Multiple studies have assessed the pharmacokinetics/pharmacodynamics (PKPD) and comparable efficacy of meropenem 1000mg intravenously (IV) every eight hours (traditional regimen) and meropenem 500mg IV every six hours (alternative regimen). However, there is limited data comparing the PKPD and clinical efficacy of these dosing strategies in an obese population. The objective of this study is to compare clinical outcomes associated with these two dosing strategies.
This retrospective study reviewed 93 obese adult patients hospitalized at two large academic medical centers between 10/2011 and 11/2014 who received at least 3 days of meropenem therapy. A minimum creatinine clearance of 30mL/min and body mass index of at least 30kg/m2 were required for inclusion. Primary outcomes included time to clinical defervescence and clinical response rate at the end of meropenem therapy or at discharge. Clinical response was defined as complete, partial, or failed based on the achievement of defervescence and resolution of infectious signs and symptoms. Secondary outcomes included in-hospital mortality, total hospital length of stay (LOS) and meropenem duration of therapy.
Of 93 patients, 37 received a traditional dosing strategy, and 56 received an alternative dosing strategy. Complete (32.4% and 53.6%), partial (56.8% and 33.9%), and failed (10.8% and 12.5%) clinical response rates occurred in the traditional and alternative dosing strategies, respectively (p=0.095). Data for time to defervescence was available for 14 and 29 patients in the traditional and alternative groups, respectively. In these patients (n=43) the mean time to defervescence was 7.07 days and 3.07 days, respectively (95% CI= -2.105 to 10.110, p=0.182). In-hospital mortality was 10.8% and 5.4% of patients, respectively (p=0.43). Total hospital LOS was 17.173 days and 13.748 days, respectively (95% CI= -1.8270 to 8.6765, p=0.198). Meropenem treatment duration was 11.92 days and 6.48 days, respectively (95% CI= 0.665 to 10.209, p= 0.027).
These results suggest that the similar clinical outcomes seen between traditional and alternative meropenem dosing strategies in previous studies may extend to obese patients. However, further research is needed to validate these findings.
L. M. Oleksiuk, None
L. Wilson, None
H. Freedy, None