Bolus Versus Prolonged Infusion of Meropenem in Newborn With Late Onset Sepsis
Bolus Versus Prolonged Infusion of Meropenem in Newborn With Late Onset Sepsis
Newborns in the neonatal intensive care unit (NICU), especially premature ones with immature
 organ systems, frequently suffer nosocomial infections caused by microorganisms resistant to
 narrow-spectrum antibiotics like ampicillin and gentamicin and require introduction of new
 agents with a wider spectrum of activity.

 Meropenem has activity against wide variety of Gram-negative and Gram-positive bacteria. It
 is well tolerated by children and neonates, including preterm babies, and allowing
 monotherapy instead of combined therapy.

 Severe neonatal infections with increasing antibiotic resistance are major problems affecting
 morbidity and mortality in the NICU. Few number of new antibacterial agents entering the
 clinic and new agents for multi-drug resistant Gram-negative bacteria will unlikely be
 available in the near future.
More research into existing antibiotics with novel mechanisms of action are required to
 combat the increased resistance and decreased development of antibiotics. Efforts were
 exerted to maximize antibiotic efficacy by optimal dosing based on pharmacodynamic and
 pharmacokinetic properties of antibiotics.

 Meropenem is administered mostly via a 30-min infusion, as some data indicate rapid
 degradation after reconstitution. Dose recommendations from two pediatric studies using Monte
 Carlo simulation have emphasized that a 4-h infusion may be needed if microorganisms showed
 increased minimal inhibitory concentrations (MICs), more specifically, for Pseudomonas
 aeruginosa. A prolonged-infusion strategy has not been tested in neonates, although some data
 suggest that extremely small infusion volumes may significantly affect the drug amount
 actually delivered.

 Aim of work:

 The objective of our study is to compare the clinical and bacteriological efficacy of
 conventional intermittent dosing of meropenem to the prolonged infusions in critically-ill
 neonates, with a proactive focus on reducing ventilator days in ventilated patients, length
 of stay in NICU, and neonatal mortality.
Inclusion Criteria:

 -  Neonates admitted to the neonatal care unit (NCU) who suffer from late onset sepsis
 (LOS) at admission or during their NICU stay and receive meropenem for at least four
 days

 Exclusion Criteria:

 -  Acute or chronic renal failure

 -  Hypersensitivity or allergy to meropenem