Meropenem pharmacokinetics in a patient with multiorgan failure from meningococcemia undergoing continuous venovenous hemodiafiltration

Meropenem is a carbapenem antibiotic with a broad antibacterial spectrum of activity. Its main route of elimination is through the kidneys, with 63% o f the drug excreted unchanged in the urine. Meropenem clearance is diminish ed in renal impairment; therefore, doses need to be adjusted in patients wi th varying degrees of renal function, An appropriate dose of meropenem for patients undergoing continuous venovenous hemodiafiltration (CVVHDF) is unk nown. We evaluated the pharmacokinetics of meropenem in a patient with fulm inant meningococcemia undergoing CVVHDF, Meropenem concentrations in serial venous, arterial, and ultrafiltrate samples after a 1 g intravenous dose w ere measured using high-performance liquid chromatography (HPLC), Meropenem clearance was found to be 129.36 mL/min and 141.29 mL/min for every 8- and 12-hour dosing, respectively. Trough levels were above the MIC90 for Neiss eria meningitidis and most anaerobic pathogens. We recommend that meropenem 1 g intravenously every 12 hours be used as the initial dose in patients u ndergoing CVVHDF, Differences between meropenem clearance during CVVHDF and other forms of renal replacement therapy are discussed. (C) 1999 by the Na tional Kidney Foundation, Inc.