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Table 4 Piperacillin/tazobactam (TZP) dosing instructions for experimental therapy arm

From: Therapeutic drug monitoring-based dose optimisation of piperacillin/tazobactam to improve outcome in patients with sepsis (TARGET): a prospective, multi-centre, randomised controlled trial

Loading dose (LD)

Patients without TZP therapy within 24 h prior to randomisation: 4.5 g TZP in 30 min

Patients with TZP therapy within 24 h prior to randomisation: at the discretion of the physician (depending on when last dose of TZP was administered)

Continuous infusion (onset after finishing LD to first dose adjustment)

eGFR ≥20 ml/min 13.5 g/24 h

eGFR < 20 ml/min 9 g/24 h

Dose adjustment

- Start: day 1 after randomisation (optional on day of randomisation)

MIC

Piperacillin target concentrationa (mg/L)

 Unknown pathogen or pathogen with MIC ≤16 mg/L

80 [64–96]

 Pathogen with MIC ≤8 mg/L

40 [32–48]

 Pathogen with MIC ≤4 mg/L

20 [16–24]

  1. Piperacillin population pharmacokinetics: t1/2 = 1 h, Vd = 18 L, Cl = 12.5 L/h, free fraction = 0.81
  2. a MIC/0.81 * 4 = target concentration [+/− 20%]