Category: Pharmacology & Therapeutics
Keywords: sepsis, piperacillin-tazobactam (PubMed Search)
Piperacillin-tazobactam is one of the most commonly used antipseudomonal antibiotics in the empiric management of patients with septic shock. The package insert recommends dose reductions for renal impairment in other infectious etiologies, but the impact of dose reduction has not been previously studied in patients with septic shock.
A recent retrospective, observational cohort study compared outcomes of patients with septic shock who received ≥ 27 grams (at least 3.375 gm q6 hours x 48 h-“NORM”) versus those who received < 27 grams (“LOW”) over the initial 48 h of septic shock (defined as concomitant norepinephrine infusion).
Patients were excluded if they had death or hospice disposition within the 48h study period. The primary outcome was the number of norepinephrine free days (NFD) at day 28. Propensity matching was utilized to account for confounders.
Results: 351 in the LOW group, 928 in the NORM group with 608 pairs in the propensity matched assessment.
Bottom Line: Dose reductions of piperacillin-tazobactam appears to be harmful early in the management of patients with septic shock.
JM Allen, Surajbali D, Ngyuen DQ, et al. Impact of piperacillin-tazobactam dosing in septic shock patients using real-world evidence: an observational retrospective cohort study. Ann Pharmacotherapy; 2022: Sep 25:10600280221125919. doi: 10.1177/10600280221125919. Epub ahead of print. PMID: 36154486.