The exploration of population pharmacokinetic model for meropenem in augmented renal clearance and investigation of optimum setting of dose

J Infect Chemother. 2018 Oct;24(10):834-840. doi: 10.1016/j.jiac.2018.07.007. Epub 2018 Aug 4.

Abstract

In recent years, augmented renal clearance (ARC), in which renal function is excessively enhanced, has been reported, and its influence on β-lactam antibiotics has been investigated. In this study, we aimed to determine the optimum population pharmacokinetic model of meropenem in patients with sepsis with ARC, and evaluated dosing regimens based on renal function. Seventeen subjects (6 with ARC and 11 without) were enrolled in this study. Predicted meropenem concentrations were evaluated for bias and precision using the Bland-Altman method. To examine the dosing regimen, Monte Carlo simulation was performed to calculate the cumulative fraction of response (CFR). In patients with ARC, the bias (average of the predicted value and measured value residuals) of models constructed by Crandon et al. (2011), Roberts et al. (2009), and Jaruratanasirikul et al. (2015) were 5.96 μg/mL, 10.91 μg/mL, and 4.41 μg/mL, respectively. Following 2 g meropenem every 8 h (180 min infusion), CFR ≥ 90%, a criterion of success for empirical therapy, was achieved, even with creatinine clearance of 130-250 mL/min. For patients with sepsis and ARC, the model of Jaruratanasirikul et al. showed the highest degree of accuracy and precision and confirmed the efficacy of the meropenem dosing regimen in this patient population.

Keywords: Augmented renal clearance; Meropenem; Pharmacodynamics; Population pharmacokinetic analysis; Sepsis.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / blood
  • Anti-Bacterial Agents / pharmacokinetics*
  • Creatinine / blood
  • Creatinine / urine
  • Female
  • Hospitals, University
  • Humans
  • Intensive Care Units
  • Kidney / physiology*
  • Male
  • Meropenem / administration & dosage*
  • Meropenem / blood
  • Meropenem / pharmacokinetics*
  • Metabolic Clearance Rate
  • Middle Aged
  • Monte Carlo Method
  • Sepsis / drug therapy*
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Creatinine
  • Meropenem