Continuous versus Intermittent Use of Meropenem in Septic Critically Ill Patients: A Randomized Controlled Trail

Abstract

Background: Meropenem is commonly used in the treatment of critically ill patients with sepsis. However, the optimal dosing regimen remains a subject of debate. This study aimed to compare the pharmacokinetic, clinical, and bacteriological efficacies of continuous infusion of meropenem versus traditional intermittent administration in critically ill patients with sepsis, and to evaluate the safety of both dosing regimens. Methods: This prospective randomized controlled trial was conducted on critically ill patients diagnosed with sepsis and admitted to the ICU. Patients were randomly assigned to either the continuous infusion group (n=30) or the intermittent intravenous group (n=30). Clinical parameters, laboratory data, and clinical outcomes were recorded. Microbiological outcomes, including microbiological eradication and superinfection, were assessed. Pharmacokinetic analysis was performed to evaluate drug concentrations. Results : The superinfection rate (requiring other antibiotics) was lower in the continuous group (3.3%) compared to 16.7% in intermittent group. The mean total fluid infusion in the first 24hr was 4190 ml in the continuous group compared to 4336 ml in the intermittent group. The mean length of ICU stay was 10.10 ± 6.12 days in the continuous group compared to 11.60 ± 5.55 days in the intermittent group. A significantly lower mean duration of meropenem treatment (9.93 days) was associated with continuous group compared to 11.53 days in intermittent group. Mortality rate was lower in the continuous group (26.7%) compared to intermittent group (40%). Conclusion: Continuous infusion of meropenem demonstrated superior clinical and bacteriological outcomes in critically ill septic patients compared to intermittent administration.