PHARMACOKINETICS AND CLINICAL EFFICACY OF MEROPENEM IN SURGICAL INFECTIONS

• Published in: CHEMOTHERAPY Vol. 40; no. Supplement1; pp. 553 - 562
• Main Authors: Tanimura, Hiroshi, Kawaguchi, Tomiji, Azuma, Yoshinori, Fukiage, Osamu, Ohnishi, Hironobu, Oka, Masami, Kobayashi, Yasuto, Uchiyama, Kazuhisa, Michiura, Jun, Aoki, Yozo, Oka, Sumikazu
• Format: Journal Article
• Language: English; Japanese
• Published: Japanese Society of Chemotherapy 1992
• Subjects: Meropenem
• DOI: 10.11250/chemotherapy1953.40.Supplement1_553
• EISSN: 1884-5894
• ISSN: 0009-3165

Meropenem (MEPM), a new injectable carbapenem antibiotic, has a broad spectrum of antibacterial activity against aerobic and anaerobic bacteria. It is expected that MEPM will be usuful for the treatment of surgical infections. Fundamental and clinical studies on MEPM in the surgical field were performed and the results were as follows. 1) The concentrations of MEPM in blood, urine, bile and pancreatic juice were determined in two patients receiving MEPM, 0.5 g. Peak levels were as follows: blood, 11.4 and 25.6 μg/ml immediately after completion of infusion; urine, 2, 210 and 2, 450 μg/ml at 1 h after completion of infusion; bile, 2.07 μg/ml at 1 h and 6.59 μg/ml at 3 h; pancreatic juice, 1.01 and 4.32 μg/ml at 1 h. 2) MEPM and IPM/CS were administered to two patients undergoing pancreatoduodenectomy in a crossover design, and the distributions of the respective drugs in the bile and pancreatic juice were compared. The blood concentrations at completion of the 30 min drip of 0.5 g MEPM were 11.2 and 16.0μg/ml; the peak concentrations in bile were 1.62 and 2.54 μg/ml; and the peak concentrations in pancreatic juice were 0.74 and 0.08 μg/ml. All these values were comparable to those for IPM. 3) MEPM at a dose of 0.5 g was administered to three patients with an indwelling T-tube and the biliary concentration of MEPM was determined. Peak biliary levels of 7.59, 2.86 and 6.43 μg/ml were obtained at 1-2 h after initiation of administration. 4) MEPM at a dose of 0.5g was administered by intravenous drip twice or three times daily for 3 to 19 days to 18 patients: 6 with peritonitis, 3 with intraperitoneal abscess, 2 with cholecystitis, 4 with cholangitis, 1 with pancreatitis and 2 with postoperative wound infection. The clinical efficacy was evaluated in 15 cases. The results were excellent in 2 cases, good in 8, fair in 3, and poor in 2, an efficacy rate of 66.7%. Abnormal laboratory findings were elevated S-GOT, S-GPT, ALP and γ-GTP in 1 case and slightly increased eosinophils in 2 cases.