-June 2004. Prior to February 2002, all patients received intermittent infusions of piperacillin-tazobactam (3.375 g intravenously for 30 min every 4 or 6 h); after this time, all patients received extended infusions of piperacillin-tazobactam (3.375 g intravenously for 4 h every 8 h). Data on demographic characteristics, disease severity, and microbiology were collected, and outcomes were compared between groups. RESULTS: A total of 194 patients comprised the 2 study groups: 102 patients received extended infusions of piperacillin-tazobactam, and 92 patients received intermittent infusions of piperacillin-tazobactam. No differences in baseline clinical characteristics were noted between the 2 groups. Among patients with Acute Physiological and Chronic Health Evaluation-II scores > or =17, 14-day mortality rate was significantly lower among patients who received extended-infusion therapy than among patients who received intermittent-infusion therapy (12.2% vs. 31.6%, respectively; P=.04), and median duration of hospital stay after collection of samples for culture was significantly shorter for patients who received extended-infusion therapy than for patients who received intermittent-infusion therapy (21 days vs. 38 days; P=.02).Conclusions. These results indicate that extended-infusion piperacillin-tazobactam therapy is a suitable alternative to intermittent-infusion piperacillin-tazobactam therapy, and they strongly suggest that improved outcomes may be realized by administering extended-infusion piperacillin-tazobactam therapy to critically ill patients with P. aeruginosa infection.
Thomas P Lodise; Ben Lomaestro; George L Drusano
Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-01-02
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  44     ISSN:  1537-6591     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-01-05     Completed Date:  2007-01-25     Revised Date:  2007-07-09    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  357-63     Citation Subset:  IM    
Department of Pharmacy Practice, Albany College of Pharmacy, Albany, NY 12208, USA.
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MeSH Terms
Aged, 80 and over
Anti-Bacterial Agents / administration & dosage*
Cohort Studies
Critical Illness
Cross Infection / drug therapy*
Dose-Response Relationship, Drug
Drug Administration Schedule
Infusions, Intravenous / methods
Microbial Sensitivity Tests
Middle Aged
Models, Biological
Monte Carlo Method
Penicillanic Acid / administration & dosage,  analogs & derivatives
Piperacillin / administration & dosage
Pseudomonas Infections / drug therapy*
Retrospective Studies
beta-Lactams / pharmacokinetics
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/beta-Lactams; 157044-21-8/piperacillin-tazobactam combination product; 61477-96-1/Piperacillin; 87-53-6/Penicillanic Acid
Comment In:
Clin Infect Dis. 2007 Jul 15;45(2):269; author reply 269-70   [PMID:  17578793 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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