Outcome of Continuous versus Intermittent Application of Meropenem in Critically Ill Patients with Septic Shock

Abstract

Abstract Background Severe infections in critically ill patients and increasing antibiotic resistance are major healthcare problems affecting morbidity and mortality in the intensive care unit. Antibacterial drug discovery and development have slowed considerably in recent years. Aim of the Work Study the outcome of continuous versus intermittent application of meropenem in critically ill patients with septic shock. Patients and Methods This study was carried out on one hundred patients of both sex from those admitted to intensive care unit in Damanhour Medical National Institute.An Informed consent was taken from all patients or their next of kin. Patients were categorized into 2 groups: Group I (Infusion group) patients received a loading dose of 2g of meropenem I.V over 30 minutes followed by continuous infusion of 4g of meropenem over 24 hours. Group II (Bolus group) patients received 2g of meropenem over 30 minutes every 8 hours. Antibiotic therapy stopped at improvement of the clinical state and signs of subsidence of infection (body temperature below 38, 3 °C for more than 24 hours, white blood cells (WBC) count less than 11, 000/mm3 or decrease by 25% of maximal value)minimum time for therapy 5days and maximum time 10 days. Results In the present study there were two groups of critically ill patients with septic shock each of 50 patients. Group one was given meropenem after culture and sensitivity as one gram infusion over 360 minutes every 6 hours. The second group was given meropenem also after culture and sensitivity as two grams bolus over 30 minutes every 8 hours. There were no significant differences between the two groups regarding age and sex distribution. On admission the two groups had high APACHE-II score, but with no significant difference. Also there was no significant difference between the two groups regarding the site of infection nor the infecting organism. As regards WBCs count the mean WBC count was higher in group II than in group I on days 1 and 3 of treatment but there was no statistically significant difference. Conclusion Administration of meropenem on cultured based treatment as 1g/6hrs infusion compared to 2g/8hrs bolus was associated with significant reduction of WBCs count, CRP levels, SOFA score and ICU stay. Improved clinical outcome, reduction in bacterial growth and decreased mortality were better in the infusion group but not significant.