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Meropenem dosing recommendations for critically ill patients receiving continuous renal replacement therapy
Weerachai Chaijamorn1, Dhakrit Rungkitwattanakul2, Sutthiporn Pattharachayakul3
1Faculty of Pharmacy, Siam University, Bangkok, Thailand.
Journal of Critical Care
|September 19, 2020
Summary
A recommended meropenem dosage of 750 mg every 8 hours is proposed for Asian critically ill patients undergoing continuous renal replacement therapy (CRRT). This regimen aims to effectively manage Gram-negative infections.
Area of Science:
- Pharmacology
- Critical Care Medicine
- Pharmacokinetics
Background:
- Meropenem dosing requires optimization in critically ill patients, especially those on continuous renal replacement therapy (CRRT).
- Limited pharmacokinetic data exists for meropenem in Asian populations undergoing CRRT.
Purpose of the Study:
- To determine optimal meropenem dosing regimens for Asian critically ill patients receiving CRRT.
- To evaluate meropenem pharmacokinetics and efficacy in this specific patient group.
Main Methods:
- Mathematical modeling of pharmacokinetic and pharmacodynamic data from Asian populations.
- Monte Carlo simulations using 5000 virtual patients to assess probability of target attainment (PTA).
- Evaluation of meropenem concentration-time profiles against a target of 40% fT > 4MIC.
Main Results:
- A meropenem regimen of 750 mg every 8 hours was identified as optimal for Asian critically ill patients on CRRT.
- This dosage achieved a high probability of target attainment (PTA > 90%) for Gram-negative infections with MIC < 2 mg/L.
- Patient weight, volume of distribution, and non-renal clearance were key factors in dosing adaptation.
Conclusions:
- The recommended meropenem dosage of 750 mg q 8h is suitable for Asian critically ill patients on CRRT with standard and high effluent rates.
- Further clinical validation is necessary to confirm the efficacy and safety of this dosing regimen.
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