Efficacy of an alternative dosing strategy of meropenem in the treatment of high-risk febrile neutropenia in adult subjects

Velliyur Viswesh, Myke R. Green, Edward P Armstrong

Research output: Contribution to journalArticle

Abstract

BACKGROUND: High-risk febrile neutropenia (FN), an oncologic emergency common in patients receiving myelosuppressive chemotherapy, requires prompt initiation of broad-spectrum antibacterials with current guidelines recommending meropenem 1 g intravenously (IV) every 8 hours as first-line treatment. However, an alternative dosage of meropenem, 500 mg IV every 6 hours, has been shown to attain a similar percentage of time above the minimum inhibitory concentration (%T > minimum inhibitory concentration) with a lower daily dose and associated drug cost in nonneutropenic subjects. METHODS: A retrospective study was conducted in adult subjects with FN who received the alternative dosage of meropenem during a 31-month period (February 2009 to August 2011). The primary end point was time to defervescence. Secondary end points included the need for additional gram-negative antibacterials, duration of meropenem treatment, and in-hospital mortality. RESULTS: A total of 449 subjects were screened with 74 meeting inclusion criteria. Median time to defervescence was 2 days. Additional gram-negative antibacterials were used in 6 subjects (8.1%), and in-hospital mortality occurred in 5 subjects (6.8%). Median duration of meropenem treatment was 5 days. There was a significant correlation toward a longer time to defervescence with longer durations of neutropenia (r = 0.272, P = 0.034). CONCLUSIONS: The alternative meropenem dosage regimen of 500 mg IV every 6 hours therefore yields similar outcomes as previously reported with conventional doses of 1 g IV every 8 hours in adults with FN, with potential cost savings due to a decreased daily meropenem dose.

Original languageEnglish (US)
Pages (from-to)283-287
Number of pages5
JournalInfectious Diseases in Clinical Practice
Volume22
Issue number5
DOIs
StatePublished - 2014

Fingerprint

meropenem
Febrile Neutropenia
Microbial Sensitivity Tests
Hospital Mortality
Therapeutics
Drug Costs
Cost Savings
Neutropenia
Emergencies

Keywords

  • dose optimization
  • febrile neutropenia
  • meropenem therapy
  • pharmacodynamics
  • pharmacokinetics

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Efficacy of an alternative dosing strategy of meropenem in the treatment of high-risk febrile neutropenia in adult subjects. / Viswesh, Velliyur; Green, Myke R.; Armstrong, Edward P.

In: Infectious Diseases in Clinical Practice, Vol. 22, No. 5, 2014, p. 283-287.

Research output: Contribution to journalArticle

@article{c4846c339bee428eb5918f1f045c8ffb,
title = "Efficacy of an alternative dosing strategy of meropenem in the treatment of high-risk febrile neutropenia in adult subjects",
abstract = "BACKGROUND: High-risk febrile neutropenia (FN), an oncologic emergency common in patients receiving myelosuppressive chemotherapy, requires prompt initiation of broad-spectrum antibacterials with current guidelines recommending meropenem 1 g intravenously (IV) every 8 hours as first-line treatment. However, an alternative dosage of meropenem, 500 mg IV every 6 hours, has been shown to attain a similar percentage of time above the minimum inhibitory concentration ({\%}T > minimum inhibitory concentration) with a lower daily dose and associated drug cost in nonneutropenic subjects. METHODS: A retrospective study was conducted in adult subjects with FN who received the alternative dosage of meropenem during a 31-month period (February 2009 to August 2011). The primary end point was time to defervescence. Secondary end points included the need for additional gram-negative antibacterials, duration of meropenem treatment, and in-hospital mortality. RESULTS: A total of 449 subjects were screened with 74 meeting inclusion criteria. Median time to defervescence was 2 days. Additional gram-negative antibacterials were used in 6 subjects (8.1{\%}), and in-hospital mortality occurred in 5 subjects (6.8{\%}). Median duration of meropenem treatment was 5 days. There was a significant correlation toward a longer time to defervescence with longer durations of neutropenia (r = 0.272, P = 0.034). CONCLUSIONS: The alternative meropenem dosage regimen of 500 mg IV every 6 hours therefore yields similar outcomes as previously reported with conventional doses of 1 g IV every 8 hours in adults with FN, with potential cost savings due to a decreased daily meropenem dose.",
keywords = "dose optimization, febrile neutropenia, meropenem therapy, pharmacodynamics, pharmacokinetics",
author = "Velliyur Viswesh and Green, {Myke R.} and Armstrong, {Edward P}",
year = "2014",
doi = "10.1097/IPC.0000000000000141",
language = "English (US)",
volume = "22",
pages = "283--287",
journal = "Infectious Diseases in Clinical Practice",
issn = "1056-9103",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Efficacy of an alternative dosing strategy of meropenem in the treatment of high-risk febrile neutropenia in adult subjects

AU - Viswesh, Velliyur

AU - Green, Myke R.

AU - Armstrong, Edward P

PY - 2014

Y1 - 2014

N2 - BACKGROUND: High-risk febrile neutropenia (FN), an oncologic emergency common in patients receiving myelosuppressive chemotherapy, requires prompt initiation of broad-spectrum antibacterials with current guidelines recommending meropenem 1 g intravenously (IV) every 8 hours as first-line treatment. However, an alternative dosage of meropenem, 500 mg IV every 6 hours, has been shown to attain a similar percentage of time above the minimum inhibitory concentration (%T > minimum inhibitory concentration) with a lower daily dose and associated drug cost in nonneutropenic subjects. METHODS: A retrospective study was conducted in adult subjects with FN who received the alternative dosage of meropenem during a 31-month period (February 2009 to August 2011). The primary end point was time to defervescence. Secondary end points included the need for additional gram-negative antibacterials, duration of meropenem treatment, and in-hospital mortality. RESULTS: A total of 449 subjects were screened with 74 meeting inclusion criteria. Median time to defervescence was 2 days. Additional gram-negative antibacterials were used in 6 subjects (8.1%), and in-hospital mortality occurred in 5 subjects (6.8%). Median duration of meropenem treatment was 5 days. There was a significant correlation toward a longer time to defervescence with longer durations of neutropenia (r = 0.272, P = 0.034). CONCLUSIONS: The alternative meropenem dosage regimen of 500 mg IV every 6 hours therefore yields similar outcomes as previously reported with conventional doses of 1 g IV every 8 hours in adults with FN, with potential cost savings due to a decreased daily meropenem dose.

AB - BACKGROUND: High-risk febrile neutropenia (FN), an oncologic emergency common in patients receiving myelosuppressive chemotherapy, requires prompt initiation of broad-spectrum antibacterials with current guidelines recommending meropenem 1 g intravenously (IV) every 8 hours as first-line treatment. However, an alternative dosage of meropenem, 500 mg IV every 6 hours, has been shown to attain a similar percentage of time above the minimum inhibitory concentration (%T > minimum inhibitory concentration) with a lower daily dose and associated drug cost in nonneutropenic subjects. METHODS: A retrospective study was conducted in adult subjects with FN who received the alternative dosage of meropenem during a 31-month period (February 2009 to August 2011). The primary end point was time to defervescence. Secondary end points included the need for additional gram-negative antibacterials, duration of meropenem treatment, and in-hospital mortality. RESULTS: A total of 449 subjects were screened with 74 meeting inclusion criteria. Median time to defervescence was 2 days. Additional gram-negative antibacterials were used in 6 subjects (8.1%), and in-hospital mortality occurred in 5 subjects (6.8%). Median duration of meropenem treatment was 5 days. There was a significant correlation toward a longer time to defervescence with longer durations of neutropenia (r = 0.272, P = 0.034). CONCLUSIONS: The alternative meropenem dosage regimen of 500 mg IV every 6 hours therefore yields similar outcomes as previously reported with conventional doses of 1 g IV every 8 hours in adults with FN, with potential cost savings due to a decreased daily meropenem dose.

KW - dose optimization

KW - febrile neutropenia

KW - meropenem therapy

KW - pharmacodynamics

KW - pharmacokinetics

UR - http://www.scopus.com/inward/record.url?scp=84906939761&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84906939761&partnerID=8YFLogxK

U2 - 10.1097/IPC.0000000000000141

DO - 10.1097/IPC.0000000000000141

M3 - Article

AN - SCOPUS:84906939761

VL - 22

SP - 283

EP - 287

JO - Infectious Diseases in Clinical Practice

JF - Infectious Diseases in Clinical Practice

SN - 1056-9103

IS - 5

ER -