Molecular Adsorbent Recirculating System (MARS®) removal of piperacillin/tazobactam in a patient with acetaminophen-induced acute liver failure

M. A. Ruggero*, A. C. Argento, M. S. Heavner, J. E. Topal

*Corresponding author for this work

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

The objective of this study was to illustrate the pharmacokinetic removal of piperacillin/tazobactam in an anuric patient on Molecular Adsorbent Recirculating System (MARS®). The patient was a 32-year-old woman who presented to a medical intensive care unit with acute liver failure secondary to an acetaminophen overdose. While awaiting transplant, she was started on MARS therapy as a bridge to liver transplant and empirically started on piperacillin/tazobactam therapy. MARS is an extracorporeal hemofiltration device, which incorporates a continuous venovenous hemofiltration (CVVHD) machine linked to an albumin-enriched dialysate filter to normalize excess electrolytes, metabolic waste, and protein-bound toxins. In addition to protein-bound waste, MARS removes water-soluble, low molecular-weight molecules. The patient received piperacillin/tazobactam 4.5 g infused intravenously over 3 h. A steep decline in serum levels occurred between hours 4 and 6 while MARS continued and no antibiotic was infused. The elimination rate constant (ke) for the removal of piperacillin in this patent was 0.453 h-1 and the half-life (λ) was 1.53 h. The ke was 2.9-fold higher than with CVVHD alone and the λ was 3.7-fold shorter. Low levels of piperacillin are achieved during MARS therapy, but in the treatment of more resistant organisms, such as Pseudomonas aeruginosa, these low levels may not be adequate to achieve bactericidal activity. Drug levels following a standard infusion of 30 min would likely be even lower. Formalized pharmacokinetic studies of piperacillin/tazobactam removal in patients on MARS therapy are necessary to make clear dosing recommendations.

Original languageEnglish (US)
Pages (from-to)214-218
Number of pages5
JournalTransplant Infectious Disease
Volume15
Issue number2
DOIs
StatePublished - Apr 1 2013

Fingerprint

Acute Liver Failure
Acetaminophen
Hemofiltration
Piperacillin
Pharmacokinetics
Transplants
Therapeutics
Dialysis Solutions
Pseudomonas aeruginosa
Electrolytes
Intensive Care Units
Half-Life
Albumins
Proteins
Molecular Weight
tazobactam drug combination piperacillin
Anti-Bacterial Agents
Equipment and Supplies
Water
Liver

Keywords

  • Acute liver failure
  • MARS
  • Molecular Adsorbent Recirculating System
  • Pharmacokinetic removal
  • Piperacillin/tazobactam
  • Zosyn

ASJC Scopus subject areas

  • Transplantation
  • Infectious Diseases

Cite this

@article{be105042f1b24a2f959f6f04bd1a77d3,
title = "Molecular Adsorbent Recirculating System (MARS{\circledR}) removal of piperacillin/tazobactam in a patient with acetaminophen-induced acute liver failure",
abstract = "The objective of this study was to illustrate the pharmacokinetic removal of piperacillin/tazobactam in an anuric patient on Molecular Adsorbent Recirculating System (MARS{\circledR}). The patient was a 32-year-old woman who presented to a medical intensive care unit with acute liver failure secondary to an acetaminophen overdose. While awaiting transplant, she was started on MARS therapy as a bridge to liver transplant and empirically started on piperacillin/tazobactam therapy. MARS is an extracorporeal hemofiltration device, which incorporates a continuous venovenous hemofiltration (CVVHD) machine linked to an albumin-enriched dialysate filter to normalize excess electrolytes, metabolic waste, and protein-bound toxins. In addition to protein-bound waste, MARS removes water-soluble, low molecular-weight molecules. The patient received piperacillin/tazobactam 4.5 g infused intravenously over 3 h. A steep decline in serum levels occurred between hours 4 and 6 while MARS continued and no antibiotic was infused. The elimination rate constant (ke) for the removal of piperacillin in this patent was 0.453 h-1 and the half-life (λ) was 1.53 h. The ke was 2.9-fold higher than with CVVHD alone and the λ was 3.7-fold shorter. Low levels of piperacillin are achieved during MARS therapy, but in the treatment of more resistant organisms, such as Pseudomonas aeruginosa, these low levels may not be adequate to achieve bactericidal activity. Drug levels following a standard infusion of 30 min would likely be even lower. Formalized pharmacokinetic studies of piperacillin/tazobactam removal in patients on MARS therapy are necessary to make clear dosing recommendations.",
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author = "Ruggero, {M. A.} and Argento, {A. C.} and Heavner, {M. S.} and Topal, {J. E.}",
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Molecular Adsorbent Recirculating System (MARS®) removal of piperacillin/tazobactam in a patient with acetaminophen-induced acute liver failure. / Ruggero, M. A.; Argento, A. C.; Heavner, M. S.; Topal, J. E.

In: Transplant Infectious Disease, Vol. 15, No. 2, 01.04.2013, p. 214-218.

Research output: Contribution to journalArticle

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T1 - Molecular Adsorbent Recirculating System (MARS®) removal of piperacillin/tazobactam in a patient with acetaminophen-induced acute liver failure

AU - Ruggero, M. A.

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