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Software- and TDM-guided dosing of Meropenem promises high rates of target attainment in critically Ill patients

Various studies have reported insufficient beta-lactam concentrations in critically ill patients. The optimal dosing strategy for beta-lactams in critically ill patients, particularly in septic patients, is an ongoing matter of discussion. This retrospective study aimed to evaluate the success of so...

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Main Authors: Chiriac, Ute (Author) , Richter, Daniel (Author) , Frey, Otto Roman (Author) , Röhr, Anka (Author) , Helbig, Sophia (Author) , Hagel, Stefan (Author) , Liebchen, Uwe (Author) , Weigand, Markus A. (Author) , Brinkmann, Alexander (Author)
Format: Article (Journal)
Language:English
Published: 2023
In: Antibiotics
Year: 2023, Volume: 12, Issue: 7, Pages: 1-14
ISSN:2079-6382
DOI:10.3390/antibiotics12071112
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.3390/antibiotics12071112
Verlag, kostenfrei, Volltext: https://www.mdpi.com/2079-6382/12/7/1112
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Author Notes:Ute Chiriac, Daniel Richter, Otto R. Frey, Anka C. Röhr, Sophia Helbig, Stefan Hagel, Uwe Liebchen, Markus A. Weigand and Alexander Brinkmann

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520 |a Various studies have reported insufficient beta-lactam concentrations in critically ill patients. The optimal dosing strategy for beta-lactams in critically ill patients, particularly in septic patients, is an ongoing matter of discussion. This retrospective study aimed to evaluate the success of software-guided empiric meropenem dosing (CADDy, Calculator to Approximate Drug-Dosing in Dialysis) with subsequent routine meropenem measurements and expert clinical pharmacological interpretations. Adequate therapeutic drug exposure was defined as concentrations of 8-16 mg/L, whereas concentrations of 16-24 mg/L were defined as moderately high and concentrations >24 mg/L as potentially harmful. A total of 91 patients received meropenem as a continuous infusion (229 serum concentrations), of whom 60% achieved 8-16 mg/L, 23% achieved 16-24 mg/L, and 10% achieved unnecessarily high and potentially harmful meropenem concentrations >24 mg/L in the first 48 h using the dosing software. No patient showed concentrations <2 mg/L using the dosing software in the first 48 h. With a subsequent TDM-guided dose adjustment, therapeutic drug exposure was significantly (p ≤ 0.05) enhanced to 70%. No patient had meropenem concentrations >24 mg/L with TDM-guided dose adjustments. The combined use of dosing software and consecutive TDM promised a high rate of adequate therapeutic drug exposures of meropenem in patients with sepsis and septic shock. 
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