In this episode, I’ll discuss whether meropenem should be given by continuous infusion in critically ill patients.
A continuous infusion of meropenem helps to ensure 100% time above MIC and is often employed for resistant infections. This has led some to question whether it is better to routinely give meropenem as a continuous infusion in critically ill patients. A group of authors published in JAMA a double blind randomized trial looking at continuous vs intermittent infusion of meropenem in critically ill patients.
The primary outcome was a composite of mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria compared with intermittent administration in critically ill patients with sepsis. Just over 600 patients were enrolled and split between the following 2 groups:
The intermittent group received meropenem 1g IVMB every 6 hours for 24 hours, then 1g every 8 hours thereafter.
The continuous group received meropenem 1g bolus followed by a 3g infusion given over 24 hours.
Both groups received 33% less meropenem if the creatinine clearance was below 50 mL/min.
Almost two-thirds of the patients in the study had septic shock and the median duration of antibiotic therapy was 11 days. The primary outcome occured in 47% of the continuous group and 49% of the intermittent group, a difference that was not statistically significant.
Several secondary outcomes were also examined, but again, there was no difference found between groups. There were no seizures, allergic reactions or other adverse events reported.
The authors concluded:
In critically ill patients with sepsis, compared with intermittent administration, the continuous administration of meropenem did not improve the composite outcome of mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28.
While this study does not refute the use of continuous infusion when warranted in a patient that requires 100% of the dosing interval to be above the MIC, it suggests that it is not worth the effort of preparing and giving continuous infusions over intermittent ones routinely to critically ill patients.
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