2 0 obj should be administered by intravenous infusion over approximately 15 minutes to 30 minutes. 1025 0 obj <>stream infusion with a pump Loading dose 5mg/kg over at least 20 minutes then continuous infusion of 500 micrograms/kg/hour Usually diluted 500mg in 250 to 500mls (1-2mg/ml) in NS or G. May use undiluted (25mg/ml) via central line at rate not exceeding 25mg/minute. Meropenem was subsequently assayed using high-performance liquid chromatography (HPLC). Traditionally, meropenem has been dosed 1 g IV q 8 hrs for serious infections. Doses of 1 gram may also be a… 2.2. should be administered by intravenous infusion over approximately 15 minutes to 30 minutes. The method was developed and validated in compliance with International Council for Harmonisation (ICH) guidelines. <> 3v2QåÑɅÖZÜßÃ|l¬b†ÌßڍۇƒÈs Ksül]{¢R>ڔv§$ª3í(2«Þ‡Å¢?oïʲˆk„ƒÈ»¸øͼZ˜ÎtqºIæˆð%˜Î5sßvV. The use of extended infusion beta-lactam dosing strategies is becoming more common and its relevance to clinical practice more relevant in the setting of a limited antibiotic development pipeline. 1014 0 obj <> endobj Each vial is for single use only. 63 Therefore, continuous infusion of meropenem 3 g/day could be divided into six … • Meropenem by CI was diluted in 100 mL of 0.9% saline solution and injected into a central venous catheter via a volumetric pump (Braum Mesulgen, Mesulgen, Germany) with an infusion dead space of < 2 mL. Preparation of Solution: 3 g/day continuous IV infusion: Reconstitute a 1 g vial according to manufacturer recommendations. (UW Health Strong Recommendation, Low Quality of Evidence) 4. Extended-Infusion Meropenem (Merrem®) Protocol Related Documents: Patient Care Manual Guide: Medication Administration IV Infusion Guidelines I. Study Protocol. The protocol consists of a model previously performed in other tissues . However, application of the PK/PD properties of meropenem to create alternative dosing strategies results in equivalent or even greater clinical success. 100 HAP patients, admitted to ICU of Qilu Hospital of Shandong University, … Study Protocol. Interview By: Timothy P. Gauthier, Pharm.D., BCPS-AQ ID [Last … Solution #2: Meropenem 100mg/50mL 0.9%NaCl for a concentration of 2mg/mL. Optimal anti-bacterial activity of meropenem requires maintenance of its plasma concentration (Cp) above the minimum inhibitory concentration (MIC) of the pathogen for at least 40% of the dosing interval (fT > MIC > 40). <>/Metadata 600 0 R/ViewerPreferences 601 0 R>> Standard aseptic techniques should be used for solution preparation and administration. Microbiologic success is dependent on pharmacokinetic and pharmacodynamic parameters and the organism’s MIC.8 As previously mentioned, the pharmacodynamic target for beta-lactam antibiotics is the time the drug concentration remains above the MIC of the infecting organism. It is given through a needle placed into one of your veins. pseudomonas) How: 1. Here, several thought-leaders in the field (Dr. Grupper, Dr. Kuti and Dr. Nicolau) weigh in on the topic. Meropenem extended infusion (over 3-hr) will be recommended by ID consult service for selected patient cases, therefore, time of infusion 30- min and 3-hr infusion will be available for clinician to order. %%EOF For example, a prolonged infusion of high-dose meropenem (2 g q8h, with each dose infused over 3 h) achieves a high likelihood of obtaining a 40% ƒT>MIC against bacteria with MICs of ≤16 μg/ml. However, the clinical outcomes between two groups remain inconclusive. One gram of meropenem was administered by intravenous infusion for 30 min. Several studies have explored the PK/PD parameters of beta lactam agents with Continuous IV Infusion: NOTE: Meropenem has not been FDA-approved for administration as a continuous intravenous infusion. For intravenous infusion, meropenem vials may be directly constituted with 0.9 % sodium chloride or 5% glucose solutions for infusion. %PDF-1.5 %âãÏÓ When treating complicated skin and skin structure infections caused by P. aeruginosa, a dose of 1 gram every 8 hours is recommended.Meropenem for injection (I.V.) Why: • PD target for β-lactams: fT>MIC (time above MIC) • Maximize the time-dependent bactericidal activity • Target pathogens with high MIC (e.g. 1 0 obj The recommended dose of Meropenem for injection (I.V.) Methods: An open-label randomized controlled clinical trial was conducted. hÞbbd``b`Ö õ@‚Q Ä5±Ê€ÄwLŒÌ­ YF$âÿ¿ ñì 0 PURPOSE Meropenem belongs to the antibiotic class of carbapenems, which are known to be broad-spectrum antibiotics effective against several drug-resistant organisms. Patients not in septic shock may or may not receive their first dose of antibiotic over 30 minutes and may have prolonged infusion started immediately. Adjust meropenem 1g IV q8hr to 500mg IV q6hr 2. Each vial is for single use only. The solution should be shaken before use . <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> is 500 mg given every 8 hours for skin and skin structure infections and 1 gram given every 8 hours for intra-abdominal infections. Infusion. Label as solution #2 c. Solution #1: Remove 2mL from a 100mL bag of 0.9% NaCl. áCX©æ °X[H1„ UØêÌÁÑÑ`ÑÁÜàÚÁ–ÑÐÐÑæ2i4¤u°x ¹@A—ˆˆDˆ e Ÿ£ƒBÿ CȑõË5 ÍĜ  cTbàrC˜0ˆÆ>q0¿tŽ= ˜nl'AZ¸Œ@ZX€T;÷O0—á'@€ Þ``c (UW Health Weak/Conditional Recommendation, Infusion . In the EI group, 18/76 patients (23.7%) received some of the meropenem doses for less than the 4–hour infusion time due to technical reasons; the mean infusion time per dose during the first 2 days of treatment was 3.62 hours (standard deviation, 0.41 hours) in the EI group. Objective To evaluate current … For carbape… One gram of meropenem was administered by intravenous infusion for 30 min. <> Proper use of meropenem A nurse or other trained health professional will give you or your child meropenem. * Extended infusion not applicable to NICU patients. * IV push available, however, prolonged infusion is the preferred method of administration ** 30-60 minute infusion on Freedom 60 pump, no IV push available *** 60-90 minute infusion on Freedom 60 pump, no IV push available Factors that prohibit short infusions or IV push antibiotics with OPAT may include (but are not limited to): The protocol consists of a model previously performed in other tissues . endstream endobj startxref 4 0 obj More frequent administration of a beta-lactam typically increases this amount of time. In this retrospective study, we compared intensive care unit (ICU) mortality and clinical response in patients who received meropenem for ≥72 hours administered per EIM protocol of 1 g over 3 hours every 8 hours versus intermittent infusion (IIM) protocol of 500 mg over 30 minutes every 6 hours. **Adjust doses for renal function based on TNMC renal adjustment protocol and infuse over 4 hours. b. Meropenem to be used for bolus intravenous injection should be reconstituted with sterile water for injection. Meropenem for injection (I.V.) If the YCD 95% minimum content limit is applied, the infusion period must be reduced to less than 6 hours for body-worn devices, especially at the higher concentration studied (25 mg/mL). The 5 mg/mL aqueous reconstituted solution of meropenem was stable for up to 8 hours in the temperature range between 25°C and 35°C, and for up to 5 hours at 40°C. Meropenem (Meronem ®, AstraZeneca Pharmaceuticals, Belgium) was administered as either II (infusion over 0.5 h) in 30 patients (II group) or EI (infusion over 3 h) in 25 patients (EI group), at a dose of 1 g every 8 h, which is usually recommended in nosocomial pneumonia. In Summary. Meropenem’s stability was examined at two temperatures 22°C and 33°C to mimic average and high temperature in hospital wards. endstream endobj 1015 0 obj <>/Metadata 80 0 R/Pages 1012 0 R/StructTreeRoot 110 0 R/Type/Catalog>> endobj 1016 0 obj <>/MediaBox[0 0 720 540]/Parent 1012 0 R/Resources<>/Pattern<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 1017 0 obj <>stream stream Objective: To Compare the clinical efficacy and safety of meropenem with a 3-hour extended infusion or conventional 30-minute infusion regimen in treatment of hospital acquired pneumonia (HAP) in intensive care unit (ICU) patients. 62 The 40 mg/mL solution of meropenem reconstituted in isotonic saline was stable at 25°C for a maximum of 8 hours. Blood samples were drawn from a peripheral vein at the end of the infusion (T1), one hour later (T2), and two hours later (T3). Conclusions Meropenem at concentrations between 6.25 mg/mL and 25 mg/mL as tested is not sufficiently stable to administer as a 24-hour infusion in ambulatory device reservoirs. Then adjust 500mg IV q6h for renal function = 500mg IV q8hr. %���� Blood samples were drawn from a peripheral vein at the end of the infusion (T1), one hour later (T2), and two hours later (T3). The medicine must be injected slowly, so the needle will need to stay in place for at least 15 to 30 minutes. Extended Infusion Cefepime and Meropenem Tip Sheet What: Cefepime orders are defaulting to 4 hour infusions; Meropenem will default to 3 hours. Renal Dosing Adjustment for Pediatric Patients all ages <40kg: • CrCl > 40ml/min = no adjustment Doses of 1 gram may also be administered as an intravenous bolus injection (5 mL to 20 mL) over approximately 3 minutes to 5 minutes . Label as solution #1. endobj We aimed to determine whether a 3-h extended infusion (EI) of meropenem achieves fT > MIC > 40 on the first and third days of therapy in patients with … x��][��6�~7�� `1@� �IQ�` ng��3�ij�E2�n������v��Q���CRR/�J�����������#���C���?����kn����˷��\�����|��=��a�����ï�k�����Wɋ�W�?�?����O���˚'������c�{������.�̒:�������4���")�"-���h��er��K��J����g�`�B$oo~���m������Ͼ������#�ez�&ȟ6�n�o�m/X��n�����?n/���a[n:��y���^ԛ������. Hence, administering these antibiotics by continuous infusion should improve the outcomes of … hÞb```¢ ÉÆ Ā BÌ,@ȱ˜A€ƒA„9x‚à„e‘Œ¼˜X3È7d3Ë0\`è?´hómnÎ@± F†X» Üg˜Ä:ÂÌÝv;¿ìöÛm„[[%[‚%\ ¬á hÞÔSÛnÛ0ýý@GJ¾)@a ɚm@7M±ò 9‚#À•[)²¿)9Ù²§½ÖmŠ"uŽäC‰J The results suggest that cefiderocol is a potential option for the treatment of patients with nosocomial pneumonia, including those caused by multidrug-resistant Gram-negative bacteria. Cefiderocol was non-inferior to high-dose, extended-infusion meropenem in terms of all-cause mortality on day 14 in patients with Gram-negative nosocomial pneumonia, with similar tolerability. •In order to optimize the pharmacodynamics of meropenem, cefepime, and piperacillin/tazobactam, dosing substitution protocols have been approved for inpatients at The Nebraska Medical Center. Remove 2mL from Solution #2. Background Meropenem exhibits time-dependent antimicrobial activity and prolonged infusion (PI) (extended infusion or continuous infusion, EI or CI) of meropenem can better achieve pharmacodynamics target when comparing with intermittent bolus (IB). endobj Meropenem: Same dose: consider prolonged infusion for critically ill patients Prolonged infusion if critically ill, obese with Cl cr > 100 ml/min, if targeting a higher PD end point of 100% fT > MIC, or infections with less susceptible pathogens (i.e., MIC > 2) Monobactam: Aztreonam: Insufficient data Place in a 100mL bag of 0.9%NaCl to create a Meropenem concentration of 4mg/100mL (0.04mg/mL). %PDF-1.5 1020 0 obj <>/Filter/FlateDecode/ID[<0C419DF5543B644C9AD9BAE2C3837EA8>]/Index[1014 12]/Info 1013 0 R/Length 51/Prev 459991/Root 1015 0 R/Size 1026/Type/XRef/W[1 2 1]>>stream protocol does NOT include patients in the neonatal intensive care unit. endobj Tazocin® and Meropenem are beta-lactam antibiotics, whose efficacy is dependent upon time above minimum inhibitory concentration (MIC) in affected tissues. Theoretically, therefore, this meropenem regimen should kill KPC-producing bacteria with MICs of 16 μg/ml or less. Further dilute in 50 mL or 250 mL of 0.9% Sodium Chloride Injection and administer over 8 hours. For intravenous infusion, meropenem vials may be directly reconstituted with 0.9 % sodium chloride or 5% glucose solutions for infusion. 3 0 obj For other pediatric patients less than 1 year of age the pharmacist must discuss the dose adjustment with the medical team who initiated the order. of antibiotic as a 30-minute infusion to reduce the time to a therapeutic concentration. Alaris pumps are programmed to deliver 4-hr infusions for cefepime and piperacillin/tazobactam in all critical care units.