Elimination of the piperacillin/tazobactam combination during continuous venovenous haemofiltration and haemodiafiltration in patients with acute renal failure

Abstract

The elimination of the piperacillin/tazobactam combination was studied in six patients with acute renal failure undergoing either continuous venovenous haemofiltration (CVVH) or continuous venovenous haemodiafiltration (CVVHDF) at 1 L/h and 2 L/h for 12 h. Piperacillin 4 g/tazobactam 0.5 g was given iv on three successive treatment periods and their concentrations in plasma, ultrafiltrate/dialysate and urine were determined for 12 h after each dose. The elimination half-life of piperacillin during CVVH (7.7 ± 2.3 h; mean ± S.D.) was significantly longer than during CVVHDF 1 L/h (6.7 ± 1.9 h) or 2 L/h (6.1 ± 2.0 h) (P < 0.05). Corresponding values for tazobactam were 13.9 ± 3.9, 11.6 ± 3.3 and 9.4 ± 2.4 h, respectively (P < 0.05). Total piperacillin clearance during CVVH (3.89 ± 1.23 L/h) was significantly lower than during CVVHDF 1 L/h (5.06 ± 1.68 L/h) or 2 L/h (5.48 ± 2.11 L/h) (P < 0.05). The corresponding tazobactam clearance values were 2.42 ± 0.75, 3.13 ± 0.66 and 3.75 ± 1.43 L/h, respectively. The mean 12 h elimination of piperacillin and tazobactam in ultrafiltrate/dialysate was 29% and 37% during CVVH, 42% and 57% during CVVHDF (1 L/h), and 46% and 69% during CVVHDF (2 L/h). We recommend 8 hourly dosing of patients with renal failure on CVVH or CVVHDF with dialysis flow rates of 1 or 2 L/h treated with piperacillin 4 g/tazobactam 0.5 g. © 2001 The British Society for Antimicrobial Chemotherapy.