Introduction

Meropenem is a significantly effective beta lactam antibiotic in patients with serious infections. Although studies have reported that prolonged infusion of meropenem had better antibacterial activity than intermittent bolus in patients infected with less sensitive pathogen, however, there is inconclusive data regarding the clinical outcomes between two groups.

Aim

To conduct a meta-analysis of published literatures to evaluate whether prolonged (extended or continuous) infusion of meropenem could improve clinical outcomes

Patient Profile

• 951 patients with severe infections treated by meropenem (mostly intensive care unit, ICU, patients)

Method

Study Design

• Meta-analysis was performed on data from six randomized control trials and four observational studies, with relatively high quality and comparing the clinical outcomes of meropenem prolonged infusion and intermittent bolus groups

Endpoints

• Clinical success: defined as clinical cure (disappearance of all signs and symptoms related to the infection) and clinical improvement (partial resolution of clinical signs and symptoms related to the infection) in some studies or as clinical cure only in some studies

Results

Efficacy

• Meropenem prolonged (extended or continuous) infusion group achieved a higher clinical success rate (odds ratio 2.10) as compared to meropenem intermittent bolus group
• Also, meropenem prolonged infusion group was associated with a lower mortality (risk ratio 0.66) versus meropenem intermittent bolus group
• One study reported that continuous infusion of meropenem reduced the length of stay in the ICU

Safety 

• Adverse events were reported in three studies during the therapy but the results were inconsistent
• The total adverse event rates were almost 40% and no significant difference was found between two groups
• One study reported that acute kidney injuries were more common in intermittent bolus group

Conclusion

Prolonged infusion of meropenem achieved better clinical success as compared to meropenem intermittent bolus in patients with severe infection or infected by less sensitive microbials.

PLoS ONE 13(7): e0201667