How to use meropenem in pediatric patients undergoing CKRT? Integrated meropenem pharmacokinetic model for critically ill children
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- dc.contributor.author Butragueño-Laiseca, Laura
- dc.contributor.author Troconiz, Iñaki F.
- dc.contributor.author Grau Cerrato, Santiago
- dc.contributor.author Campillo Ambrós, Núria
- dc.contributor.author Padilla, Belén
- dc.contributor.author Fernández, Sarah Nicole
- dc.contributor.author Slöcker, María
- dc.contributor.author Herrera Castillo, Laura
- dc.contributor.author Santiago, María José
- dc.date.accessioned 2025-02-19T07:23:19Z
- dc.date.available 2025-02-19T07:23:19Z
- dc.date.issued 2024
- dc.description.abstract Standard dosing could fail to achieve adequate systemic concentrations in ICU children or may lead to toxicity in children with acute kidney injury. The population pharmacokinetic analysis was used to simultaneously analyze all available data (plasma, prefilter, postfilter, effluent, and urine concentrations) and provide the pharmacokinetic characteristics of meropenem. The probability of target fT > MIC attainment, avoiding toxic levels, during the entire dosing interval was estimated by simulation of different intermittent and continuous infusions in the studied population. A total of 16 critically ill children treated with meropenem were included, with 7 of them undergoing continuous kidney replacement therapy (CKRT). Only 33% of children without CKRT achieved 90% of the time when the free drug concentration exceeded the minimum inhibitory concentration (%fT > MIC) for an MIC of 2 mg/L. In dose simulations, only continuous infusions (60-120 mg/kg in a 24-h infusion) reached the objective in patients <30 kg. In patients undergoing CKRT, the currently used schedule (40 mg/kg/12 h from day 2 in a short infusion of 30 min) was clearly insufficient in patients <30 kg. Keeping the dose to 40 mg/kg q8h without applying renal adjustment and extended infusions (40 mg/kg in 3- or 4-h infusion every 12 h) was sufficient to reach 90% fT > MIC (>2 mg/L) in patients >10 kg. In patients <10 kg, only continuous infusions reached the objective. In patients >30 kg, 60 mg/kg in a 24-h infusion is sufficient and avoids toxicity. This population model could help with an individualized dosing approach that needs to be adopted in critically ill pediatric patients. Critically ill patients subjected to or not to CKRT may benefit from the administration of meropenem in an extended or continuous infusion.
- dc.format.mimetype application/pdf
- dc.identifier.citation Butragueño-Laiseca L, Troconiz IF, Grau S, Campillo N, Padilla B, Fernández SN, et al. How to use meropenem in pediatric patients undergoing CKRT? Integrated meropenem pharmacokinetic model for critically ill children. Antimicrob Agents Chemother. 2024 Jun 5;68(6):e0172923. DOI: 10.1128/aac.01729-23
- dc.identifier.doi http://dx.doi.org/10.1128/aac.01729-23
- dc.identifier.issn 0066-4804
- dc.identifier.uri http://hdl.handle.net/10230/69635
- dc.language.iso eng
- dc.publisher American Society for Microbiology
- dc.relation.ispartof Antimicrob Agents Chemother. 2024 Jun 5;68(6):e0172923
- dc.rights © 2024 Butragueño-Laiseca et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license (http://creativecommons.org/licenses/by/4.0/).
- dc.rights.accessRights info:eu-repo/semantics/openAccess
- dc.rights.uri http://creativecommons.org/licenses/by/4.0/
- dc.subject.keyword Acute kidney injury
- dc.subject.keyword Continuous kidney replacement therapy
- dc.subject.keyword Continuous renal replacement therapy
- dc.subject.keyword Critically ill children
- dc.subject.keyword Dose individualization
- dc.subject.keyword Meropenem
- dc.subject.keyword Population pharmacokinetics
- dc.title How to use meropenem in pediatric patients undergoing CKRT? Integrated meropenem pharmacokinetic model for critically ill children
- dc.type info:eu-repo/semantics/article
- dc.type.version info:eu-repo/semantics/publishedVersion