Related Experiment Videos
Continuous infusion versus intermittent administration of meropenem in critically ill patients
F Thalhammer1, F Traunmüller, I El Menyawi
1Department of Internal Medicine I, University of Vienna, Austria. florian.thalhammer@akh-wien.ac.at
Abstract:
This prospective crossover study compared the pharmacokinetics of meropenem by continuous infusion and by intermittent administration in critically ill patients. Fifteen patients were randomized to receive meropenem either as a 2 g iv loading dose, followed by a 3 g continuous infusion (CI) over 24 h, or by intermittent administration (IA) of 2 g iv every 8 h (q8h). Each regimen was followed for a period of 2 days, succeeded by crossover to the alternative regimen for the same period. Pharmacokinetic parameters (mean +/- SD) of CI included the following: concentration at steady state (Css) was 11.9+/-5.0 mg/L; area under the curve (AUC) was 117.5+/-12.9 mg/L x h. The maximum and minimum serum concentrations of meropenem (Cmax, Cmin) and total meropenem clearance (CItot) for IA were 110.1+/-6.9 mg/L, 8.5+/-1.0 mg/L and 9.4+/-1.2 L/h, respectively. The AUC during the IA regimen was larger than the AUC during CI (P < 0.001). In both treatment groups, meropenem serum concentrations remained above the MICs for the most common bacterial pathogens. We conclude that CI of meropenem is equivalent to the IA regimen and is therefore suitable for treating critically ill patients. Further studies are necessary to compare the clinical effects of CI and IA in this patient group.
Insights
Continuous infusion (CI) meropenem is as effective as intermittent administration (IA) for critically ill patients, maintaining therapeutic levels against common pathogens. Further research is needed to compare clinical outcomes between these meropenem dosing strategies.
Area of Science:
- Pharmacology
- Critical Care Medicine
- Infectious Diseases
Background:
- Meropenem is a broad-spectrum carbapenem antibiotic crucial for treating severe bacterial infections.
- Optimizing meropenem dosing in critically ill patients is essential for achieving therapeutic targets and improving patient outcomes.
- Continuous infusion (CI) and intermittent administration (IA) are two common methods for delivering meropenem.
Purpose of the Study:
- To compare the pharmacokinetic profiles of meropenem when administered via continuous infusion versus intermittent administration in critically ill patients.
- To evaluate if continuous infusion meropenem achieves comparable exposure to intermittent administration in this patient population.
Main Methods:
- A prospective crossover study design was employed.
- Fifteen critically ill patients received meropenem via a 2 g IV loading dose followed by either a 3 g continuous infusion over 24 hours or 2 g IV every 8 hours, with crossover after 2 days.
- Pharmacokinetic parameters including concentration at steady state (Css), area under the curve (AUC), maximum (Cmax) and minimum (Cmin) serum concentrations, and total meropenem clearance (CItot) were measured.
Main Results:
- Continuous infusion (CI) resulted in a steady-state concentration (Css) of 11.9+/-5.0 mg/L and an area under the curve (AUC) of 117.5+/-12.9 mg/L x h.
- Intermittent administration (IA) yielded Cmax of 110.1+/-6.9 mg/L, Cmin of 8.5+/-1.0 mg/L, and total clearance (CItot) of 9.4+/-1.2 L/h.
- The AUC for the IA regimen was significantly larger than for the CI regimen (P < 0.001).
- Meropenem serum concentrations remained above the minimum inhibitory concentrations (MICs) for common bacterial pathogens in both groups.
Conclusions:
- Continuous infusion meropenem is pharmacokinetically equivalent to intermittent administration in critically ill patients.
- Both CI and IA meropenem regimens maintain concentrations above MICs for common pathogens, suggesting suitability for treating critically ill patients.
- Further studies are warranted to directly compare the clinical efficacy of continuous versus intermittent meropenem administration in this population.