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Software- and TDM-Guided Dosing of Meropenem Promises High Rates of Target Attainment in Critically Ill Patients

ORCID
0000-0002-4288-1745
Affiliation
Department of Pharmacy, Heidelberg University Hospital, Im Neuenheimer Feld 670, 69120 Heidelberg, Germany
Chiriac, Ute;
ORCID
0000-0003-1786-5919
Affiliation
Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
Richter, Daniel;
ORCID
0000-0001-9482-5094
Affiliation
Department of Clinical Pharmacy, Heidenheim Hospital, Schlosshaustraße 100, 89522 Heidenheim, Germany
Frey, Otto R.;
Affiliation
Department of Clinical Pharmacy, Heidenheim Hospital, Schlosshaustraße 100, 89522 Heidenheim, Germany
Röhr, Anka C.;
Affiliation
Department of Clinical Pharmacy, Heidenheim Hospital, Schlosshaustraße 100, 89522 Heidenheim, Germany
Helbig, Sophia;
Affiliation
Institute for Infectious Diseases and Infection Control, Jena University Hospital—Friedrich Schiller University Jena, 07740 Jena, Germany
Hagel, Stefan;
ORCID
0000-0002-4375-0923
Affiliation
Department of Anaesthesiology, University Hospital LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany
Liebchen, Uwe;
Affiliation
Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
Weigand, Markus A.;
Affiliation
Department of Anesthesiology, Heidenheim Hospital, Schlosshaustraße 100, 89522 Heidenheim, Germany
Brinkmann, Alexander

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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