Concentrations of piperacillin-tazobactam in human jaw and hip bone

Objectives: It is unclear to what extent pharmacokinetic data from bone outside the facial area can be transferred to the maxillofacial area. The aim of this study was to evaluate the penetration characteristics of piperacillin-tazobactam into human jaw and hipbone as a model for different bone characteristics. Materials and methods: The drug was administered at the start of surgery in a single 15-min intravenous infusion dose (4 g piperacillin & 0.5 g tazobactam i.v.). Plasma and bone samples of ten patients were analyzed. Results: Mean concentration of piperacillin in plasma was 309 mu g/ml at 0.5 h declining at 4 h to 14 mu g/ml. The respective values for tazobactam were 34 mu g/ml declining to 2.8 mu g/ml. The piperacillin-tazobactam ratio dropped during the study interval from 0.5 h: 9.2% +/- 0.8 to 2 h: 7.2% +/- 1.1 and 4 h: 4.9% +/- 0.7. Mean bone concentrations of piperacillin and tazobactam were 9.0 +/- 11.6 mu g/g and 1.2 +/- 1.3 mu g/g, respectively. Mean penetration ratios for all bone samples were 15% (+/- 17) for piperacillin and 13% (+/- 14) for tazobactam without a difference between bone of different origin. Discussion: Piperacillin-tazobactam levels in jaw bone tissue after a single dose are sufficient to assure antibacterial activity of the combination and are above the minimal inhibitory concentrations of the most relevant pathogens in head and neck surgery. Our data suggests the use of piperacillin-tazobactam as an alternative for the therapy of severe infections of the head and neck. (C) 2008 European Association for Cranio-Maxillofacial Surgery