A Case of Septicaemic Melioidosis: Utility of Therapeutic Drug Monitoring and High-Dose Meropenem in Successful Management

Gunasekaran, Karthik; Amladi, Anushree; Mathew, Sumith K; Miraclin, T Angel; Iyyadurai, Ramya

doi:10.4103/ijmm.ijmm_18_433

Cited by 2 publications

(2 citation statements)

References 11 publications

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“…The included studies are summarised in Table S3 [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 ]. Best practice for carbapenem TDM is not known, which has led to differences in the way it is carried out, particularly concerning pharmacological targets, dose-adjustment protocols, and frequency of antibiotic concentration measurement.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of the Effect of Therapeutic Drug Monitoring on Patient Health Outcomes during Treatment with Carbapenems

et al. 2022

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Adjusting dosing regimens based on measurements of carbapenem levels may improve carbapenem exposure in patients. This systematic review aims to describe the effect carbapenem therapeutic drug monitoring (TDM) has on health outcomes, including the emergence of antimicrobial resistance (AMR). Four databases were searched for studies that reported health outcomes following adjustment to dosing regimens, according to measurements of carbapenem concentration. Bias in the studies was assessed with risk of bias analysis tools. Study characteristics and outcomes were tabulated and a narrative synthesis was performed. In total, 2 randomised controlled trials (RCTs), 17 non-randomised studies, and 19 clinical case studies were included. Significant variation in TDM practice was seen; consequently, a meta-analysis was unsuitable. Few studies assessed impacts on AMR. No significant improvement on health outcomes and no detrimental effects of carbapenem TDM were observed. Five cohort studies showed significant associations between achieving target concentrations and clinical success, including suppression of resistance. Studies in this review showed no obvious improvement in clinical outcomes when TDM is implemented. Optimisation and standardisation of carbapenem TDM practice are needed to improve intervention success and enable study synthesis. Further suitably powered studies of standardised TDM are required to assess the impact of TMD on clinical outcomes and AMR.

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Section: Resultsmentioning

confidence: 99%

A Systematic Review of the Effect of Therapeutic Drug Monitoring on Patient Health Outcomes during Treatment with Carbapenems

et al. 2022

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“…Clinical suspicion of melioidosis would have helped in the early initiation of meropenem at the appropriate dose. Gunasekaran et al advocate the use of high-dose meropenem (2 g eighth hourly as 3 h infusion) in combination with therapeutic drug monitoring to manage septicaemic melioidosis successfully [22]. The eradication phase consists of the administration of oral antibiotics such as trimethoprim-sulfamethoxazole alone or in combination with doxycycline for a period of 3 to 6 months, depending on presentation.…”

Section: Discussionmentioning

confidence: 99%

Melioidosis in Bihar, India: unearthing the first of many?

Halim

Kokkayil

Kirti

et al. 2021

Access Microbiology

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Melioidosis, a disease with protean clinical manifestations, is prevalent in many parts of India, with established endemic hotspots on the southern coast of the country. However, it is still underdiagnosed in many resource-poor regions of the country. We report what is, to the best of our knowledge, the first case of melioidosis diagnosed and treated in Bihar, an economically underdeveloped state in East India. The patient, a 52-year-old diabetic male, presented to the outpatient department with a fever of insidious onset along with pain and restriction of movement in the right shoulder joint and right knee joint, and swelling and tenderness of bilateral ankle joints. Radiological features were suggestive of multiple joint and organ abscesses. A diagnosis of disseminated septicaemic melioidosis was confirmed microbiologically. The patient improved clinically following aggressive treatment with meropenem and cotrimoxazole. The case highlights the need for increased clinical suspicion of melioidosis and adequate diagnostic facilities, as well as the need for early institution of appropriate empirical antibiotics in suspected cases of melioidosis in this region of the world.

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A Case of Septicaemic Melioidosis: Utility of Therapeutic Drug Monitoring and High-Dose Meropenem in Successful Management

Cited by 2 publications

References 11 publications

A Systematic Review of the Effect of Therapeutic Drug Monitoring on Patient Health Outcomes during Treatment with Carbapenems

A Systematic Review of the Effect of Therapeutic Drug Monitoring on Patient Health Outcomes during Treatment with Carbapenems

Melioidosis in Bihar, India: unearthing the first of many?

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