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  • Continuous infusions of meropenem in ambulatory care: clinical efficacy, safety and stability.

Continuous infusions of meropenem in ambulatory care: clinical efficacy, safety and stability.

PloS one (2014-07-16)
Laurens Manning, Cameron Wright, Paul R Ingram, Timothy J Whitmore, Christopher H Heath, Ingrid Manson, Madhu Page-Sharp, Sam Salman, John Dyer, Timothy M E Davis
ABSTRACT

Concerns regarding the clinical impact of meropenem instability in continuous infusion (CI) devices may contribute to inconsistent uptake of this method of administration across outpatient parenteral antimicrobial therapy (OPAT) services. We retrospectively reviewed the clinical efficacy and safety of CIs of meropenem in two Australian tertiary hospitals and assessed its stability under simulated OPAT conditions including in elastomeric infusion devices containing 1% (2.4 g) or 2% (4.8 g) concentrations at either 'room temperature' or 'cooled' conditions. Infusate aliquots were assayed at different time-points over 24 hours. Forty-one (82%) of 50 patients had clinical improvement or were cured. Adverse patient outcomes including hemato-, hepato- and nephrotoxicity were infrequent. Cooled infusers with 1% meropenem had a mean 24-hour recovery of 90.3%. Recoveries of 1% and 2% meropenem at room temperature and 2% under cooled conditions were 88%, 83% and 87%, respectively. Patients receiving 1% meropenem are likely to receive >95% of the maximum deliverable dose (MDD) over a 24-hour period whilst patients receiving 2% meropenem should receive 93% and 87% of the MDD under cooled and room temperature conditions, respectively. Meropenem infusers are likely to deliver ∼95% MDD and maintain effective plasma concentrations throughout the dosing period. These data reflect our local favourable clinical experience with meropenem CIs.

MATERIALS
Product Number
Brand
Product Description

USP
Meropenem, United States Pharmacopeia (USP) Reference Standard
Sigma-Aldrich
Meropenem trihydrate, ≥98% (HPLC)
Supelco
Meropenem trihydrate, VETRANAL®, analytical standard
Meropenem trihydrate, European Pharmacopoeia (EP) Reference Standard