Usefulness of therapeutic drug monitoring of piperacillin and meropenem in routine clinical practice: a prospective cohort study in critically ill patients

Arnaiz, Juan Antonio Schoenenberger; Ahmad-Diaz, Faten; Miralbes-Torner, Mar; Aragones-Eroles, Ana; Cano-Marron, Manuel; Palomar-Martínez, Mercedes

doi:10.1136/ejhpharm-2018-001713

Cited by 28 publications

(40 citation statements)

References 42 publications

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“…17,22,34 Vd values, in litres, ranged from 19.83 to 44.1 L 17,30 ; when analysed in litres per kilogram, they ranged from 0.40 to 0.60 L/Kg. 22,27,28 Clearance values analysed in ml/min variated from 125 ml/min to 176.1 ml/min. 27,30 This variation correlated principally to creatinine clearance, the intensity of continuous renal replacement therapy beyond the pathophysiological changes presented by critical patients.…”

Section: Re Sultsmentioning

confidence: 96%

“…These patients received support with mechanical ventilation in approximately 68% of the cases, sometimes with vasoactive drugs. [20][21][22][23][24][25] Considering the infections, the bacterial strains frequently involved were Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter baumannii. [26][27][28][29][30] Typically, the MIC values considered for these microorganisms are usually obtained from the medical record of the patient (when there are culture and MIC performed in the unit) or from the European Committee for Antimicrobial Susceptibility and Testing (EUCAST) data for the identified or supposed microorganism.…”

Section: Re Sultsmentioning

confidence: 99%

“…5,17,30,34,36 In the analysis of dosing regimens for the intravenous administration of meropenem, the posologic regimen reported in studies mentioned infusions that ranged from 1 to 2 g every 6, 8 or 12 h, totalling 3 to 6 g/day. 22,33,35,[39][40][41] Doses were often higher if the patient had a severe infection or a bacterium with high MIC. 16 The meropenem infusion can be continuous (for 24 h) or prolonged.…”

Section: Re Sultsmentioning

confidence: 99%

“…The pharmacodynamic (PD) parameter that best predicts microbiological efficacy of meropenem against microorganisms is the percentage of the time interval between drug administration during which the plasma concentration remains above the minimum inhibitory concentration (MIC) of the causative pathogen. 5,22 As a time-dependent drug, increases in meropenem concentration do not exactly mean a rise in the rate of bacterial killing. Recent studies showed that a successful clinical result could be obtained in treatments by optimizing the duration of exposure to adequate antimicrobial concentrations.…”

Section: Re Sultsmentioning

confidence: 99%

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Meropenem use and therapeutic drug monitoring in clinical practice: a literature review

et al. 2021

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What is known and objective: Meropenem, a carbapenem antibiotic, is widely prescribed for the treatment of life-threatening infections. The main parameter associated with its therapeutic success is the percentage of time that the levels remain above the minimum inhibitory concentration. Inadequate levels of meropenem can lead to therapeutic failure and increase the possibility of microbial resistance. The employment of strategies involving dose regimens and drug pharmacodynamics has become increasingly important to optimize therapies. In the present study, we conducted a review with the purpose of assembling information about the clinical use of meropenem and therapeutic drug monitoring. Methods:A literature review emphasizing the application of therapeutic drug monitoring (TDM) of meropenem in clinical practice has been done. To identify articles related to the topic, we performed a standardized search from January 21, 2020 to December 21, 2020, using specific descriptors in PubMed, Lilacs and Embase.Results and discussion: In total, 35 studies were included in the review. The daily dose of meropenem commonly ranged from 3 to 6 g/day. Critically ill patients and those with impaired renal function appear to be the most suitable patients for the application of meropenem TDM, in order to guide therapy. We observed that most of the studies recommend TDM and that, in nine locations, the TDM of meropenem and of other beta-lactams is a routine practice. TDM data can help to maximize the clinical outcomes of the treatment with meropenem. It can also improve the patient care by providing suitable levels of meropenem, guiding the most appropriate dose regimens, which is the main parameter associated with therapeutic success. What is new and conclusion:The findings from this review suggest that the therapeutic monitoring of meropenem can be beneficial, since it adjusts the treatment and aids clinical outcomes. It does so by indicating the appropriate dosage and preventing failure, toxicity and possible antimicrobial resistance. The multidisciplinary effort, basic knowledge and communication among the medical team are also essential.

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Section: Re Sultsmentioning

confidence: 96%

Section: Re Sultsmentioning

confidence: 99%

Section: Re Sultsmentioning

confidence: 99%

Section: Re Sultsmentioning

confidence: 99%

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Meropenem use and therapeutic drug monitoring in clinical practice: a literature review

et al. 2021

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“…Notes: Data from these studies. [19][20][21][22][23][24][25][26][27][28] Abbreviations: c.i., continuous infusion; E, efficacy; PAS, para-aminosalicylic acid; T, prevent toxicity; TDM, therapeutic drug monitoring. TB patients.…”

Section: Pas E/tmentioning

confidence: 99%

<p>Advantages and Challenges of Tailored Regimens for Drug-Resistant Tuberculosis: A StopTB Italia Look into the Future</p>

Riccardi¹,

Villa²,

Alagna³

et al. 2020

IDR

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The emerge of drug-resistant tuberculosis (TB) strain in recent decades is hampering the efforts of the international community to eliminate the disease worldwide. The World Health Organization (WHO) has drafted many strategies to achieve this ambitious goal. In the very beginning, the aim was to standardize inadequate regimens used in many countries and, thereafter, evolved to tackle the social determinants which hinder TB elimination. However, following the path of narrowing the clinical vision to deal with TB, there is an increased need to personalize the treatment considering both patients and pathogen unique characteristics. In our narrative review, we report the advantages and the backwards in developing a method to implement the concept of precision medicine to the treatment of TB. In this dissertation, we highlight the importance to address different aspects of the diseases encompassing the host and pathogen features, as well as the needs to further implement an adequate follow-up based on the available resources. Nevertheless, many things may hamper the vision of precision medicine in TB, such as the complexity and the costs to develop novel compounds and the costs related to global-scale implementation of patient-centered follow-up. To achieve the ambitious goal of TB elimination, a radical change in TB treatment is needed in order to give a more comprehensive approach based both on patients' peculiarities and driven by drug susceptibility tests and whole-genome sequencing.

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A sensitive and high‐throughput quantitative liquid chromatography high‐resolution mass spectrometry method for therapeutic drug monitoring of 10 β‐lactam antibiotics, linezolid and two β‐lactamase inhibitors in human plasma

Vooren

Verstraete

2021

Biomedical Chromatography

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An ultra-high pressure liquid chromatography high-resolution mass spectrometric (UHPLC-HRMS) method was developed for the simultaneous and sensitive quantification of 10 β-lactam antibiotics (cefepime, meropenem, amoxicillin, cefazolin, benzylpenicillin, ceftazidime, piperacillin, flucloxacillin, cefuroxime and aztreonam), linezolid and β-lactamase inhibitors tazobactam and clavulanic acid in human plasma. Validation according to the EMA guidelines showed excellent withinand between-run accuracy and precision (i.e. between 1.1 and 8.5%) and high sensitivity (i.e. lower limit of quantification between 0.25 and 1 mg/L). The UHPLC-HRMS method enables a short turnaround time and high sensitivity and needs only a small amount of plasma, allowing appropriate routine therapeutic drug monitoring.The short turnaround time is obtained by speeding up the protocol on multiple levels, i.e. fast and workload-efficient sample preparation (i.e. protein precipitation and dilution), short (4 min) instrument run time, simultaneous measurement of all relevant β-lactam antibiotics used in the intensive care unit and the use of the same instrument, column and mobile phases as for the other routine methods in our laboratory. K E Y W O R D Sβ-lactam antibiotics, HRMS, therapeutic drug monitoring | INTRODUCTIONSevere infection and associated septic shock persist as significant healthcare concerns as they are the most common cause of mortality in critically ill patients worldwide (Vincent et al., 2009). Since adequate and early administration of antibiotics remains the mainstay of therapy for the treatment of severe infections, there is a high level of consumption of antibiotics in intensive care units (ICU) (Dellinger et al., 2013). A single-day point prevalence study showed that 71% of the ICU patients received antimicrobial therapy (Vincent et al., 2009). However, in specific patient populations like critically ill patients, cystic fibrosis patients, elderly patients, neonates, etc., the pharmacokinetics of these antibiotics may be profoundly disturbed owing to pathophysiological changes in distribution and elimination (Roberts et al., 2014;Taccone et al., 2010;Theuretzbacher, 2012). Consequently, an empirical fixed dose approach, in which every patient is treated according to the same dosing scheme, appears to be inadequate and can lead to excessive drug exposure with an increased risk of toxicity or inadequate drug exposure with clinical failure and/or antimicrobial resistance (Roberts & Lipman, 2006). Optimizing antibiotic dosing may be a key intervention, not only to improve clinical outcome and minimize toxicity, but also to prolong the clinical lifespan of the currently available antibiotics by limiting the emergence of

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Usefulness of therapeutic drug monitoring of piperacillin and meropenem in routine clinical practice: a prospective cohort study in critically ill patients

Cited by 28 publications

References 42 publications

Meropenem use and therapeutic drug monitoring in clinical practice: a literature review

Meropenem use and therapeutic drug monitoring in clinical practice: a literature review

<p>Advantages and Challenges of Tailored Regimens for Drug-Resistant Tuberculosis: A StopTB Italia Look into the Future</p>

A sensitive and high‐throughput quantitative liquid chromatography high‐resolution mass spectrometry method for therapeutic drug monitoring of 10 β‐lactam antibiotics, linezolid and two β‐lactamase inhibitors in human plasma

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