From the Guidelines
The recommended duration of therapy for ESBL infections treated with Merrem (meropenem) is 7 to 14 days, depending on the site and severity of infection, as indicated in the most recent guidelines 1.
Key Considerations
- The duration of therapy should be individualized according to infection sites, source control, underlying comorbidities, and the initial response to therapy 1.
- For bloodstream infections, the recommended treatment duration is 7 to 14 days 1.
- For complicated urinary tract infections and complicated intra-abdominal infections, the recommended treatment duration is 5 to 7 days 1.
Treatment Details
- The standard adult dosage of meropenem for serious ESBL infections is 1 gram administered intravenously every 8 hours, with dose adjustments needed for patients with renal impairment.
- Extended-infusion of meropenem for 3 hours is suggested if the meropenem MIC is ≥ 8 mg/L 1.
Clinical Response
- Clinical improvement should be evident within 48-72 hours of initiating appropriate therapy.
- Follow-up cultures may be warranted to confirm clearance of the infection.
Rationale
- Meropenem is effective against ESBL-producing organisms because it belongs to the carbapenem class of antibiotics, which are resistant to hydrolysis by ESBL enzymes due to their unique molecular structure 1.
From the Research
Duration of Therapy for Merrem ESBL
The recommended duration of therapy for ESBL (Extended-Spectrum Beta-Lactamase) infections treated with Merrem (meropenem) can vary depending on the specific infection and patient population.
- For complicated urinary tract infections, a study found that short courses of antimicrobial treatment (≤ 7 days) were effective, with no significant difference in mortality or reinfection rates compared to longer courses (> 7 days) 2.
- Another study reported a median treatment duration of 11 days with ertapenem, a similar antibiotic, for ESBL-positive gram-negative bacteraemia 3.
- A study on the use of meropenem for urinary tract infections found that a treatment course of 7 to 10 days was effective 4.
- The duration of therapy may also depend on the severity of the infection, the patient's underlying health conditions, and the susceptibility of the infecting organism to meropenem.
Treatment Duration in Specific Patient Populations
- In children with complicated urinary tract infections caused by ESBL-producing bacteria, a mean duration of ertapenem treatment of 7.8 days was reported 5.
- In adults with ESBL-positive gram-negative bacteraemia, a median treatment duration of 11 days with ertapenem was reported 3.
Considerations for Treatment Duration
- The treatment duration should be individualized based on the patient's response to therapy and the severity of the infection.
- The use of meropenem or other antibiotics should be guided by susceptibility testing and clinical experience 6.