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Meropenem treatment optimisation in patients using PK/PD criteria
European Statement
Clinical Pharmacy Services
Author(s)
Marina Rodríguez-Marín, Paula Novo-González
Why was it done?
To optimize and improve patient treatment as well as reduce the risk of multiresistance in the case of broad-spectrum antibiotics.
What was done?
Using Monte Carlo simulation to calculate the probability of treatment success (pTA) in patients receiving meropenem, defined as the percentage of time the drug level is above the minimum inhibitory concentration (MIC). The cumulative fraction of response of the antibiotic meropenem was also measured.
How was it done?
At a hospital in the Community of Madrid, the TDMx pharmacokinetics program was employed by inputting clinical and pharmacokinetic data of patients who had received meropenem between September 15th and October 15th, 2022. The data were extracted from the SELENE electronic medical records system, and both probabilistic dosing and Bayesian dosing were performed using these data. The following information was entered: age, weight, height, antibiotic dose, dosing interval, creatinine level, MIC, and meropenem PK/PD parameter (% of time above MIC).
What has been achieved?
Twenty patients were recruited: 10 women and 10 men, with a median age of 84 years [Q1: 77, Q3: 89] years.
With a dose of 1000 mg every 4 hours, all patients, assuming a PTA of either 50% or 90%, achieved the desired probability of success.
When the PTA was set at 50%, all patients could benefit from the Monte Carlo simulation within the studied intervals. However, when the PTA was set at 90%, a dose of 2000 mg every 1 hour was required in an infusion time interval.
The majority of patients (17 out of 20) were prescribed a dose of 1000 mg every 8 hours.
Except for two patients, most of the MICs were unknown. Since this parameter influences the probability of success, the results obtained are theoretical.
What next?
1- Obtain the minimum inhibitory concentrations (MICs) for all patients using this antibiotic, with the aim of planning the program and providing recommendations.
2- Additionally, gradually implement this approach in other medications