scholarly journals Population Pharmacokinetics of Meropenem in Critically Ill Korean Patients and Effects of Extracorporeal Membrane Oxygenation

Pharmaceutics ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 1861
Author(s):  
Dong-Hwan Lee ◽  
Hyoung-Soo Kim ◽  
Sunghoon Park ◽  
Hwan-il Kim ◽  
Sun-Hee Lee ◽  
...  

Limited studies have investigated population pharmacokinetic (PK) models and optimal dosage regimens of meropenem for critically ill adult patients using the probability of target attainment, including patients receiving extracorporeal membrane oxygenation (ECMO). A population PK analysis was conducted using non-linear mixed-effect modeling. Monte Carlo simulation was used to determine for how long the free drug concentration was above the minimum inhibitory concentration (MIC) at steady state conditions in patients with various degrees of renal function. Meropenem PK in critically ill patients was described using a two-compartment model, in which glomerular filtration rate was identified as a covariate for clearance. ECMO did not affect meropenem PK. The simulation results showed that the current meropenem dosing regimen would be sufficient for attaining 40%fT>MIC for Pseudomonas aeruginosa at MIC ≤ 4 mg/L. Prolonged infusion over 3 h or a high-dosage regimen of 2 g/8 h was needed for MIC > 2 mg/L or in patients with augmented renal clearance, for a target of 100%fT>MIC or 100%fT>4XMIC. Our study suggests that clinicians should consider prolonged infusion or a high-dosage regimen of meropenem, particularly when treating critically ill patients with augmented renal clearance or those infected with pathogens with decreased in vitro susceptibility, regardless of ECMO support.

Critical Care ◽  
2018 ◽  
Vol 22 (1) ◽  
Author(s):  
Cyril Touchard ◽  
Alexandra Aubry ◽  
Philippine Eloy ◽  
Nicolas Bréchot ◽  
Guillaume Lebreton ◽  
...  

2018 ◽  
Vol 57 (9) ◽  
pp. 1107-1121 ◽  
Author(s):  
Idoia Bilbao-Meseguer ◽  
Alicia Rodríguez-Gascón ◽  
Helena Barrasa ◽  
Arantxazu Isla ◽  
María Ángeles Solinís

2017 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Seyed Reza Saghebi ◽  
Behrooz Farzanegan ◽  
Payam Tabarsi ◽  
Rokhsaneh Zangooi ◽  
Batoul Khoundabi ◽  
...  

2014 ◽  
Vol 42 (6) ◽  
pp. 715-722 ◽  
Author(s):  
S. Adnan ◽  
S. Ratnam ◽  
S. Kumar ◽  
D. Paterson ◽  
J. Lipman ◽  
...  

Augmented renal clearance (ARC) refers to increased solute elimination by the kidneys. ARC has considerable implications for altered drug concentrations. The aims of this study were to describe the prevalence of ARC in a select cohort of patients admitted to a Malaysian intensive care unit (ICU) and to compare measured and calculated creatinine clearances in this group. Patients with an expected ICU stay of >24 hours plus an admission serum creatinine concentration <120 μmol/l, were enrolled from May to July 2013. Twenty-four hour urinary collections and serum creatinine concentrations were used to measure creatinine clearance. A total of 49 patients were included, with a median age of 34 years. Most study participants were male and admitted after trauma. Thirty-nine percent were found to have ARC. These patients were more commonly admitted in emergency ( P=0.03), although no other covariants were identified as predicting ARC, likely due to the inclusion criteria and the study being under-powered. Significant imprecision was demonstrated when comparing calculated Cockcroft-Gault creatinine clearance (Crcl) and measured Crcl. Bias was larger in ARC patients, with Cockcroft-Gault Crcl being significantly lower than measured Crcl ( P <0.01) and demonstrating poor correlation (rs=-0.04). In conclusion, critically ill patients with ‘normal’ serum creatinine concentrations have varied Crcl. Many are at risk of ARC, which may necessitate individualised drug dosing. Furthermore, significant bias and imprecision between calculated and measured Crcl exists, suggesting clinicians should carefully consider which method they employ in assessing renal function.


2020 ◽  
Vol 49 (1) ◽  
pp. 569-569
Author(s):  
Yeshwanter Radhakrishnan ◽  
Ali Syed ◽  
Jaimini Patel ◽  
Chanda Mullen ◽  
Michaelia Cucci

2017 ◽  
Vol 32 (suppl_3) ◽  
pp. iii180-iii180
Author(s):  
Georgios Vlachopanos ◽  
Jovana Kusic ◽  
Omar Shaikh ◽  
Nicholas Barrett ◽  
Marlies Ostermann

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