Evaluation of the safety of piperacillin-tazobactam extended infusion in pediatric cystic fibrosis patients

Pediatr Pulmonol. 2023 Apr;58(4):1092-1099. doi: 10.1002/ppul.26299. Epub 2023 Jan 13.


Background: Patients with cystic fibrosis (CF) may be treated with piperacillin-tazobactam (PZT) for acute pulmonary exacerbations. Extending the infusion of PZT is one strategy to increase efficacy. Direct comparison, with respect to the incidence of acute kidney injury (AKI), between these two strategies has not been evaluated in pediatric patients with CF. The primary objective of this study was to compare the incidence of AKI in pediatric CF patients receiving extended infusion (EI) PZT versus traditional infusion (TI).

Methods: This IRB-approved, retrospective analysis included patients ages 30 days to 18 years that received PZT for at least 48 h between January 1, 2008, and January 1, 2020. PZT was infused over 30 min (TI group) or 4 h (EI group).

Results: Two hundred and four patients were included (TI: 109, EI: 95). Median age was 8 years (4-13) and 7 years (3-12) in the TI and EI groups (p = 0.15). The groups did not differ significantly in their baseline characteristics. There were 12 (11%) AKIs in the TI group and 8 (8.4%) in the EI group (p = 0.53). There was one occurrence of serum sickness in the TI group and none in the EI group. The incidence of thrombocytopenia was similar between the two groups. Median treatment duration was 8 days (5-11) and 9 days (5-13) for the TI and EI groups, respectively (p = 0.24).

Conclusions: There was no significant increase in AKI in pediatric patients with CF receiving PZT by EI compared with TI. EI may be utilized to optimize the pharmacokinetics of PZT in pediatric CF patients.

Keywords: cystic fibrosis; extended infusion; nephrotoxicity; pediatric; piperacillin-tazobactam.

MeSH terms

  • Acute Kidney Injury* / chemically induced
  • Acute Kidney Injury* / epidemiology
  • Adolescent
  • Anti-Bacterial Agents / therapeutic use
  • Child
  • Child, Preschool
  • Cystic Fibrosis* / complications
  • Cystic Fibrosis* / drug therapy
  • Drug Therapy, Combination
  • Humans
  • Infant, Newborn
  • Infusions, Intravenous
  • Penicillanic Acid / adverse effects
  • Piperacillin / adverse effects
  • Piperacillin, Tazobactam Drug Combination
  • Retrospective Studies


  • Anti-Bacterial Agents
  • Piperacillin
  • Penicillanic Acid
  • Piperacillin, Tazobactam Drug Combination