In acute pulmonary exacerbation of Cystic fibrosis:

Treatment duration varies and is dependent on patient-specific factors including response to therapy; typical duration is 10 to 21 days.

Standard dose: IV: 240 to 400 mg piperacillin/kg/day divided every 8 hours, infused over 30 minutes or 4 hours; others have used 350 to 400 mg/kg/day divided every 4 hours in early piperacillin trials.

High dose: Limited data available: IV: 450 mg piperacillin/kg/day divided every 4 to 6 hours or 600 mg piperacillin/kg/day divided every 4 hours has been described in studies of piperacillin alone; usual maximum daily dose: 18 to 24 g piperacillin/day.

Note: Piperacillin doses >600 mg/kg/day or an extended duration of therapy (>14 days) have been associated with dose-related adverse effects, including serum sickness, immune-mediated hemolytic anemia, and bone marrow suppression.

References:

• Abbott L, Plummer A, Hoo ZH, Wildman M. Duration of intravenous antibiotic therapy in people with cystic fibrosis. Cochrane Database Syst Rev. 2019;9(9):CD006682. doi:10.1002/14651858.CD006682.pub6 [PubMed 31487382]
• Nicholson TT, Smith A, McKone EF, Gallagher CG. Duration of intravenous antibiotic treatment for acute exacerbations of cystic fibrosis: A systematic review. J Cyst Fibros. 2022;21(4):562-573. doi:10.1016/j.jcf.2021.08.017 [PubMed 34588142]
• VanDevanter DR, Flume PA, Morris N, Konstan MW. Probability of IV antibiotic retreatment within thirty days is associated with duration and location of IV antibiotic treatment for pulmonary exacerbation in cystic fibrosis. J Cyst Fibros. 2016;15(6):783-790. doi:10.1016/j.jcf.2016.04.005 [PubMed 27139161]
• Egan ME, Schechter MS, Voynow JA. Cystic fibrosis. In: Kliegman RM, St. Geme J, eds. Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020:chap. 432.
• Riggsbee D, Engdahl S, Pettit RS. Evaluation of the safety of piperacillin-tazobactam extended infusion in pediatric cystic fibrosis patients. Pediatr Pulmonol. 2023;58(4):1092-1099. doi:10.1002/ppul.26299 [PubMed 36593628]
• Zobell JT, Waters CD, Young DC, et al. Optimization of anti-pseudomonal antibiotics for cystic fibrosis pulmonary exacerbations: II. Cephalosporins and penicillins. Pediatr Pulmonol. 2013;48(2):107-122. [PubMed 22949297]