Related Experiment Video

Updated: Oct 14, 2025

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
11:17

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

13.0K

Does Prolonged Infusion Time Really Improve the Efficacy of Meropenem Therapy? A Prospective Study in Critically Ill

Yi-Chang Zhao1, Yang Zou2,3, Yi-Wen Xiao1

  • 1Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China.

Infectious Diseases and Therapy
|November 8, 2021
PubMed
Abstract

Insights

Meropenem dosing in critically ill patients requires careful consideration of renal function and uric acid levels. Prolonged infusion may not always improve therapeutic outcomes, especially for higher drug concentrations.

Area of Science:

  • Pharmacology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Meropenem, a carbapenem antibiotic, exhibits potent activity against gram-negative pathogens.
  • Its use is common in critically ill patients, necessitating optimized dosing strategies.

Purpose of the Study:

  • To determine the pharmacokinetics/pharmacodynamics (PK/PD) of meropenem in critically ill patients.
  • To evaluate the benefit of prolonged meropenem infusion duration in this population.

Main Methods:

  • Prospective study involving 64 patients and 209 samples.
  • Population pharmacokinetic (PPK) analysis and Monte Carlo dosing simulations using Phoenix software.

Main Results:

  • A two-compartment model adequately described meropenem disposition.
  • Creatinine clearance and uric acid levels were significant covariates influencing meropenem PK/PD.
  • Patients with creatinine clearance ≤ 60 mL/min and uric acid > 400 μmol/L could achieve target PK/PD goals with standard dosing and 2-hour infusions for MICs up to 8 mg/L.
  • Prolonged infusion improved outcomes for MIC < 4 mg/L but showed no significant difference for 100% fT > MIC or 100% fT > 4 MIC targets.

Conclusions:

  • Lower meropenem dosages may be suitable for critically ill patients with reduced creatinine clearance and elevated uric acid.
  • Prolonged infusion is not universally beneficial, particularly for higher therapeutic targets or MICs > 4 mg/L.
  • Alternative strategies or dose escalation may be needed for drug-resistant infections or severe cases, guiding rational meropenem use.
Keywords:
Critically ill patientsGram-negative pneumoniaMeropenemPharmacodynamicsPopulation pharmacokinetics

More Related Videos

Antibiotic Efficacy Testing in an Ex vivo Model of Pseudomonas aeruginosa and Staphylococcus aureus Biofilms in the Cystic Fibrosis Lung09:26

Antibiotic Efficacy Testing in an Ex vivo Model of Pseudomonas aeruginosa and Staphylococcus aureus Biofilms in the Cystic Fibrosis Lung

Published on: January 22, 2021

7.2K
Cystic Fibrosis Aggregate Biofilm Model to Study Infection-relevant Gene Expression08:58

Cystic Fibrosis Aggregate Biofilm Model to Study Infection-relevant Gene Expression

Published on: April 18, 2025

711

Related Concept Videos

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...
18
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...
26
Acute Pyelonephritis II: Diagnostic Studies and Management01:28

Acute Pyelonephritis II: Diagnostic Studies and Management

Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
73
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
29
Antimicrobial Effectiveness01:28

Antimicrobial Effectiveness

The effectiveness of antimicrobial agents depends on various factors influencing their ability to eliminate microbial populations. Larger microbial populations require more time for complete eradication, emphasizing the importance of population size analysis when evaluating antimicrobial efficacy.Microbial resistance to antimicrobial agents varies significantly. Highly resilient microorganisms include endospores, gram-negative bacteria, and non-enveloped viruses, while prions are exceptionally...
412
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...
23