| Primary Author: | Rubiya Azmiree, PharmD, BCPS |
| Co-Principal Investigators/Collaborators: | Rehana Jamali, PharmD, Leonard T. Langino, MS, RPh, Bruce Hirsch, MD |
| Organization | North Shore University Hospital |
Abstract
Purpose
The objective of this study was to evaluate the implementation of an automatic interchange of piperacillin-tazobactam from a 30 minute-intermittent infusion to a 4 hour-extended infusion dosing strategy.
Background
Piperacillin-tazobactam is a broad spectrum β-lactam-β-lactamase inhibitor commonly used at our institution. Piperacillin-tazobactam is traditionally dosed intermittently every 6 hours and infused over 30 minutes1. Pharmacokinetic-pharmacodynamic characteristics of β-lactams display time dependent bactericidal effects. This implies that the important relationship for these antibiotics is the duration that drug concentrations exceed the mean inhibitory concentration (MIC)2 . Furthermore, Monte Carlo simulation has shown that a 4 hour extended infusion dosing regimen has the highest probability of achieving the drug exposure target associated with maximal microbiological effect across a range of MICs3.
Thus, the decision to adapt an extended infusion piperacillin-tazobactam dosing strategy was made. We implemented an automatic interchange strategy to convert patients receiving traditional intermittent infusion to extended infusion piperacillin-tazobactam. Optimizing the pharmacokinetic-pharmacodynamic profile of the drug and reducing the patient’s total drug exposure are both important quality assurance issues and would increase probability of attaining a good clinical outcome.
Materials & Methods
- Multidisciplinary team consulted to approve practicality of converting patients to an extended infusion dosing strategy
- Reports generated daily to identify eligible patients
- Clinical Pharmacists recommended extended infusion dosing strategy for eligible patients (pediatric and emergency department patients were excluded)
- Patients followed to ensure infusion pumps were appropriately adjuste
- Pharmacy and Therapeutics Committee and Medical Board approval attained to allow automatic interchange of intermittently infused piperacillin-tazobactam to extended infusion dosing
- Post-Automatic Interchange:
- Pharmacy Department uses Therapeutic Interchange Notice to convert patients to extended infusion dosing
Results & Conclusions
At the initiation of the change towards extended infusion dosing of Piperacillin-Tazobactam (third quarter of 2009), 40% of patients were on extended infusion dosing while 60% of patients were on intermittent infusions. By the second quarter of 2011, 95% of patients were on extended infusion dosing while 5% of patients were on intermittent infusions. The doses of this specific antibiotic exposure decreased by nearly 1,400 doses per month resulting in both reduced patient exposure to antibiotic and Pharmacy Department expenditures.
Bibliography
Zosyn® (piperacillin-tazobactam) package insert. Philadelphia: Wyeth Pharmaceuticals Inc.; 2009.
Burgess DS. Antimicrobial Regimen Selection. In: Pharmacotherapy A Pathophysiologic Approach. 7th ed. DiPiro JT, Talbert RL, Yee GC et al., eds. New York: McGraw-Hill: 2008; 1731-60.
Lodise TP, Lomaestro B, Drusano GL. Piperacillin-tazobactam for Pseudomonas aeruginosa infection: clinical implications of an extended-infusion dosing strategy. Clin Infect Dis. 2007 Feb 1;44(3):357-63.
© Improvement Science Research Network, 2012
The ISRN published this as received and with permission from the author(s).