Pharmacokinetics and Pharmacodynamics of Meropenem by Extended or Continuous Infusion in Low Body Weight Critically Ill Patients
Luque, Sonia (Institut Hospital del Mar d'Investigacions Mèdiques)
Benítez-Cano, Adela (Institut Hospital del Mar d'Investigacions Mèdiques)
Larrañaga, Leire (Institut Hospital del Mar d'Investigacions Mèdiques)
Sorlí, Luisa (Institut Hospital del Mar d'Investigacions Mèdiques)
Navarrete-Rouco, Maria Eugenia (Institut Hospital del Mar d'Investigacions Mèdiques)
Campillo, Núria (Institut Hospital del Mar d'Investigacions Mèdiques)
Carazo, Jesús (Institut Hospital del Mar d'Investigacions Mèdiques)
Ramos, Isabel (Institut Hospital del Mar d'Investigacions Mèdiques)
Adalia, Ramón (Institut Hospital del Mar d'Investigacions Mèdiques)
Grau, Santiago (Institut Hospital del Mar d'Investigacions Mèdiques)
Universitat Autònoma de Barcelona

Fecha:	2021
Resumen:	Background : Pathophysiological changes such as extreme body weights in critically ill patients with severe infections may alter the pharmacokinetics (PK) of antimicrobials, leading to treatment failure or toxicity. There are almost no PK data on meropenem in critically ill patients with low body weight (LwBW) and therefore information is lacking on the most appropriate dosing regimens, especially when administered by extended infusion. Objectives : To assess if the current administered doses of meropenem could lead to supratherapeutic concentrations in LwBW patients and to identify the factors independently associated with overexposure. Methods: A matched case-control 1:1 study of surgical critically ill patients treated with meropenem administered by extended or continuous infusion and undergoing therapeutic drug monitoring was conducted. Cases (patients with LwBW (body mass index (BMI) < 18. 5 kg/m 2)) were matched with normal body weight controls (NBW) (patients with BMI ≥ 18. 5 kg/m 2 and ≤30 kg/m 2)) by age, gender, baseline renal function and severity status (APACHE II score). A 100% fT > MIC was considered an optimal pharmacokinetic/pharmacodynamic (PK/PD) target and 100% fT > 10 × MIC as supratherapeutic exposure. Results : Thirty-six patients (18 cases and 18 controls) were included (median (range) age, 57. 5 (26-75) years; 20 (55. 6% male)). Meropenem was administered by 6 h (extended) or 8 h (continuous) infusion at a median (range) daily dose of 5 (1-6) g/day. Similar median meropenem trough plasma concentrations (Cmin,ss), measured pre-dose on day three to four of treatment) were observed in the two groups (19. 9 (22. 2) mg/L vs 22. 4 (25. 8) mg/L, p > 0. 999). No differences in the proportion of patients with an optimal or a supratherapeutic PKPD target between cases and controls were observed. A baseline estimated glomerular filtration rate (eGFR) < 90 mL/min was the only factor independently associated with a supratherapeutic PK/PD target. Conclusions : LwBW seems not to be a risk factor for achieving a supratherapeutic PK/PD target in critically ill patients receiving meropenem at standard doses by extended or continuous infusion.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Antibiotics ; Pharmacokinetics ; Pharmacodynamics ; Low body weight ; Meropenem
Publicado en:	Antibiotics, Vol. 10 (june 2021) , ISSN 2079-6382

DOI: 10.3390/antibiotics10060666
PMID: 34204943

10 p, 696.8 KB

El registro aparece en las colecciones:
Artículos > Artículos de investigación
Artículos > Artículos publicados