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Pharmacokinetics of meropenem in intensive care patients receiving continuous renal replacement therapy
Critical Care volume 2, Article number: P130 (1998)
This study was conducted to determine the appropriate dose of meropenem in critically ill patients with acute renal failure treated by continuous veno-venous haemofiltration (CVVH) or haemodiafiltration (CVVHDF) who require this antibiotic therapy.
Ten critically ill patients (7m, 3f, mean age 65 years (range: 51–77 years), mean weight 80 kg (range: 51–119 kg), mean APACHE II 27.7 (range: 21-37) were included. All patients were receiving CVVH (n = 5) (haemofiltration rate 1–2 l/h) or CVVHDF (n = 5) (haemofiltration rate 1–1.5 l/h: dialysis rate 1–1.5 l/h) using a polyacrylonitrile (AN69) hollow fibre 0.9 m2 filter (Multiflow 100, Hospal). All patients received a meropenem dose of 1 g 12 hourly, intravenously over 5 min. Venous serum samples were taken pre-dose and 5, 15, 30, 60, 90, 120, 240, 360, 480 min post-dose on day 3 to approximate steady state conditions. Haemofiltrate was collected for determination of a sieving coefficient. Samples were analysed by high performance liquid chromatography.
Sieving coefficient for meropenem with the AN69 filter was 0.93 ± 0.06 (n = 9) indicating free flow across the membrane. Mean (± SD) serum concentrations at pre-dose, 5, 15, 30, 60, 90, 120, 240, 360, 480 mins post-dose were: 7.6 (5.1), 90.9 (23.9), 66.0 (13.0), 53.9 (15.7), 40.0 (10.3), 39.0 (9.2), 31.0 (10.4), 21.1 (6.9), 17.2 (6.2), 13.8 (6.4) mg/l respectively. Actual pre-dose (Ctrough), 5 min (Cpeak) and 480 min levels are given below. Serum concentrations remained above the MIC90 for Ps. aeruginosa (4 mg/l) in all patients for two-thirds of the dosage interval which is the target recommended for β-lactam antibiotics. A lower dose may not have been sufficient for all the patients.
A meropenem dose of 1 g 12 hourly is adequate in patients treated with CVVH or CVVHDF using an AN69 HF 0.9 m2 filter.
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Giles, L., Barber, A., Creed, G. et al. Pharmacokinetics of meropenem in intensive care patients receiving continuous renal replacement therapy. Crit Care 2, P130 (1998). https://doi.org/10.1186/cc259
- High Performance Liquid Chromatography
- Acute Renal Failure
- Renal Replacement Therapy
- Hollow Fibre