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Carbapenems in paediatrics
1Departments of Pediatrics and Pharmacology, Case Western Reserve University, Cleveland, Ohio, USA.
Insights
Meropenem monotherapy is effective and safe for treating serious infections in children, showing comparable results to cefotaxime-based regimens. This carbapenem offers a good option for empiric therapy in pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Pharmacology
- Antimicrobial Therapy
Background:
- Serious infections in children present unique challenges due to age-related physiological changes.
- Current multidrug antibiotic therapy is often empiric, lacking confident monotherapy options.
- Carbapenems demonstrate ideal pharmacokinetic and pharmacodynamic profiles for pediatric serious infections.
Purpose of the Study:
- To evaluate the efficacy and safety of meropenem monotherapy versus cefotaxime-based regimens in pediatric patients with serious infections.
- To assess meropenem as a potential monotherapy for empiric treatment in infants and children.
Main Methods:
- Two multicenter, randomized evaluations compared meropenem monotherapy with cefotaxime-based regimens.
- Infections treated included lower respiratory tract, urinary tract, intra-abdominal, skin/skin structure, and sepsis.
- Efficacy and safety were assessed for both treatment groups.
Main Results:
- Meropenem achieved an overall clinical efficacy rate of 98%, compared to 95% for cefotaxime-based regimens.
- Both meropenem monotherapy and cefotaxime-based regimens were well-tolerated.
- No significant clinical or laboratory adverse events were noted for either treatment.
Conclusions:
- Meropenem monotherapy is as effective and well-tolerated as cefotaxime-based regimens in pediatric patients.
- Meropenem represents a viable and potentially advantageous option for empiric therapy in serious pediatric infections.
Abstract:
Serious infections in paediatric patients pose some unique challenges to clinicians. Children represent a dynamic group of patients in whom there are age-related changes as well as age-related alterations in the biodisposition of various antimicrobial agents. In infants and children with serious infections multidrug therapy is generally employed. This occurs because most antibiotic therapy in these patients is initiated and continued on an empiric basis and few, if any, of the currently available agents may be employed confidently as monotherapy. When the agents currently available are compared on a pharmacokinetic and pharmacodynamic basis the carbapenems emerge as close to ideal for the treatment of serious infections in infants and children. Imipenem is the only member of this group currently available. It lacks paediatric labelling in the USA and its efficacy has not been compared directly with that of antibiotic regimens commonly employed in children. Meropenem is a new carbapenem currently under evaluation of the treatment of moderate to severe infections in children and adults. In 2 multicentre, randomised evaluations of the treatment of a variety of infections including lower respiratory tract infections, urinary tract infections, intra-abdominal infections, infections of the skin and skin structures, and septicaemia, the efficacy and safety of meropenem monotherapy were compared with those of cefotaxime-based regimens. Meropenem had an overall clinical efficacy rate of 98% compared with a rate of 95% for cefotaxime-based regimens. Neither regimen was associated with any significant clinical or laboratory adverse events. The carbapenem, meropenem, appears to be a reasonable choice for empiric therapy in infants and children with serious infections. Meropenem monotherapy has been evaluated and has been found to be as well tolerated and as effective as cefotaxime-based regimens in these patients.