Résumé
This prospective pharmacokinetic study aimed to describe plasma and interstitial fluid (ISF) pharmacokinetics of piperacillin and tazobactam in critically ill patients on continuous venovenous haemodiafiltration (CVVHDF). Piperacillin/tazobactam (4 g/0.5 g) was administered every 8 h and CVVHDF was performed as a 3-3.5 L/h exchange using a polyacrylonitrile filter with a surface area of 1.05 m(2). Serial blood (pre- and post-filter), filtrate/dialysate, urine and ISF concentrations were measured. Subcutaneous tissue ISF concentrations were determined using microdialysis. A total of 407 samples were collected. Median peak plasma concentrations were 210.5 (interquartile range = 161.5-229.0) and 29.4 (27.9-32.0) mg/L and median trough plasma concentrations were 64.3(49.0-68.9) and 12.3(7.7-13.7) mg/L for piperacillin and tazobactam, respectively. The plasma elimination half-life was 6.4(4.6-8.7) and 7.3 (4.6-11.8) h, volume of distribution 0.42(0.29-0.49) and 0.32(0.24-0.36) L/kg, total clearance 5.1 (4.2-6.2) and 3.8 (3.3-4.2) L/h and CVVHDF clearance 2.5 (2.3-3.1) and 2.5 (2.3-3.2) L/h for piperacillin and tazobactam, respectively. The tissue penetration ratio or ratio of area under the concentration-time curve of the unbound drug in ISF to plasma (unbound AUC(ISF)/AUC(plasma)) was ca. 1 for both piperacillin and tazobactam. This is the first report of concurrent plasma and ISF concentrations of piperacillin and tazobactam during CVVHDF. For the CVVHDF settings used in this study, a dose of 4.5 g piperacillin/tazobactam administered evry 8 h resulted in piperacillin concentrations in plasma and ISF >32 mg/L throughout most of the dosing interval. (C) 2014 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.