First dose target attainment with extended infusion regimens of piperacillin and meropenem
Authors' conclusion
Despite aggressive dosing, plasma concentrations often fail to reach 100% fT > MIC during the first dosing interval.
Study context
- Population
- Adult intensive care unit (ICU) patients at first administration of meropenem or piperacillin-tazobactam, excluding those requiring RRT65 meropenem, 142 piperacillin measurements
- Participants
- 22 vs 48
- Exposure
- Meropenem vs Piperacillin
- Meropenemn = 22
- Piperacillinn = 48
- Outcome
- Proportion of patients achieving 100% fT > MIC (observed Cmin above 2 mg/L meropenem, 20 mg/L piperacillin)
- Follow-up
- First dosing interval
Methodological detailssingle ICU, a posteriori Bayesian pharmacokinetic modelling
- Single ICU
- A posteriori Bayesian pharmacokinetic modelling
Main finding
As reported in the abstract
Failure to reach 100% fT > MIC
Observational data: associations, not effects.
Further findings
| Outcome | Meropenem | Piperacillin |
|---|---|---|
| Determinants of target non-attainment | ||
| Non-attainers with eGFR > 90 mL/min/1.73 m² | All | 76% |
Determinants of target non-attainment
- Target non-attainment associated with high estimated glomerular filtration rates (eGFR) and suspected augmented renal clearance (ARC)
- Suspected ARC frequently showed tenfold or greater peak-to-trough decline (Cmin/Cmax < 0.1)
Original publication
First dose target attainment with extended infusion regimens of piperacillin and meropenem. Crit Care. Published 22 May 2025. doi:10.
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