title: Continuous infusions of meropenem in ambulatory care: clinical efficacy, safety and stability.
abstract: OBJECTIVE
  Concerns regarding the clinical impact of meropenem instability in continuous infusion (CI) devices may contribute to inconsistent uptake of this method of administration across outpatient parenteral antimicrobial therapy (OPAT) services.
  
  
  METHODS
  We retrospectively reviewed the clinical efficacy and safety of CIs of meropenem in two Australian tertiary hospitals and assessed its stability under simulated OPAT conditions including in elastomeric infusion devices containing 1% (2.4 g) or 2% (4.8 g) concentrations at either 'room temperature' or 'cooled' conditions. Infusate aliquots were assayed at different time-points over 24 hours.
  
  
  RESULTS
  Forty-one (82%) of 50 patients had clinical improvement or were cured. Adverse patient outcomes including hemato-, hepato- and nephrotoxicity were infrequent. Cooled infusers with 1% meropenem had a mean 24-hour recovery of 90.3%. Recoveries of 1% and 2% meropenem at room temperature and 2% under cooled conditions were 88%, 83% and 87%, respectively. Patients receiving 1% meropenem are likely to receive >95% of the maximum deliverable dose (MDD) over a 24-hour period whilst patients receiving 2% meropenem should receive 93% and 87% of the MDD under cooled and room temperature conditions, respectively.
  
  
  CONCLUSIONS
  Meropenem infusers are likely to deliver ∼95% MDD and maintain effective plasma concentrations throughout the dosing period. These data reflect our local favourable clinical experience with meropenem CIs.
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Infectious Diseases, Fremantle Hospital and Health Service, Fremantle, Western Australia, Australia.
authors.forename: Laurens
authors.initials: L
authors.lastname: Manning
authors.affiliation: Pharmacy Department, Fremantle Hospital and Health Service, Fremantle, Western Australia, Australia.
authors.forename: Cameron
authors.initials: C
authors.lastname: Wright
authors.affiliation: Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Ingram
authors.affiliation: Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Whitmore
authors.affiliation: Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia; School of Medicine and Pharmacology, University of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Heath
authors.affiliation: Pharmacy Department, Fremantle Hospital and Health Service, Fremantle, Western Australia, Australia.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Manson
authors.affiliation: School of Pharmacy, Curtin University, Bentley, Western Australia, Australia.
authors.forename: Madhu
authors.initials: M
authors.lastname: Page-Sharp
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: Sam
authors.initials: S
authors.lastname: Salman
authors.affiliation: Department of Infectious Diseases, Fremantle Hospital and Health Service, Fremantle, Western Australia, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Dyer
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: Timothy M E
authors.initials: TM
authors.lastname: Davis
mesh_terms: D000553:Ambulatory Care / Q000379:methods*; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D001315:Australia; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007260:Infusion Pumps / Q000009:adverse effects / Q000592:standards*; D007263:Infusions, Parenteral / Q000379:methods*; D000077731:Meropenem; D012189:Retrospective Studies; D013696:Temperature; D013845:Thienamycins / Q000008:administration & dosage* / Q000737:chemistry
chemical_list: D000890:Anti-Infective Agents; D013845:Thienamycins; D000077731:Meropenem