System-wide implementation of the use of an extended-infusion piperacillin/tazobactam dosing strategy: feasibility of utilization from a children's hospital perspective.

BACKGROUND Use of extended infusions of piperacillin/tazobactam (PT) in adult patients has been described, but data in children are limited. OBJECTIVE The goal of this study was to determine the feasibility of using an extended-infusion PT dosing strategy as the standard of care in a children's hospital. METHODS This was a prospective observational study of patients aged >30 days who received PT after admission to a freestanding, tertiary care children's hospital. After institution of an extended-infusion PT dosing protocol as the standard dosing option, patients receiving PT were prospectively assessed for presence of and reasons for changes in dosing regimen. RESULTS A total of 332 patients, with a median age of 5 years (interquartile range, 1.9-12 years) and median weight of 19.9 kg (interquartile range, 11.7 - 37.6 kg) received PT (100 mg/kg based on piperacillin component). Extended-infusion PT was used for the duration of PT therapy in 92% (n = 304) of patients. Twenty-eight patients (8%) received a traditional infusion over 30 minutes, with 19 of 28 being changed from extended infusion and 9 of 28 being empirically prescribed traditional infusion PT. The most commonly encountered reason for not using extended infusions was coadministration of vancomycin (17 of 28 [61%]) and lack of compatibility data with PT. Dosing errors, which were voluntarily reported, were infrequent (1.8% [n = 6]). The few observed dosing errors were likely attributable to the overall ordering process at our institution, which requires ordering as the milligram per kilogram dose as total PT rather than based on piperacillin component as is commonly documented in pediatric dosing references. CONCLUSIONS Results of this study suggest that extended-infusion PT dosing was feasible in this specific children's hospital. Ninety-two percent of patients received our institution's preferred dosing regimen; a small percentage of patients still needed to receive traditional infusion times.