- Jan 24, 2019 -

Introduction: Severe nosocomial pneumonia in patients in ICUs is caused by a wide range of bacteria and is associated with high rates of morbidity and mortality, as well as high costs.1,2 In this setting, prompt use of b-lactams remains the cornerstone of antibiotic therapy, and among these drugs, meropenem is often chosen because it is well tolerated and has a wide spectrum of activity. 

Meropenem is a time-dependent antibiotic: maintaining unbound drug concentrations in plasma above the MIC for pathogens for at least 40% of the time between doses (≥40% T.MIC) is usually required for optimal bactericidal activity.3,4 In serious bacterial infections this goal could be extended to 100% of the dosing interval,5– 7 so that extended infusion (EI, i.e. dose delivered over several hours) or even continuous infusion (i.e. dose delivered over 24 h) has been proposed in place of the usual intermittent infusion (II, i.e. over a few minutes) to improve pharmacokinetic (PK) and pharmacodynamic (PD) properties.5–13 Furthermore, drug concentration at the site of infection seems to influence efficacy.3,4Dosage of antibiotics in the epithelial lining fluid (ELF) is advocated as the best marker of drug exposure at the site of infection in patients with pneumonia, particularly for extracellular respiratory tract pathogens, although this method has some limitations.14–17 Because PK data can be difficult to obtain, especially at the site of infection, population PK modelling and Monte Carlo simulations

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