Optimizing Piperacillin/Tazobactam Dosing in ACLF Patients through Interprofessional Therapeutic Drug Monitoring

Background: Acute-on-chronic liver failure (ACLF) is a rapidly progressing condition in patients with pre-existing liver cirrhosis, often triggered by bacterial infections. Optimizing antibiotic therapy, particularly Piperacillin/Tazobactam, is crucial. Therapeutic drug monitoring (TDM) ensures effective dosing, improving patient outcomes. This study evaluates the impact of an interprofessional TDM strategy on Piperacillin/Tazobactam dosing in ACLF patients in an ICU setting.

Methods: This retrospective analysis was conducted in the ICU of the Department of Internal Medicine I at the University Hospital Regensburg, focusing on interprofessional collaboration between physicians, pharmacists, and nursing staff. The cohort included 27 ACLF patients who underwent initial TDM and 8 patients with follow-up TDM. Outcomes were compared to a control period without TDM. Piperacillin/Tazobactam dosing was adjusted based on weekly serum concentration measurements via high-performance liquid chromatography (HPLC). Patients were assessed using Child-Pugh, SOFA, MELD, and CLIF-C-ACLF scores.

Results: TDM results led to the recommendation of the interprofessional team to maintain the current dosage in 63% of patients, reduce the dosage in 15%, and increase the dosage in 7%. Furthermore, antibiotic discontinuation was recommended for 11% of patients, and in 4%, a switch to an alternative antibiotic was advised due to resistance. Follow-up TDM indicated that 54% of patients remained within the target range, 23% exceeded it, and 8% fell below it, with adjustments of the dosage recommended accordingly. All interprofessional recommendations were fully implemented.

Conclusions: The interprofessional TDM approach improved Piperacillin/Tazobactam dosing in ACLF patients, optimizing antibiotic management and supporting global antibiotic stewardship efforts in critically ill patients.

Publication History

Article published online:
20 January 2025