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.
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.
Arnold
Heather M
HM
Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri 63110, USA.
McKinnon
Peggy S
PS
Augustin
Kristan M
KM
Hladnik
Lindsay M
LM
Casabar
Ed
E
Reichley
Richard M
RM
Dubberke
Erik R
ER
Westervelt
Peter
P
Ritchie
David J
DJ
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
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D004338:Drug Combinations; D013845:Thienamycins; D015377:Cilastatin; D015378:Imipenem; D000077723:Cefepime; D000077728:Cilastatin, Imipenem Drug Combination; D000077731:Meropenem