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

Heather A Personett1, Scott L Larson1, Erin N Frazee1,2,3

  • 1Pharmacy Services, Mayo Clinic Hospital, Rochester, Minnesota.

Pharmacotherapy
|August 21, 2015
PubMed

Insights

Molecular Adsorbent Recirculating System (MARS) therapy may enhance piperacillin/tazobactam clearance. Extended infusions maintained therapeutic piperacillin serum levels in patients undergoing MARS treatment.

Area of Science:

  • Pharmacology
  • Nephrology
  • Critical Care Medicine

Background:

  • The Molecular Adsorbent Recirculating System (MARS) is increasingly used for liver support, removing various molecules from the blood.
  • The impact of MARS on drug elimination, particularly antibiotics, is not well understood.
  • Suboptimal antibiotic levels can lead to poor patient outcomes in acute care settings.

Observation:

  • This study investigated piperacillin/tazobactam clearance in two patients undergoing MARS therapy.
  • Piperacillin concentrations were measured within the MARS circuit and in patient serum.
  • The study assessed the effectiveness of extended-infusion strategies for maintaining therapeutic drug levels.

Findings:

  • Piperacillin concentrations within the MARS circuit indicated enhanced drug elimination.
  • Extended-infusion piperacillin/tazobactam (3.375 or 4.5 g every 8 hours) successfully maintained desired serum concentrations.
  • Achieved piperacillin levels exceeded the minimum inhibitory concentrations for gram-negative infections.

Implications:

  • Successful dosing strategies for piperacillin/tazobactam in patients on MARS therapy were identified.
  • The study quantifies the influence of MARS components on piperacillin extraction.
  • Findings are crucial for acute care practitioners managing patients requiring antibiotics during liver support therapy.
Keywords:
Molecular Adsorbent Recirculating Systemacute liver failurealbumin dialysismolecular adsorbent recirculating system therapypharmacokinetics

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