Extended-Infusion Meropenem Now Available

The new meropenem order panel is now available in Epic, which includes the options for extended-infusion (3-hour infusion) and traditional infusion (30-minute infusion). Extended-infusion optimizes the pharmacokinetics/pharmacodynamics of beta-lactam antibiotics, including piperacillin/tazobactam, cefepime, and meropenem.

Several published studies have demonstrated a mortality benefit utilizing extended-infusion. This infusion strategy has been implemented in many academic medical centers and community hospitals across the United States, and is becoming the standard of care.

At UMMC, we are beginning the transition to extended-infusion of beta-lactam antibiotics with meropenem due to it being a restricted antimicrobial. The switch to extended-infusion will only affect the adult medical floors and ICU tower, not pediatric patients.

Extended-infusion is recommended for most patients, but patients can be exempted from receiving extended-infusion if they meet the following exclusion criteria:

• Patients admitted to the emergency department, OR, PACU, and ambulatory areas.
• Medication scheduling and/or drug compatibility conflicts that cannot be resolved without placing additional lines.
• Patients with fluid restriction that will not allow for extra volume (~150 ml/day).

The new meropenem order panel can be located in Epic by typing in "Meropenem," and the order panel can be seen in screenshots below. When extended-infusion is chosen, you will have the option to give a loading dose (LD) or start the medication without a LD. A LD should be considered in patients presenting with sepsis or septic shock, and the maintenance dose should be initiated 4 hours after the LD is given in this patient population. For patients who are not presenting in sepsis or septic shock, and who have received a one-time dose in the ED, the maintenance dose can be scheduled with the normal dosing interval (8 hours after the initial dose).

Please contact your unit-based pharmacists or antimicrobial stewardship (asp@umc.edu) if you need assistance with ordering or have questions regarding extended-infusion.