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Estimation of piperacillin clearance with different glomerular filtration rate formulas in critically ill children

Agathe Béranger1,2, Sihem Benaboud1,3, Saïk Urien1,4

  • 1Pharmacologie et évaluations thérapeutiques chez l'enfant et la femme enceinte, Université de Paris, Paris, France.

British Journal of Clinical Pharmacology
|August 2, 2020
PubMed

Insights

Accurate glomerular filtration rate (GFR) estimation is crucial for critically ill children. The Bouvet combined formula best predicts piperacillin clearance, offering a vital alternative for GFR assessment in pediatric intensive care.

Area of Science:

  • Pediatric Nephrology
  • Pharmacokinetics
  • Critical Care Medicine

Background:

  • Assessing glomerular filtration rate (GFR) in critically ill children is challenging using standard methods.
  • There is a need for reliable alternative GFR estimation formulas in this population.
  • Piperacillin pharmacokinetics (PK) are influenced by renal function.

Purpose of the Study:

  • To identify the most accurate GFR estimation formula for piperacillin clearance in critically ill children.
  • To compare 13 different GFR estimation formulas using a population PK model.

Main Methods:

  • A prospective study included critically ill children receiving piperacillin.
  • Nonlinear mixed-effects modeling (MONOLIX) was used to describe piperacillin PK.
  • Twelve GFR formulas (creatinine and/or cystatin C based) were evaluated alongside the Schwartz 1976 formula.

Main Results:

  • Twenty children were included, with a median age of 1.9 years.
  • The Schwartz 1976 formula yielded a median GFR of 160.5 mL/min/1.73 m².
  • The Bouvet combined formula demonstrated the lowest between-subject variability for piperacillin clearance.

Conclusions:

  • The Bouvet combined formula is the most accurate GFR estimation method for critically ill children.
  • This finding aids in optimizing antibiotic dosing and managing critically ill pediatric patients.
Abstract

Keywords:
clearancecreatininecystatin Cpaediatric intensive care unitrenal elimination

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