Comparison of two empirical prolonged infusion dosing regimens for meropenem in patients with septic shock: A two-center pilot study.
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents
/ blood
Bacteria
/ drug effects
Bacterial Infections
/ drug therapy
Dose-Response Relationship, Drug
Drug Monitoring
Female
Humans
Intensive Care Units
Male
Meropenem
/ blood
Microbial Sensitivity Tests
Middle Aged
Monte Carlo Method
Pilot Projects
Shock, Septic
/ drug therapy
Treatment Outcome
Critical care
Meropenem
Septic shock
Therapeutic drug monitoring
Journal
International journal of antimicrobial agents
ISSN: 1872-7913
Titre abrégé: Int J Antimicrob Agents
Pays: Netherlands
ID NLM: 9111860
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
19
10
2020
revised:
13
01
2021
accepted:
20
01
2021
pubmed:
31
1
2021
medline:
14
9
2021
entrez:
30
1
2021
Statut:
ppublish
Résumé
Due to high pharmacokinetic variability, standard doses of meropenem are frequently inadequate in septic patients. Therapeutic drug monitoring of meropenem is not widely available; therefore, improved empiric dosing recommendations are needed. This study aimed to compare the attainment of pharmacologic targets for two common empirical dosing regimens for meropenem in patients with septic shock. Two empiric dosing schemes for meropenem were compared using extended infusions (120 minutes) in 32 patients with septic shock in the intensive care units at two different hospitals. One regimen was 3 × 2 g meropenem/24 h for two days, followed by 3 × 1 g meropenem/24 h; the other regimen was 4 × 1 g meropenem/24 h. Serum meropenem concentrations were measured for the first 72 h of therapy, and pharmacokinetic modelling was performed to define the percentage of time the free drug concentration was above various target MICs for each regimen (%fT Both regimens led to a sufficiently high %fT The results of this study can guide clinicians in their choice of an empirical dosing regimen for meropenem. If pathogens with low MICs (< 4 mg/L) are targeted, both dosing regimens are adequate, whereas more resistant strains require higher doses.
Sections du résumé
BACKGROUND
BACKGROUND
Due to high pharmacokinetic variability, standard doses of meropenem are frequently inadequate in septic patients. Therapeutic drug monitoring of meropenem is not widely available; therefore, improved empiric dosing recommendations are needed.
OBJECTIVES
OBJECTIVE
This study aimed to compare the attainment of pharmacologic targets for two common empirical dosing regimens for meropenem in patients with septic shock.
METHODS
METHODS
Two empiric dosing schemes for meropenem were compared using extended infusions (120 minutes) in 32 patients with septic shock in the intensive care units at two different hospitals. One regimen was 3 × 2 g meropenem/24 h for two days, followed by 3 × 1 g meropenem/24 h; the other regimen was 4 × 1 g meropenem/24 h. Serum meropenem concentrations were measured for the first 72 h of therapy, and pharmacokinetic modelling was performed to define the percentage of time the free drug concentration was above various target MICs for each regimen (%fT
RESULTS
RESULTS
Both regimens led to a sufficiently high %fT
CONCLUSIONS
CONCLUSIONS
The results of this study can guide clinicians in their choice of an empirical dosing regimen for meropenem. If pathogens with low MICs (< 4 mg/L) are targeted, both dosing regimens are adequate, whereas more resistant strains require higher doses.
Identifiants
pubmed: 33515688
pii: S0924-8579(21)00019-4
doi: 10.1016/j.ijantimicag.2021.106289
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Meropenem
FV9J3JU8B1
Types de publication
Comparative Study
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
106289Informations de copyright
Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.