Use of pharmacodynamic concepts in developing a cost-effective dosing method for piperacillin
R Quintiliani1, C H Nightingale, M C Sullivan
1Division of Infectious Diseases and Immunology/Allergy, Hartford Hospital, Connecticut.
Clinical Therapeutics
|January 1, 1993
Summary
Four grams of piperacillin demonstrated superior bactericidal activity compared to 3 grams of piperacillin or 5 grams of mezlocillin. This finding supports a new antibiotic regimen, optimizing patient care and reducing hospital costs.
Area of Science:
- Pharmacology
- Infectious Diseases
- Hospital Pharmacy
Background:
- Piperacillin and mezlocillin are commonly used antibiotics, often in combination with aminoglycosides.
- Hartford Hospital, a 900-bed teaching facility, considered these antibiotics as therapeutic alternatives.
- A need existed to compare their efficacy and determine optimal dosing.
Purpose of the Study:
- To compare the bactericidal activities of different doses of piperacillin and mezlocillin.
- To establish an appropriate comparative dose for antibiotic therapy.
- To evaluate the impact on hospital antibiotic management and cost-effectiveness.
Main Methods:
- Comparative analysis of bactericidal activity.
- Testing of 5 gm mezlocillin, 4 gm piperacillin, and 3 gm piperacillin.
- Evaluation of antibiotic management program adjustments.
Main Results:
- Four grams of piperacillin exhibited stronger bactericidal activity than 3 gm of piperacillin.
- Four grams of piperacillin showed greater bactericidal activity than 5 gm of mezlocillin.
- The new regimen resulted in significant cost savings.
Conclusions:
- A dosing regimen of 4 gm of piperacillin every 8 hours is recommended.
- The modified antibiotic program provides cost savings without compromising patient care quality.
- Optimized antibiotic selection enhances hospital pharmacy management.
Related Concept Videos
01:28Dosage Regimens: Designs and Approaches
Designing a dosage regimen, which refers to the manner of drug administration, is a complex process involving the selection of drug dose, route, and frequency. This process is underpinned by pharmacokinetic parameters derived from tests and population averages. These parameters are then tailored to patient-specific variables such as diagnosis, demographics, and allergy status. Once therapy commences, therapeutic response monitoring is critical and achieved through clinical and physical...
01:01Dosage Regimens: Partial Pharmacokinetic Parameters
It is not uncommon for complete drug pharmacokinetic profiles to remain elusive in pharmacokinetics. This necessitates certain educated assumptions by pharmacokineticists to determine appropriate dosage regimens without comprehensive pharmacokinetic data from animal or human studies. One prevalent assumption is setting the bioavailability factor, denoted as F, to 1 or 100%. This assumption caters to the scenario where a drug doesn't achieve full systemic absorption, resulting in the patient...
01:19Dosage Interval and Administration Route: Determination Methods
A medication’s effectiveness largely depends on its appropriate dosage and the route of administration. Dosage ensures that a sufficient drug concentration is maintained in the bloodstream to elicit the desired therapeutic effect without causing toxicity. The route of administration affects the drug's bioavailability, rate of absorption, and onset of action, which are crucial for achieving optimal therapeutic outcomes. Drug dosage calculations are critical to tailoring therapy to individual...
01:25Determination of Multiple Dosing Parameters: Loading and Maintenance Doses
A loading dose is an essential pharmacological strategy to rapidly achieve the target plasma drug concentration necessary for an immediate therapeutic effect. This approach is especially critical for drugs characterized by slow absorption or extended half-lives, where delaying therapeutic plasma levels could compromise treatment outcomes. By administering a loading dose, clinicians ensure a prompt onset of drug action, even for agents with complex pharmacokinetic profiles.Achieving steady-state...
01:24Pharmacokinetic–Pharmacodynamic Relationship: Problems
The empirical approach to drug therapy optimization relies on correlating pharmacological response with administered dosage. Such an approach can be costly, time-consuming, and often yields poor correlation due to variables like formulation factors and drug elimination characteristics. A more precise approach correlates response with plasma drug concentration or the amount of drug in the body, rather than dosage. This is achieved through pharmacokinetic-pharmacodynamic (PK/PD) modeling, which...
01:27Pharmacodynamic Models: Overview
Pharmacodynamic (PD) responses describe the interaction between a drug and its biological target, culminating in a physiological effect. These responses can be classified into different types: continuous variables, such as blood glucose levels; categorical outcomes, like survival rates; and time-to-event metrics, such as disease progression. Understanding and modeling PD responses are critical for optimizing drug efficacy and safety.PD models describe the relationship between drug concentration...