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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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Autores principales: Chiriac, Ute, Richter, Daniel, Frey, Otto R., Röhr, Anka C., Helbig, Sophia, Hagel, Stefan, Liebchen, Uwe, Weigand, Markus A., Brinkmann, Alexander
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10376356/
https://www.ncbi.nlm.nih.gov/pubmed/37508207
http://dx.doi.org/10.3390/antibiotics12071112
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author Chiriac, Ute
Richter, Daniel
Frey, Otto R.
Röhr, Anka C.
Helbig, Sophia
Hagel, Stefan
Liebchen, Uwe
Weigand, Markus A.
Brinkmann, Alexander
author_facet Chiriac, Ute
Richter, Daniel
Frey, Otto R.
Röhr, Anka C.
Helbig, Sophia
Hagel, Stefan
Liebchen, Uwe
Weigand, Markus A.
Brinkmann, Alexander
author_sort Chiriac, Ute
collection PubMed
description 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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spelling pubmed-103763562023-07-29 Software- and TDM-Guided Dosing of Meropenem Promises High Rates of Target Attainment in Critically Ill Patients Chiriac, Ute Richter, Daniel Frey, Otto R. Röhr, Anka C. Helbig, Sophia Hagel, Stefan Liebchen, Uwe Weigand, Markus A. Brinkmann, Alexander Antibiotics (Basel) Article 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. MDPI 2023-06-27 /pmc/articles/PMC10376356/ /pubmed/37508207 http://dx.doi.org/10.3390/antibiotics12071112 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Chiriac, Ute
Richter, Daniel
Frey, Otto R.
Röhr, Anka C.
Helbig, Sophia
Hagel, Stefan
Liebchen, Uwe
Weigand, Markus A.
Brinkmann, Alexander
Software- and TDM-Guided Dosing of Meropenem Promises High Rates of Target Attainment in Critically Ill Patients
title Software- and TDM-Guided Dosing of Meropenem Promises High Rates of Target Attainment in Critically Ill Patients
title_full Software- and TDM-Guided Dosing of Meropenem Promises High Rates of Target Attainment in Critically Ill Patients
title_fullStr Software- and TDM-Guided Dosing of Meropenem Promises High Rates of Target Attainment in Critically Ill Patients
title_full_unstemmed Software- and TDM-Guided Dosing of Meropenem Promises High Rates of Target Attainment in Critically Ill Patients
title_short Software- and TDM-Guided Dosing of Meropenem Promises High Rates of Target Attainment in Critically Ill Patients
title_sort software- and tdm-guided dosing of meropenem promises high rates of target attainment in critically ill patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10376356/
https://www.ncbi.nlm.nih.gov/pubmed/37508207
http://dx.doi.org/10.3390/antibiotics12071112
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