Effectiveness, Tolerance, and Safety of Meropenem in a Pediatric Outpatient Parenteral Antimicrobial Therapy Program
Shengyu Yu1, Stéphanie Tremblay2, Léna Coïc3
1is with the Department of Pharmacy, CHU Sainte-Justine, and is a student in the PharmD program of the Université de Montréal, Montréal, Quebec.
Background:
Outpatient parenteral antimicrobial therapy (OPAT) is often used for patients who need long-term antimicrobial therapy. Meropenem is a broad-spectrum antibiotic used to treat polymicrobial and multidrug-resistant bacterial infections.
Objective:
To evaluate the efficacy, tolerance, and safety of IV meropenem for pediatric patients in the OPAT program at CHU Sainte-Justine in Montréal, Quebec.
Methods:
At the study institution, meropenem solutions (1-40 mg/mL) are prepared in polyvinylchloride bags or cassettes. Each delivery device contains one daily dose, and infusions (at room temperature) take place every 8 hours. Devices are delivered to the patient's home in batches every 3 or 4 days. With refrigeration, the drug solution has a short period of stability (96 hours). This single-centre retrospective study included all patients under 18 years of age who received IV meropenem therapy as part of the OPAT program between April 2000 and April 2024. For the current analysis, demographic data, clinical data, serum alanine aminotransferase levels, and white blood cell counts were collected using a standardized template.
Results:
A total of 349 courses of therapy (for 262 patients) met the inclusion criteria. For most patients, the treatments were successful and well tolerated, with an overall success rate of 93.4% (326/349). Few gastrointestinal symptoms and rashes were reported. Neutropenia and eosinophilia were more frequently observed than in previous studies. OPAT-related adverse events were mainly catheter-related (8.9%, 31/349) or pump-related (6.3%, 22/349) issues.
Conclusions:
These results suggest that IV meropenem can be safely and effectively used in pediatric OPAT, although the target concentration of 90% may not be retained, according to current stability data.
Insights
Intravenous meropenem is effective and well-tolerated for pediatric outpatient parenteral antimicrobial therapy (OPAT), demonstrating a high success rate. While generally safe, monitoring for neutropenia and eosinophilia is advised in this OPAT setting.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Pharmacokinetics and Pharmacodynamics
Background:
- Outpatient parenteral antimicrobial therapy (OPAT) is crucial for long-term antimicrobial needs.
- Meropenem, a broad-spectrum antibiotic, is vital for treating complex bacterial infections.
Purpose of the Study:
- To assess the efficacy, tolerance, and safety of intravenous meropenem in pediatric OPAT.
- To evaluate meropenem's use at CHU Sainte-Justine in Montréal, Quebec.
Main Methods:
- Retrospective single-centre study of pediatric patients (<18 years) receiving IV meropenem in OPAT.
- Data collected: demographics, clinical outcomes, liver enzymes, and white blood cell counts.
- Analysis of 349 therapy courses from April 2000 to April 2024.
Main Results:
- High treatment success rate of 93.4% (326/349) observed.
- Most patients tolerated therapy well, with minimal gastrointestinal symptoms and rashes.
- Increased incidence of neutropenia and eosinophilia noted; OPAT-related adverse events were primarily catheter or pump-related.
Conclusions:
- Intravenous meropenem is a safe and effective option for pediatric OPAT.
- Stability data suggests target concentrations may not always be maintained.
- Further monitoring for specific adverse events is warranted in pediatric OPAT settings.
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