title: Assessment of an alternative meropenem dosing strategy compared with imipenem-cilastatin or traditional meropenem dosing after cefepime failure or intolerance in adults with neutropenic fever.
abstract: OBJECTIVE
  To compare clinical outcomes of patients receiving an alternative dosage of meropenem with those of patients receiving imipenem-cilastatin or the traditional dosage of meropenem after failure of or intolerance to cefepime for treatment of febrile neutropenia.
  
  
  METHODS
  Retrospective, single-center cohort study.
  
  
  METHODS
  1250-bed urban academic medical center.
  
  
  METHODS
  One hundred twenty-seven adults with neutropenic fever who received either imipenem-cilastatin or meropenem; imipenem-cilastatin was the preferred carbapenem until September 1, 2006, after which meropenem became the formulary carbapenem.
  
  
  RESULTS
  Of the 127 patients, 40 received imipenem-cilastatin 500 mg every 6 hours between September 1, 2005, and August 31, 2006; 87 patients received meropenem between September 1, 2006, and August 31, 2007: 29 received a traditional dosage of meropenem 1 g every 8 hours, and 58 received an alternative dosage of meropenem 500 mg every 6 hours. Primary outcomes of time to defervescence (median 3 vs 2 vs 3 days), need for additional antibiotics (20% vs 17% vs 14%), and time to receipt of additional antibiotics (median 5 vs 2 vs 1 days) were not significantly different among the imipenem-cilastatin, traditionally dosed meropenem, and alternatively dosed meropenem groups, respectively. In addition, significant differences in secondary outcomes, which were treatment duration (median 10 vs 8 vs 8 days), seizure rate (0% vs 0% vs 0%), in-hospital mortality (5% vs 7% vs 7%), and 30-day mortality (13% vs 7% vs 14%), were not identified among the three groups, respectively.
  
  
  CONCLUSIONS
  The alternative meropenem dosage of 500 mg every 6 hours yielded similar patient outcomes, including time to defervescence, need for additional antibiotics, duration of therapy, and mortality, when compared with the traditional meropenem dosage and imipenem-cilastatin in adults with febrile neutropenia. In addition, no adverse effects on clinical outcomes were observed with the alternative dosage of meropenem.
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri 63110, USA.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Arnold
authors.forename: Peggy S
authors.initials: PS
authors.lastname: McKinnon
authors.forename: Kristan M
authors.initials: KM
authors.lastname: Augustin
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Hladnik
authors.forename: Ed
authors.initials: E
authors.lastname: Casabar
authors.forename: Richard M
authors.initials: RM
authors.lastname: Reichley
authors.forename: Erik R
authors.initials: ER
authors.lastname: Dubberke
authors.forename: Peter
authors.initials: P
authors.lastname: Westervelt
authors.forename: David J
authors.initials: DJ
authors.lastname: Ritchie
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000077723:Cefepime; D002511:Cephalosporins / Q000009:adverse effects* / Q000627:therapeutic use; D015377:Cilastatin / Q000008:administration & dosage; D000077728:Cilastatin, Imipenem Drug Combination; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D005260:Female; D005334:Fever / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D019233:Retreatment; D012640:Seizures / Q000188:drug therapy; D013845:Thienamycins / Q000008:administration & dosage*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D004338:Drug Combinations; D013845:Thienamycins; D015377:Cilastatin; D015378:Imipenem; D000077723:Cefepime; D000077728:Cilastatin, Imipenem Drug Combination; D000077731:Meropenem