Plasma and ascites pharmacokinetics of meropenem in patients with decompensated cirrhosis and spontaneous bacterial peritonitis

Schultalbers, Marie; Grote-Koska, Denis; Cornberg, Markus; Schmidt, Julius J.; Maasoumy, Benjamin; Book, Thorsten; Bremer, Birgit; Schulte, Benjamin; Manns, Michael P.; Wedemeyer, Heiner; Brand, Korbinian

doi:10.1016/j.jhep.2021.07.015

Cited by 3 publications

(1 citation statement)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the case of spontaneous bacterial peritonitis, a common source of sepsis among hospitalized patients with cirrhosis, peritoneal antibiotic penetration is an essential concept. While some agents like cephalosporins, fluoroquinolones, and meropenem[ 120 - 122 ] achieve high concentrations in ascitic fluid, others such as aminoglycosides and tigecycline have reduced penetration[ 123 , 124 ]. The use of continuous or extended infusions of beta-lactams increases the duration of antibiotic levels over the MIC and lead to higher cure rates and decreased mortality in RCTs among patients without cirrhosis[ 125 - 127 ].…”

Section: Antibioticsmentioning

confidence: 99%

Emerging concepts in the care of patients with cirrhosis and septic shock

Jiménez¹,

Garcia‐Tsao²,

Saffo³

2023

World J Hepatol

View full text Add to dashboard Cite

Septic shock impacts approximately 6% of hospitalized patients with cirrhosis and is associated with high rates of morbidity and mortality. Although a number of landmark clinical trials have paved the way for incremental improvements in the diagnosis and management of septic shock in the general population, patients with cirrhosis have largely been excluded from these studies and critical knowledge gaps continue to impact the care of these individuals. In this review, we discuss nuances in the care of patients with cirrhosis and septic shock using a pathophysiology-based approach. We illustrate that septic shock may be challenging to diagnose in this population in the context of factors such as chronic hypotension, impaired lactate metabolism, and concomitant hepatic encephalopathy. Furthermore, we demonstrate that the application of routine interventions such as intravenous fluids, vasopressors, antibiotics, and steroids should be carefully considered among those with decompensated cirrhosis in light of hemodynamic, metabolic, hormonal, and immunologic disturbances. We propose that future research should include and characterize patients with cirrhosis in a systematic manner, and clinical practice guidelines may need to be refined accordingly.

show abstract

Section: Antibioticsmentioning

confidence: 99%

Emerging concepts in the care of patients with cirrhosis and septic shock

Jiménez¹,

Garcia‐Tsao²,

Saffo³

2023

World J Hepatol

View full text Add to dashboard Cite

show abstract

Population pharmacokinetics and dosing simulations of meropenem in septic critically ill patients with complicated intra-abdominal infection or pneumonia

Huang,

Wu,

Tan

et al. 2024

Journal of Pharmaceutical Sciences

View full text Add to dashboard Cite

Pharmacokinetics of ceftriaxone, gentamicin, meropenem and vancomycin in liver cirrhosis: a systematic review

Comce,

Weersink,

Beuers

et al. 2024

Journal of Antimicrobial Chemotherapy

View full text Add to dashboard Cite

Objectives Patients with liver cirrhosis are prone to develop severe bacterial infections. Pharmacokinetics (PK) of antibiotics in cirrhosis are potentially affected by impaired biotransformation phases 0–3 and consequences of portal hypertension such as portovenous shunting, ascites formation and/or acute kidney injury (AKI). We aimed to elucidate to what extent PK of selected antibiotics and, therefore, dosage recommendations are affected in adults with cirrhosis. Methods We performed a systematic search in PubMed, Embase, Cochrane and CINAHL on effects of cirrhosis on PK profiles of ceftriaxone, fosfomycin, gentamicin, meropenem, nitrofurantoin, piperacillin/tazobactam and vancomycin in adults. Antibiotics were selected based on the lack of specific dosing recommendations for adults with cirrhosis. We included studies reporting on ≥1 of the following PK parameters: AUC, half-life (t½), CL, volume of distribution (Vd), peak (Cmax) or trough concentrations (Cmin). Results We identified 15 studies (ceftriaxone, n = 5; gentamicin, n = 3; meropenem n = 5; vancomycin, n = 2), including 379 patients with cirrhosis, of which two were of high quality. No eligible studies were identified for fosfomycin, nitrofurantoin or piperacillin/tazobactam. Ceftriaxone unbound concentration increased in cirrhosis, but was mitigated by increased renal CL. Gentamicin levels in ascitic fluid were comparable to those in plasma. Meropenem PK parameters were not altered in cirrhosis without AKI, but in the presence of AKI a decrease in CL was observed. In contrast, vancomycin CL decreased in advanced cirrhosis. Conclusions Available data in studies of mostly moderate quality suggest that PK of ceftriaxone, meropenem and vancomycin are altered in cirrhosis. More advanced PK studies are needed to provide specific dosing recommendations.

show abstract

Plasma and ascites pharmacokinetics of meropenem in patients with decompensated cirrhosis and spontaneous bacterial peritonitis

Cited by 3 publications

References 7 publications

Emerging concepts in the care of patients with cirrhosis and septic shock

Emerging concepts in the care of patients with cirrhosis and septic shock

Population pharmacokinetics and dosing simulations of meropenem in septic critically ill patients with complicated intra-abdominal infection or pneumonia

Pharmacokinetics of ceftriaxone, gentamicin, meropenem and vancomycin in liver cirrhosis: a systematic review

Contact Info

Product

Resources

About