Meropenem dosing recommendations for critically ill patients receiving continuous renal replacement therapy

• Published in: Journal of critical care Vol. 60; pp. 285 - 289
• Main Authors: Chaijamorn, Weerachai, Rungkitwattanakul, Dhakrit, Pattharachayakul, Sutthiporn, Singhan, Wanchana, Charoensareerat, Taniya, Srisawat, Nattachai
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2020; Elsevier Limited
• Subjects: Antibiotics; Antimicrobial agents; Asian critically ill patients; Blood; Continuous renal replacement therapy; Critical care; Dialysate; Drug dosages; Drug dosing; Effluents; Hemodialysis; Kidney diseases; Meropenem; Monte Carlo simulation; Monte Carlo simulations; Patients; Pharmacodynamics; Pharmacokinetics; Renal replacement therapy; Asian critically ill patients; Meropenem; Monte Carlo simulations; Drug dosing; Continuous renal replacement therapy
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2020.09.001

To gather available meropenem pharmacokinetics and define drug dosing regimens for Asian critically ill patients receiving CRRT. All necessary pharmacokinetic and pharmacodynamic data from Asian population were gathered to develop mathematic models with first order elimination. Meropenem concentration-time profiles were calculated to evaluate efficacy based on the probability of target attainment (PTA) of 40%fT>4MIC. A group of 5000 virtual patients was created and tested using Monte Carlo simulations for each dose in the models. The optimal dosing regimens were defined as the doses achieved at least 90% of the PTA. The recommended meropenem dosing regimen for Asian critically ill patients receiving CRRT with standard (20–25 mL/kg/h) and high (35 mL/kg/h) effluent rates was 750 mg q 8 h to manage Gram negative infections with expected MIC < 2 mg/L in virtual Asian patients. Some meropenem dosages from available clinical resources could not achieve the aforementioned target. The volume of distribution, body weights and nonrenal clearance significantly contributed to drug dosing adaptation especially in the specific population. A meropenem regimen of 750 mg q 8 h was recommended for Asian critically ill patients receiving 2 different CRRT modalities with standard and high effluent rates. Clinical validation of these results is needed. •No meropenem dosing recommendations for Asian critically ill patients exist.•Pharmacokinetic parameters and weights in Asians are different from Western patients and contribute to meropenem dosing adaptation.•Some recommended dosing regimens from clinical resources could not achieve the pharmacodynamic target in Asian patient population.•The meropenem dosing regimen for Asian critically ill patients receiving CRRT was suggested.