Meropenem Clearance in a Child With End-stage Renal Disease Undergoing Prolonged Intermittent Renal Replacement Therapy: A Case Report and Literature Review.

Abstract

BACKGROUND:

Meropenem is frequently used to treat severe infections in critically ill children. However, pharmacokinetic data on meropenem in children with end-stage renal disease (ESRD) undergoing prolonged intermittent renal replacement therapy (PIRRT) is limited. Our objectives were to evaluate meropenem clearance in a child with ESRD with and without PIRRT, compare the results to previous continuous renal replacement therapy studies in children, toddlers and neonates, and assess whether the currently used dose of meropenem is sufficient.

CASE DESCRIPTION:

A 5-year-old girl with an estimated glomerular filtration rate of 12.8 mL/min/1.73 m 2 was diagnosed with pulmonary infection and treated with 300 mg meropenem once a day. PIRRT was performed for 8 hours every 2 days. We used WinNonlin to evaluate meropenem clearance with and without PIRRT.

RESULTS:

Our case showed that PIRRT increased the clearance of meropenem from 1.39 (1.3) to 2.42 L/h (2.3 mL/kg/min) and caught up 42.6% of the total clearance. This result is in accordance with previous studies in children but slightly less than seen in toddlers and neonates under continuous renal replacement therapy. The current dose of 300 mg once a day is not sufficient to reach the therapeutic target.

CONCLUSIONS:

Predicting meropenem clearance in children with ESRD undergoing PIRRT is difficult as clearance will be affected by renal function, PIRRT settings and other factors. Further studies are needed to explore the individual variability of meropenem clearance and optimize the dosing regimen.

• Authors: Hai-Yan Shi, Wei Zhang, Wei Cao, John van den Anker, Xiao-Yu Chen, Wei Zhao
• Journal: The Pediatric infectious disease journal (Pediatr Infect Dis J) Vol. 42 Issue 12 Pg. 1073-1076 (Dec 01 2023) ISSN: 1532-0987 [Electronic] United States
• PMID: 37725827 (Publication Type: Review, Case Reports, Journal Article)
• Copyright: Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Meropenem

Topics

• Child, Preschool
• Female
• Humans
• Anti-Bacterial Agents (pharmacokinetics)
• Continuous Renal Replacement Therapy
• Critical Illness (therapy)
• Intermittent Renal Replacement Therapy (methods)
• Kidney Failure, Chronic (therapy, drug therapy)
• Meropenem (pharmacokinetics)
• Drug Elimination Routes