Extracorporeal Elimination of Piperacillin/Tazobactam during Molecular Adsorbent Recirculating System Therapy

Use of the Molecular Adsorbent Recirculating System (MARS) as a liver support device continues to grow worldwide. Various components of the MARS circuit remove both protein‐bound and water‐soluble molecules. Little is known about the extent of the enhanced clearance mechanisms used in MARS therapy o...

Full description

Saved in:
Bibliographic Details
Published in:Pharmacotherapy 2015-08, Vol.35 (8), p.e136-e139
Main Authors: Personett, Heather A., Larson, Scott L., Frazee, Erin N., Nyberg, Scott L., El‐Zoghby, Ziad M.
Format: Article
Language:English
Subjects:
acute liver failure
Adult
albumin dialysis
Anti-Bacterial Agents - blood
Anti-Bacterial Agents - therapeutic use
Female
Humans
Middle Aged
Molecular Adsorbent Recirculating System
molecular adsorbent recirculating system therapy
Penicillanic Acid - analogs & derivatives
Penicillanic Acid - blood
Penicillanic Acid - therapeutic use
pharmacokinetics
Piperacillin - blood
Piperacillin - therapeutic use
Sorption Detoxification
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Use of the Molecular Adsorbent Recirculating System (MARS) as a liver support device continues to grow worldwide. Various components of the MARS circuit remove both protein‐bound and water‐soluble molecules. Little is known about the extent of the enhanced clearance mechanisms used in MARS therapy on drug elimination. Of particular interest to acute care practitioners is the impact of MARS on antibiotic clearance, as suboptimal concentrations of such drugs can negatively impact patient outcomes. The properties of piperacillin/tazobactam suggest that elimination may be enhanced in the setting of MARS therapy. We describe two cases in which this was studied. Piperacillin concentrations were determined at various points within the MARS circuit, and patient serum concentrations were reported throughout the dosing interval while receiving MARS therapy. Piperacillin concentrations in both cases were in excess of the desired goal minimum inhibitory concentrations for treatment of gram‐negative infections. Use of an extended‐infusion strategy of piperacillin/tazobactam 3.375 or 4.5 g given every 8 hours maintained desired serum levels throughout the dosing interval. To our knowledge, this is the second published report on the use of piperacillin/tazobactam during MARS therapy. These case reports reveal successful dosing strategies for patients requiring piperacillin/tazobactam while receiving MARS therapy, as well as quantify the influence of individual MARS elements on drug extraction.
ISSN:0277-0008
1875-9114
DOI:10.1002/phar.1618