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Safety of megadose meropenem in the empirical treatment of nosocomial sepsis: a pilot randomized clinical trial

    Mohammadreza Salehi

    Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital Complex, Department of Infectious Diseases, Tehran University of Medical Sciences, Tehran, Iran

    ,
    Farah Rezazade-Moayed

    Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital Complex, Department of Infectious Diseases, Tehran University of Medical Sciences, Tehran, Iran

    ,
    Hossein Khalili

    *Author for correspondence: Tel.: +98 216 695 4709;

    E-mail Address: khalilih@tums.ac.ir

    Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital Complex, Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

    ,
    Homa Hemati

    Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital Complex, Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

    ,
    Nasser Aghdami

    Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital Complex, Department of Infectious Diseases, Tehran University of Medical Sciences, Tehran, Iran

    Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology & Technology, Academic Center for Education, Culture & Research, Tehran, Iran

    ,
    Mohadese Dashtkoohi

    Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran

    ,
    Mohammad Dashtkoohi

    Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran

    ,
    Mohammad-Taghi Beig-Mohammadi

    Critical Care Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

    ,
    Masoud Ramezani

    Critical Care Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

    ,
    Mahboobeh Hajiabdolbaghi

    Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital Complex, Department of Infectious Diseases, Tehran University of Medical Sciences, Tehran, Iran

    &
    Samrand Fattah-Ghazi

    Critical Care Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

    Published Online:https://doi.org/10.2217/fmb-2022-0170

    Objective: To evaluate the safety of megadose meropenem as empirical treatment of nosocomial sepsis. Materials & methods: Critically ill patients diagnosed with sepsis received either high-dose (2 g every 8 h) or megadose (4 g every 8 h) meropenem as an intravenous infusion over 3 h. Results: A total of 23 patients with nosocomial sepsis were eligible and included in the megadose (n = 11) or high-dose (n = 12) group. No treatment-related adverse events were observed during a 14-day follow-up. Clinical response was also comparable between the groups. Conclusion: Megadose meropenem may be considered for empirical treatment of nosocomial sepsis without serious concern regarding its safety.

    Plain language summary

    As resistance to antibiotics is increasing among microbes, rational use of these drugs is important both in the community and in hospitals. Many infections with resistant microorganisms may be fatal. For a long time, carbapenems have been the last resort for treatment of resistant microorganisms. Unfortunately, resistance to these drugs is increasing. It appears that use of higher doses of antibiotics may help in some cases. However, the potential harm caused by higher doses is a problem. In this primary study, higher doses of meropenem, a common carbapenem, were found to be safe.

    Papers of special note have been highlighted as: • of interest; •• of considerable interest

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