Piperacillin for Sepsis: Bolus or Continuous Administration?

The cornerstone of sepsis treatment is rapid initiation of adequate antibiotic therapy in a dose sufficient to reach the infectious focus. Piperacillin/β-lactamase inhibitor combinations are frequently used for this indication. However, pathophysiologic changes that occur in patients with sepsis complicate dosing. Pharmacokinetic considerations suggest that continuous infusion of β-lactam antibiotics may be advantageous. This idea is based on the observation that for treatment success, time of concentration above the MIC for a given pathogen is more important than peak antibiotic concentration.

Now, using subcutaneously inserted microdialysis probes and serial sampling, researchers in Australia have investigated plasma and tissue concentrati…