Pharmacodynamics of intermittent and continuous infusion piperacillin/tazobactam and cefepime against extended-spectrum beta-lactamase-producing organisms.
The pharmacodynamics of piperacillin/tazobactam and cefepime were evaluated against extended-spectrum beta-lactamase (ESBL)-producing organisms. Ten thousand patients were simulated based on ESBL minimum inhibitory concentrations (MICs) from our laboratory (N=39) and on pharmacokinetic data from peer-reviewed literature. The desired proportion of the dosing interval that the concentration remains above the MIC (\%T>MIC) for the intermittent bolus regimens was >/=40\% for piperacillin/tazobactam and >/=60\% for cefepime. The desired C(ss)/MIC ratio (where C(ss) is the concentration at steady state) was >/=2 for all continuous infusion (CI) regimens. MIC(50), MIC(90) and \%S were, respectively, 64/4mug/mL, 1024/4mug/mL and 33\% for piperacillin/tazobactam and 8mug/mL, 16mug/mL and 0\% for cefepime. For piperacillin/tazobactam, 3.375g every 4h (q4h) achieved the highest probability of target attainment (43\%), followed by 13.5g CI (31\%), 3.375g q6h (27\%), 4.5g q8h (17\%) and 6.75g CI (10\%). However, for cefepime, 4g CI had the highest probability of target attainment (77\%), followed by 1g q8h (65\%), 2g q12h (58\%), 3g CI (46\%) and 1g q12h (27\%). Although the probabilities of target attainment for cefepime were higher than for piperacillin/tazobactam, neither agent achieved a high probability of target attainment and should not be used routinely for the treatment of ESBL infections.
%0 Journal Article
%1 Reese2005
%A Reese, Alicia M.
%A Frei, Christopher R.
%A Burgess, David S.
%D 2005
%J Int J Antimicrob Agents
%K drug drugresistance dosing betalactamases
%N 2
%P 114--119
%R 10.1016/j.ijantimicag.2005.06.004
%T Pharmacodynamics of intermittent and continuous infusion piperacillin/tazobactam and cefepime against extended-spectrum beta-lactamase-producing organisms.
%U http://dx.doi.org/10.1016/j.ijantimicag.2005.06.004
%V 26
%X The pharmacodynamics of piperacillin/tazobactam and cefepime were evaluated against extended-spectrum beta-lactamase (ESBL)-producing organisms. Ten thousand patients were simulated based on ESBL minimum inhibitory concentrations (MICs) from our laboratory (N=39) and on pharmacokinetic data from peer-reviewed literature. The desired proportion of the dosing interval that the concentration remains above the MIC (\%T>MIC) for the intermittent bolus regimens was >/=40\% for piperacillin/tazobactam and >/=60\% for cefepime. The desired C(ss)/MIC ratio (where C(ss) is the concentration at steady state) was >/=2 for all continuous infusion (CI) regimens. MIC(50), MIC(90) and \%S were, respectively, 64/4mug/mL, 1024/4mug/mL and 33\% for piperacillin/tazobactam and 8mug/mL, 16mug/mL and 0\% for cefepime. For piperacillin/tazobactam, 3.375g every 4h (q4h) achieved the highest probability of target attainment (43\%), followed by 13.5g CI (31\%), 3.375g q6h (27\%), 4.5g q8h (17\%) and 6.75g CI (10\%). However, for cefepime, 4g CI had the highest probability of target attainment (77\%), followed by 1g q8h (65\%), 2g q12h (58\%), 3g CI (46\%) and 1g q12h (27\%). Although the probabilities of target attainment for cefepime were higher than for piperacillin/tazobactam, neither agent achieved a high probability of target attainment and should not be used routinely for the treatment of ESBL infections.
@article{Reese2005,
abstract = {The pharmacodynamics of piperacillin/tazobactam and cefepime were evaluated against extended-spectrum beta-lactamase (ESBL)-producing organisms. Ten thousand patients were simulated based on ESBL minimum inhibitory concentrations (MICs) from our laboratory (N=39) and on pharmacokinetic data from peer-reviewed literature. The desired proportion of the dosing interval that the concentration remains above the MIC (\%T>MIC) for the intermittent bolus regimens was >/=40\% for piperacillin/tazobactam and >/=60\% for cefepime. The desired C(ss)/MIC ratio (where C(ss) is the concentration at steady state) was >/=2 for all continuous infusion (CI) regimens. MIC(50), MIC(90) and \%S were, respectively, 64/4mug/mL, 1024/4mug/mL and 33\% for piperacillin/tazobactam and 8mug/mL, 16mug/mL and 0\% for cefepime. For piperacillin/tazobactam, 3.375g every 4h (q4h) achieved the highest probability of target attainment (43\%), followed by 13.5g CI (31\%), 3.375g q6h (27\%), 4.5g q8h (17\%) and 6.75g CI (10\%). However, for cefepime, 4g CI had the highest probability of target attainment (77\%), followed by 1g q8h (65\%), 2g q12h (58\%), 3g CI (46\%) and 1g q12h (27\%). Although the probabilities of target attainment for cefepime were higher than for piperacillin/tazobactam, neither agent achieved a high probability of target attainment and should not be used routinely for the treatment of ESBL infections.},
added-at = {2013-02-28T02:58:41.000+0100},
author = {Reese, Alicia M. and Frei, Christopher R. and Burgess, David S.},
biburl = {https://www.bibsonomy.org/bibtex/2d461eb28b54af6683edf0ae779fbfe6f/aorchid},
doi = {10.1016/j.ijantimicag.2005.06.004},
file = {:ID_General/IntlJAntimicrobAgents.26.114_cef_pip_infusionesbl.pdf:PDF},
groups = {public},
institution = {Division of Pharmacotherapy, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.},
interhash = {b072eb57d88f3049394f49ab0efb986a},
intrahash = {d461eb28b54af6683edf0ae779fbfe6f},
journal = {Int J Antimicrob Agents},
keywords = {drug drugresistance dosing betalactamases},
language = {eng},
medline-pst = {ppublish},
month = Aug,
number = 2,
pages = {114--119},
pii = {S0924-8579(05)00167-6},
pmid = {16029947},
timestamp = {2013-02-28T02:58:41.000+0100},
title = {Pharmacodynamics of intermittent and continuous infusion piperacillin/tazobactam and cefepime against extended-spectrum beta-lactamase-producing organisms.},
url = {http://dx.doi.org/10.1016/j.ijantimicag.2005.06.004},
username = {aorchid},
volume = 26,
year = 2005
}