The 5 mg/mL aqueous reconstituted solution of meropenem was stable for up to 8 hours in the temperature range between 25°C and 35°C, and for up to 5 hours at 40°C. of antibiotic as a 30-minute infusion to reduce the time to a therapeutic concentration. Proper use of meropenem A nurse or other trained health professional will give you or your child meropenem. Meropenem’s stability was examined at two temperatures 22°C and 33°C to mimic average and high temperature in hospital wards. One gram of meropenem was administered by intravenous infusion for 30 min. The method was developed and validated in compliance with International Council for Harmonisation (ICH) guidelines. PURPOSE Meropenem belongs to the antibiotic class of carbapenems, which are known to be broad-spectrum antibiotics effective against several drug-resistant organisms. Alaris pumps are programmed to deliver 4-hr infusions for cefepime and piperacillin/tazobactam in all critical care units. However, the clinical outcomes between two groups remain inconclusive. Meropenem to be used for bolus intravenous injection should be reconstituted with sterile water for injection. Place in a 100mL bag of 0.9%NaCl to create a Meropenem concentration of 4mg/100mL (0.04mg/mL). Meropenem was subsequently assayed using high-performance liquid chromatography (HPLC). Hence, administering these antibiotics by continuous infusion should improve the outcomes of … One gram of meropenem was administered by intravenous infusion for 30 min. protocol does NOT include patients in the neonatal intensive care unit. hÞbbd``b`Ö õ@‚Q Ä5±Ê€ÄwLŒÌ­ YF$âÿ¿ ñì * Extended infusion not applicable to NICU patients. Meropenem by CI was diluted in 100 mL of 0.9% saline solution and injected into a central venous catheter via a volumetric pump (Braum Mesulgen, Mesulgen, Germany) with an infusion dead space of < 2 mL. 1020 0 obj <>/Filter/FlateDecode/ID[<0C419DF5543B644C9AD9BAE2C3837EA8>]/Index[1014 12]/Info 1013 0 R/Length 51/Prev 459991/Root 1015 0 R/Size 1026/Type/XRef/W[1 2 1]>>stream endobj %PDF-1.5 %���� Here, several thought-leaders in the field (Dr. Grupper, Dr. Kuti and Dr. Nicolau) weigh in on the topic. Conclusions Meropenem at concentrations between 6.25 mg/mL and 25 mg/mL as tested is not sufficiently stable to administer as a 24-hour infusion in ambulatory device reservoirs. The medicine must be injected slowly, so the needle will need to stay in place for at least 15 to 30 minutes. should be administered by intravenous infusion over approximately 15 minutes to 30 minutes. Microbiologic success is dependent on pharmacokinetic and pharmacodynamic parameters and the organism’s MIC.8 As previously mentioned, the pharmacodynamic target for beta-lactam antibiotics is the time the drug concentration remains above the MIC of the infecting organism. Adjust meropenem 1g IV q8hr to 500mg IV q6hr 2. %%EOF infusion with a pump Loading dose 5mg/kg over at least 20 minutes then continuous infusion of 500 micrograms/kg/hour Usually diluted 500mg in 250 to 500mls (1-2mg/ml) in NS or G. May use undiluted (25mg/ml) via central line at rate not exceeding 25mg/minute. 0 Meropenem for injection (I.V.) is 500 mg given every 8 hours for skin and skin structure infections and 1 gram given every 8 hours for intra-abdominal infections. Patients not in septic shock may or may not receive their first dose of antibiotic over 30 minutes and may have prolonged infusion started immediately. Each vial is for single use only. •In order to optimize the pharmacodynamics of meropenem, cefepime, and piperacillin/tazobactam, dosing substitution protocols have been approved for inpatients at The Nebraska Medical Center. Standard aseptic techniques should be used for solution preparation and administration. Solution #2: Meropenem 100mg/50mL 0.9%NaCl for a concentration of 2mg/mL. Renal Dosing Adjustment for Pediatric Patients all ages <40kg: • CrCl > 40ml/min = no adjustment 3v2QåÑɅÖZÜßÃ|l¬b†ÌßڍۇƒÈs Ksül]{¢R>ڔv§$ª3í(2«Þ‡Å¢?oïʲˆk„ƒÈ»¸øͼZ˜ÎtqºIæˆð%˜Î5sßvV. Why: • PD target for β-lactams: fT>MIC (time above MIC) • Maximize the time-dependent bactericidal activity • Target pathogens with high MIC (e.g. should be administered by intravenous infusion over approximately 15 minutes to 30 minutes. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 1025 0 obj <>stream Meropenem extended infusion (over 3-hr) will be recommended by ID consult service for selected patient cases, therefore, time of infusion 30- min and 3-hr infusion will be available for clinician to order. The protocol consists of a model previously performed in other tissues . Doses of 1 gram may also be a… 3 0 obj <> pseudomonas) How: 1. In the EI group, 18/76 patients (23.7%) received some of the meropenem doses for less than the 4–hour infusion time due to technical reasons; the mean infusion time per dose during the first 2 days of treatment was 3.62 hours (standard deviation, 0.41 hours) in the EI group. 2.2. endstream endobj startxref Interview By: Timothy P. Gauthier, Pharm.D., BCPS-AQ ID [Last … Blood samples were drawn from a peripheral vein at the end of the infusion (T1), one hour later (T2), and two hours later (T3). Label as solution #1. In Summary. (UW Health Weak/Conditional Recommendation, Methods: An open-label randomized controlled clinical trial was conducted. The use of extended infusion beta-lactam dosing strategies is becoming more common and its relevance to clinical practice more relevant in the setting of a limited antibiotic development pipeline. 2 0 obj endobj endstream endobj 1015 0 obj <>/Metadata 80 0 R/Pages 1012 0 R/StructTreeRoot 110 0 R/Type/Catalog>> endobj 1016 0 obj <>/MediaBox[0 0 720 540]/Parent 1012 0 R/Resources<>/Pattern<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 1017 0 obj <>stream The recommended dose of Meropenem for injection (I.V.) Cefiderocol was non-inferior to high-dose, extended-infusion meropenem in terms of all-cause mortality on day 14 in patients with Gram-negative nosocomial pneumonia, with similar tolerability. 100 HAP patients, admitted to ICU of Qilu Hospital of Shandong University, … More frequent administration of a beta-lactam typically increases this amount of time. For intravenous infusion, meropenem vials may be directly reconstituted with 0.9 % sodium chloride or 5% glucose solutions for infusion. 63 Therefore, continuous infusion of meropenem 3 g/day could be divided into six … e Ÿ£ƒBÿ CȑõË5 ÍĜ  cTbàrC˜0ˆÆ>q0¿tŽ= ˜nl'AZ¸Œ@ZX€T;÷O0—á'@€ Þ``c Infusion . 1014 0 obj <> endobj For example, a prolonged infusion of high-dose meropenem (2 g q8h, with each dose infused over 3 h) achieves a high likelihood of obtaining a 40% ƒT>MIC against bacteria with MICs of ≤16 μg/ml. 4 0 obj áCX©æ °X[H1„ UØêÌÁÑÑ`ÑÁÜàÚÁ–ÑÐÐÑæ2i4¤u°x ¹@A—ˆˆDˆ Study Protocol. b. Doses of 1 gram may also be administered as an intravenous bolus injection (5 mL to 20 mL) over approximately 3 minutes to 5 minutes . <>/Metadata 600 0 R/ViewerPreferences 601 0 R>> Label as solution #2 c. Solution #1: Remove 2mL from a 100mL bag of 0.9% NaCl. Meropenem: Same dose: consider prolonged infusion for critically ill patients Prolonged infusion if critically ill, obese with Cl cr > 100 ml/min, if targeting a higher PD end point of 100% fT > MIC, or infections with less susceptible pathogens (i.e., MIC > 2) Monobactam: Aztreonam: Insufficient data 1 0 obj • We aimed to determine whether a 3-h extended infusion (EI) of meropenem achieves fT > MIC > 40 on the first and third days of therapy in patients with … endobj Each vial is for single use only. The solution should be shaken before use . Continuous IV Infusion: NOTE: Meropenem has not been FDA-approved for administration as a continuous intravenous infusion. (UW Health Strong Recommendation, Low Quality of Evidence) 4. However, application of the PK/PD properties of meropenem to create alternative dosing strategies results in equivalent or even greater clinical success. hÞb```¢ ÉÆ Ā BÌ,@ȱ˜A€ƒA„9x‚à„e‘Œ¼˜X3È7d3Ë0\`è?´hómnÎ@± F†X» Üg˜Ä:ÂÌÝv;¿ìöÛm„[[%[‚%\ ¬á stream Traditionally, meropenem has been dosed 1 g IV q 8 hrs for serious infections. x��][��6�~7�� `1@� �IQ�` ng��3�ij�E2�n������v��Q���CRR/�J�����������#���C���?����kn����˷��\�����|��=��a�����ï�k�����Wɋ�W�?�?����O���˚'������c�{������.�̒:�������4���")�"-���h��er��K��J����g�`�B$oo~���m������Ͼ������#�ez�&ȟ6�n�o�m/X��n�����?n/���a[n:��y���^ԛ������. Study Protocol. If the YCD 95% minimum content limit is applied, the infusion period must be reduced to less than 6 hours for body-worn devices, especially at the higher concentration studied (25 mg/mL). 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