The Impact of Meropenem Infusion Time on Resistant Strains Selection in Anus and Throat

• Main Authors: Yi-Chun Hung, 洪宜君
• Other Authors: 王任賢
• Format: Others
• Language: zh-TW
• Published: 2007
• Online Access: http://ndltd.ncl.edu.tw/handle/41441225607354931669

碩士 === 中國醫藥大學 === 醫學研究所碩士班 === 95 === Background Meropenem, a broad-spectrum antibiotic of carbapenem, is active against both gram-positive and negative organisms. There were postulate that the way of administration may influence effect of the pharmacodynamics in bactericidal activity (%T＞MIC). However , the bactericidal activity is coherent between the high dosage (2000 mg) and low dosage (500 mg). In the view of cost effectiveness goal, choice the low dose 500 mg meropenem with correct administration way may a best priority of strategy. Objectives The aims of this study was to differentiated the pharmacodynamics between 3 hours infusion and 30 minutes infusion of 500 mg meropenem. Materials and methods This was open-randomized study, adults with ventilation in the intensive care had infection required antimicrobial agent treatment were randomized to receive 500 mg of meropenem every 6 hours by 3 hours or 30 minutes infusion for 2 weeks. Throat and anus swab cultures were obtained at baseline and at the end of study therapy and take culture to compare the change of throat and gut flora. Endpoints： Observations and comparison the change of throat and gut flora. Result： One hundred and four patients were randomized to receive 30 minutes (n=55) or 3 hours (n=49) infusion of meropenem. Throat and anus swab cultures of these patients were done before and after meropenem administration. The throat culture results of 30 minutes infusion group before and after meropenem use were Enterobacteriaceae (27/3)、ESBL-producing Enterobacteriaceae (12/0) and glucose-non-ferment gram-negative bacilli (GNFGNB) (30/31); 3 hours group were Enterobacteriaceae (23/0)、ESBL-producing Enterobacteriaceae (8/0) and GNFGNB (39/37). The anus culture results of 30 minutes infusion group before and after meropenem use were Enterobacteriaceae (53/48)、ESBL-producing Enterobacteriaceae (42/28) and GNFGNB (15/27); 3 hours group were Enterobacteriaceae (46/32)、ESBL-producing Enterobacteriaceae (38/16) and GNFGNB (12/20). Conclusion： 3 hours infusion of meropenem 500 mg every 6 hours has more decreasing the colonization of Enterobacteriaceae, ESBL– producing Enterobacteriaceae strains and Amp C inducible strains in throat and anus than 30 minutes infusion.