What is the recommended dose of Tazact (piperacillin/tazobactam) for a patient with severe impaired renal function (creatinine clearance 24ml/hr)?

Tazact (Piperacillin/Tazobactam) Dosing for Patients with Creatinine Clearance of 24 mL/hr

For patients with creatinine clearance of 24 mL/hr, the recommended dose of Tazact (piperacillin/tazobactam) is 2.25 g every 6 hours for nosocomial pneumonia or 2.25 g every 8 hours for all other indications. 1

Dosage Recommendations Based on Renal Function

• For patients with creatinine clearance between 20-40 mL/min:

  • 2.25 g every 6 hours for nosocomial pneumonia 1
  • 2.25 g every 6 hours for all other indications 1

• For patients with creatinine clearance less than 20 mL/min:

  • 2.25 g every 6 hours for nosocomial pneumonia 1
  • 2.25 g every 8 hours for all other indications 1

Administration Considerations

• Administer piperacillin/tazobactam by intravenous infusion over 30 minutes 1
• For patients on hemodialysis, an additional dose of 0.75 g should be administered following each dialysis session on hemodialysis days 1
• Post-dialysis administration is preferred to facilitate drug delivery and avoid premature clearance of the drug 2, 3

Pharmacokinetic Considerations in Renal Impairment

• Both piperacillin and tazobactam are cleared by the kidneys, and their clearance correlates with renal function 4
• The half-lives of piperacillin and tazobactam are significantly prolonged in patients with renal impairment 4
• Dosage alterations are recommended for creatinine clearance values less than 40 mL/min to prevent drug accumulation 4

Monitoring Recommendations

• Therapeutic drug monitoring (TDM) is suggested for patients with impaired renal function 2
• Measure plasma trough concentration in case of intermittent administration and plasma steady-state concentration in case of continuous administration 2
• Perform TDM 24 to 48 hours after treatment initiation, after any dosage change, or with significant changes in clinical condition 2

Risk of Acute Kidney Injury

• Higher doses of piperacillin/tazobactam (4.5 g) may increase the risk of acute kidney injury in patients with pre-existing renal impairment 5
• Monitor renal function regularly during treatment, especially with higher doses 5

Alternative Dosing Strategies

• Continuous infusion may be considered for severe infections to optimize antibiotic exposure and pharmacokinetic/pharmacodynamic target attainment 6
• For continuous infusion in patients with impaired renal function, dose adjustment is still necessary based on creatinine clearance 7

Common Pitfalls to Avoid

• Avoid using standard dosing regimens without appropriate adjustments for renal impairment 3
• Do not administer before dialysis sessions as this would lead to premature removal of the drug 3
• Avoid excessive accumulation by properly spacing doses according to the degree of renal impairment 3
• Be cautious with higher doses (4.5 g) in patients with pre-existing renal impairment due to increased risk of acute kidney injury 5

Remember that the goal of dosage adjustment in renal impairment is to maintain therapeutic drug levels while avoiding toxicity due to drug accumulation.