Related Experiment Videos

Pharmacokinetics of meropenem during intermittent and continuous intravenous application in patients treated by

Julia Langgartner1, Antje Vasold, Thomas Glück

  • 1Department of Internal Medicine I, University of Regensburg, Regensburg, Germany. julia.langgartner@klinik.uni-regensburg.de

Intensive Care Medicine
|February 26, 2008
PubMed
Abstract

Insights

Continuous infusion (CI) of meropenem provides effective drug concentrations in patients undergoing continuous renal replacement therapy (CRRT), comparable to intermittent bolus injections (IB). This suggests CI is a viable alternative for meropenem dosing in CRRT patients.

Area of Science:

  • Pharmacokinetics and Pharmacodynamics
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • The efficacy of beta-lactam antibiotics, including meropenem, is linked to maintaining drug concentrations above the minimal inhibitory concentration (MIC).
  • Continuous infusion (CI) may offer a more rational dosing strategy for beta-lactams compared to intermittent bolus injections (IB).
  • Patients on continuous renal replacement therapy (CRRT) present unique challenges for antibiotic dosing due to altered drug clearance.

Purpose of the Study:

  • To evaluate if continuous infusion (CI) of meropenem achieves effective drug concentrations comparable to intermittent bolus injections (IB).
  • To assess meropenem pharmacokinetics in patients receiving CRRT.
  • To determine the suitability of CI as an alternative meropenem dosing regimen in CRRT patients.

Main Methods:

  • Prospective, randomized cross-over study conducted in a medical intensive care unit (ICU).
  • Six ICU patients received meropenem via IB (1 g every 12 h) and CI (0.5 g loading dose followed by 2 g over 24 h) in a cross-over design.
  • Meropenem pharmacokinetics, including serum concentrations and area under the curve (AUC), were measured on days 2 and 4.

Main Results:

  • Peak serum concentrations after IB were 62.8 mg/l, with trough levels at 12 h of 8.1 mg/l.
  • Steady-state concentrations during CI were 18.6 mg/l.
  • AUCs were comparable between IB (233 mg/l*h) and CI (227 mg/l*h); however, meropenem concentrations dropped below CI steady-state levels within 4 hours after IB.

Conclusions:

  • Continuous infusion of meropenem easily achieves appropriate antibacterial concentrations in patients undergoing CRRT.
  • CI represents an effective alternative dosing regimen to IB for meropenem in this patient population.
  • Further prospective studies comparing the clinical efficacy of CI versus IB meropenem dosing are warranted.

Related Concept Videos

Drug Accumulation During Multiple Dosing: Intermittent IV Infusions01:24

Drug Accumulation During Multiple Dosing: Intermittent IV Infusions

Intermittent intravenous (IV) infusion is a method of drug administration where medications are delivered over short infusion periods followed by intervals of no drug delivery. This approach helps to prevent sustained high drug concentrations in the bloodstream, reducing the risk of adverse effects associated with prolonged exposure. Unlike continuous infusion, steady-state concentrations may not be achieved during a single dosing cycle but can be reached through repeated...
Continuous Renal Replacement Therapy01:30

Continuous Renal Replacement Therapy

Continuous Renal Replacement Therapy, also known as CRRT, is a procedural treatment for acute kidney injury (AKI) that gradually removes uremic toxins and fluids while maintaining acid-base balance and stabilizing electrolytes. It is particularly useful for hemodynamically unstable patients. Unlike intermittent hemodialysis, which is faster, CRRT provides a gentler approach over 24 hours, closely mimicking the function of natural kidneys. However, CRRT is not ideal for patients with...
Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy01:26

Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy

Continuous Renal Replacement Therapy (CRRT) is an essential intervention for patients experiencing severe kidney dysfunction. This therapy offers a continuous mechanism for removing fluids and toxins from the bloodstream, leveraging the patient’s blood pressure to facilitate filtration through a specialized filter. This method contrasts with intermittent dialysis, providing a gentler and more consistent removal of waste products and excess fluid, which is particularly beneficial in critically...
Determination of Multiple Dosing Parameters: Steady-State, Minimum and Maximum Concentrations01:15

Determination of Multiple Dosing Parameters: Steady-State, Minimum and Maximum Concentrations

Gentamicin, an aminoglycoside antibiotic, is commonly administered via intermittent intravenous infusion to treat severe infections. An intermittent one-hour infusion of gentamicin, administered at eight-hour intervals, allows for precise control of plasma drug concentrations, minimizing toxicity while ensuring therapeutic efficacy. Pharmacokinetic principles govern the dynamics of plasma concentrations and can be mathematically described using specific equations.The plasma drug concentration...
Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant01:25

Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant

In patients with renal disease, dosage adjustments are necessary to maintain therapeutic plasma drug concentrations and prevent toxicity or subtherapeutic exposure. Renal impairment alters drug pharmacokinetics, especially in conditions like uremia, where changes such as prolonged elimination half-life and altered apparent volume of distribution can significantly affect drug disposition. These changes require careful modification of the dosing regimen to achieve the desired clinical...