Continuous infusion versus intermittent administration of meropenem in critically ill patients: a pilot study

This prospective crossover study compares the pharmacokinetics of meropenem administered by continuous infusion with intermittent administration in critically ill patients. Fifteen patients were randomized to receive meropenem either as a 2 g iv loading dose followed by a 3 g continuous infusion (CI) over 24 h or as intermittent administration (IA) of 2 g iv every 8 h (98 h). Each regimen was performed over a period of 2 days followed by a cross over to the alternative regimen for the same time. Pharmacokinetic parameters (mean ± SD) of CI included following: concentration at steady state (C_SS) was 11.9 ± 5.0 mg/l, area under the curve (AUC) was 117.5 ± 12.9 mg/l/h. Maximum and minimum scrum concentration of meropenem (C_max, C_min) and total meropenem clearance(Cl_tot) for IA were 110.1 ± 6.9 mg/l, 8.5 ± 1.0 mg/l and 9.4 ± 1.2 l/h, respectively. The AUC during IA regimen was larger than the AUC during CI (P < 0.001). In both treatment groups meropenem scrum concentrations remained above the minimal inhibitory concentration tor the most important bacterial strains all the time. We conclude that CI of meropenem is equivalent to the IA regimen and is therefore suitable for treating critically ill patients. Additionally, a CI regimen can save costs of antibiotic therapv as bactericidal serum levels can be achieved with only 50% of the amount of drug used for IA.