After standard dosage of piperacillin plasma concentrations of drug are subtherapeutic in burn patients

Infections are a major problem in patients with burn diseases. Mortality is high despite antibiotic therapy as studies are controversial concerning drug underdosing. The aims of this prospective, observational study were to monitor plasma concentrations of piperacillin during standard piperacillin/tazobactam treatment in 20 burn patients and 16 controls from the intensive care unit (ICU) and to optimize doses by in silico analyses. Piperacillin/tazobactam (4/0.5g, tid) was administered over 0.5h. Blood samples were taken at 1, 4, and 7.5h after the end of the infusion. Free piperacillin plasma concentrations were determined. Pharmacokinetic parameters and in silico analysis results were calculated using the freeware TDMx. The primary target was defined as percentage of the day (fT(>1xMIC); fT(>4xMIC)) when piperacillin concentrations exceeded 1xMIC/4xMIC (minimum inhibitory concentration), considering a MIC breakpoint of 16mg/L for Pseudomonas aeruginosa. In an off-label approach, two burn patients were treated with 8/1g piperacillin/tazobactam, 3h qid. fT(>1xMIC) (55 +/- 22% vs. 77 +/- 24%) and fT(>4xMIC) (17 +/- 11% vs. 30 +/- 11%) were lower in burn than in ICU patients after 4/0.5g, 0.5h, tid. In silico analyses indicated that fT(>1xMIC) (93 +/- 12% burn, 97 +/- 4% ICU) and fT(>4xMIC) (62 +/- 23% burn, 84 +/- 19% ICU) values increase by raising the piperacillin dosage to 8/1g qid and prolonging the infusion time to 3h. Off-label treatment results were similar to in silico data for burn patients (84%fT(>1xMIC) and 47%fT(>4xMIC)). Standard dosage regimens for piperacillin/tazobactam resulted in subtherapeutic piperacillin concentrations in burn and ICU patients. Dose adjustments via in silico analyses can help to optimize antibiotic therapy and to predict respective concentrations in vivo. Trial registration: NCT03335137, registered 07.11.2017, retrospectively.