The Latest in Critical Care, 7/10/23 (Issue #8)
Continuous meropenem infusion for critically ill patients with sepsis
Antibiotics have a time-dependent effect on bacteria; maintaining bacteriocidal concentrations of antibiotics should help subdue infections better than intermittent dosing. A 2018 meta-analysis reviewed here suggested that prolonged infusion of antipseudomonal beta-lactams reduced mortality by 30% compared with shorter infusions, and more observational data has accumulated since that time.
Many institutions have created protocols for extended infusions of beta lactam antibiotics, available online. However, the practice has not been supported by randomized trials.
In the MERCY trial, 607 critically ill patients with sepsis (most with septic shock) at 26 hospitals in Croatia, Italy, Kazakhstan, and Russia were randomized to receive meropenem by either continuous (3 g / 24 hours) or intermittent administration (1 g every 8 hours).
At 28 days, there were no observed differences in the primary outcome (an odd composite of …
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