{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T17:30:26Z","timestamp":1786987826356,"version":"build-2736575974"},"reference-count":28,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Open Access Publication Fund of Leipzig University"},{"id":[{"id":"https:\/\/ror.org\/03s7gtk40","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>Background: Therapeutic drug monitoring (TDM) for piperacillin\/tazobactam has become established in intensive care. TDM should be used in a structured approach to optimize dosing. We evaluated a newly designed TDM- and algorithm-based clinical-pharmacy-service to determine whether it is appropriate for optimization. Methods: We developed a clinical pharmacy service providing algorithmic recommendations for optimizing piperacillin\/tazobactam dosing based on piperacillin TDM. After implementing the clinical pharmacy service, we evaluated the treatment of intensive-care patients with piperacillin\/tazobactam in terms of achieving the minimum-inhibitory-concentration-(MIC)-related target concentration at the following four time points: t1, t2, t3, and t4 (1\u20134 working days after piperacillin\/tazobactam therapy was started). Results: A total of 132 patients (including 36% women), median age 78 years, received piperacillin\/tazobactam therapy. Sepsis or septic shock was the most common indication (43%), while a pulmonary focus was most frequent (40%). From 132 patients (t1), 19% had \u201ctoo low piperacillin concentrations\u201d, 20% \u201cappropriate concentrations\u201d, and 61% \u201ctoo high concentrations\u201d. After recommendations were given (acceptance rate 100%) the corresponding numbers from 93 remaining patients (t2) were 16%, 35%, and 48%, from 49 patients (t3) 8%, 53%, and 39% and from 29 patients (t4) 38%, 45%, and 17%. In (t1), dose reduction was the main recommendation (49%). The number of patients with \u201cappropriate concentrations\u201d increased in one comparison (t1\u2013t2: n.s.; t1\u2013t3: p = 0.0013; t1\u2013t4: n.s.; Bonferroni-corrected McNemar test), while \u201ctoo high concentrations\u201d decreased (t1\u2013t2: p = 0.0080; t1\u2013t3: p = 0.0056; t1\u2013t4: p = 0.0095). \u201ctoo low concentrations\u201d were not influenced (t1\u2013t2: n.s.; t1\u2013t3: n.s.; t1\u2013t4: n.s.). Conclusions: Inappropriate piperacillin plasma concentrations were common. A TDM- and algorithm-based clinical-pharmacy-service especially decreased the number of overdosed patients in routine practice.<\/jats:p>","DOI":"10.3390\/pharmacy14050120","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T16:35:08Z","timestamp":1786984508000},"page":"120","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Retrospective Cohort Study to Optimize Piperacillin\/Tazobactam Dosing in Routine Intensive-Care Patients via a Newly Designed Clinical Pharmacy Service Including TDM- and Algorithm-Based Recommendations"],"prefix":"10.3390","volume":"14","author":[{"given":"Johanna","family":"Dicken","sequence":"first","affiliation":[{"name":"Pharmacy Department, Bundeswehr Hospital Hamburg, 22049 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"D\u00f6nisch","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive-Care, Bundeswehr Hospital Hamburg, 22049 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Hensen","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Bundeswehr Hospital Hamburg, 22049 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olaf","family":"Zube","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Bundeswehr Hospital Hamburg, 22049 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4930-6655","authenticated-orcid":false,"given":"Thilo","family":"Bertsche","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Bundeswehr Hospital Hamburg, 22049 Hamburg, Germany"},{"name":"Clinical Pharmacy Department, Institute of Pharmacy, Medical Faculty, Leipzig University, 04103 Leipzig, Germany"},{"name":"Drug Safety Center, Medical Faculty, Leipzig University Hospital, Leipzig University, 04103 Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"ref_1","unstructured":"European Centre for Disease Prevention and Control (2024). 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Care"}],"container-title":["Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2226-4787\/14\/5\/120\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T16:47:18Z","timestamp":1786985238000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2226-4787\/14\/5\/120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,17]]},"references-count":28,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["pharmacy14050120"],"URL":"https:\/\/doi.org\/10.3390\/pharmacy14050120","relation":{},"ISSN":["2226-4787"],"issn-type":[{"value":"2226-4787","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,17]]}}}