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Beta-Lactam PK Optimisation — SCE Infectious Diseases MCQ

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HardAntimicrobial StewardshipBeta-Lactam PK OptimisationSCE Infectious Diseases

A 50-year-old man with end-stage liver disease awaiting transplant develops hepatorenal syndrome and sepsis. He is started on IV Tazocin (Piperacillin/Tazobactam). What dosing consideration applies to Piperacillin/Tazobactam in critically ill patients with augmented renal clearance?

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Correct answer: B — Standard dosing may be inadequate; consider extended or continuous infusion and therapeutic drug monitoring where available

Critically ill patients frequently exhibit pathophysiological changes that alter antibiotic pharmacokinetics: augmented renal clearance (ARC, creatinine clearance >130 mL/min), increased volume of distribution, and altered protein binding. These changes can result in subtherapeutic beta-lactam levels with standard dosing. Extended (3–4 hour) or continuous infusion of Piperacillin/Tazobactam maximises %fT>MIC. TDM for beta-lactams is increasingly available and recommended in critical care settings.

Reference: BSAC 2023 – PK/PD optimisation in critical care; BLING III 2022