International Journal of Clinical Pharmacy

, Volume 38, Issue 5, pp 1087–1093 | Cite as

Evaluation of an alternative extended-infusion piperacillin–tazobactam dosing strategy for the treatment of gram-negative infections

  • Erin M. Winstead
  • Patrick D. RatliffEmail author
  • Ryan P. Hickson
  • Joseph E. Mueller
  • William R. Judd
Research Article


Introduction To enhance the probability of pharmacodynamic target attainment, piperacillin–tazobactam can be administered as either a continuous or extended-infusion dosage regimen for the treatment of gram-negative infections. Four hour extended-infusions of piperacillin–tazobactam 3.375 g administered intravenously (IV) every 8 h have been widely studied as an alternative to conventional, intermittent dosage regimens with largely favorable outcomes. Objective To assess the clinical and economic impact of a novel 3-h extended-infusion piperacillin–tazobactam dosing strategy for the treatment of gram-negative infections. Setting 433-bed community hospital in Lexington, KY. Methods Retrospective cohort study before and after the implementation of an alternative dosing protocol using a 3-h infusion of piperacillin–tazobactam 3.375 g IV every 6 h. Main outcome measures The primary outcome was in-hospital mortality. Secondary outcomes include length of stay, ICU length of stay, 30-day all-cause hospital readmissions, total cost per admission, complications, and a composite of in-hospital mortality and readmission within 30 days of discharge. Results Readmission within 30 days of hospital discharge was significantly reduced in the extended-infusion arm (1.2 vs. 13.7 %, P = 0.002). A composite endpoint of death or readmission was lower among patients who received the extended-infusion dosing regimen [ORadj 0.20; 95 % CI (0.07–0.57)]. However this was likely driven by reductions in readmission. Conclusion An alternative regimen of extended-infusion piperacillin–tazobactam resulted in a significant reduction in 30-day all-cause hospital readmission. These results indicate that 3-h infusions of piperacillin–tazobactam 3.375 g IV every 6 h may represent a clinically effective alternative to other commonly used regimens and results in fewer readmissions within 30 days.


Antibiotics Beta-lactams Infectious disease Pharmacology Pharmacodynamics 



The authors received no financial support for the research, authorship, or publication of this article.

Conflicts of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


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Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  • Erin M. Winstead
    • 1
  • Patrick D. Ratliff
    • 2
    Email author
  • Ryan P. Hickson
    • 3
  • Joseph E. Mueller
    • 4
  • William R. Judd
    • 2
  1. 1.Department of Pharmacy ServicesUK HealthcareLexingtonUSA
  2. 2.Department of Pharmacy ServicesSaint Joseph HospitalLexingtonUSA
  3. 3.Division of Pharmaceutical Outcomes and PolicyThe University of North Carolina at Chapel HillChapel HillUSA
  4. 4.Center for Health Services Research, UK HealthcareLexingtonUSA

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