Meropenem Exposure, Target Attainment, and Therapeutic Drug Monitoring Practices in Critically Ill Adults Receiving Continuous Renal Replacement Therapy: A Systematic Review.

Authors

Nazatul Adhwa Mohd Rozi, Lim Jia Hui, Shamin Saffian, Mohd Makmor-Bakry, Aliza Mohamad Yusof, Ruslinda Mustafar, Muhammad Nordin M Saud, Nor Asyikin Mohd Tahir

Published in

The Annals of pharmacotherapy. Pages 10600280261489958. Oct 19, 2026. Epub Oct 19, 2026.

Abstract

To critically evaluate meropenem pharmacokinetics/pharmacodynamics (PK/PD) target attainment, therapeutic drug monitoring (TDM), infusion strategies, and clinical outcomes during continuous renal replacement therapy (CRRT).
Ovid MEDLINE, PubMed, Scopus, Web of Science, and the Cochrane Library were searched from inception to August 15, 2026, using meropenem, TDM, β-lactam, and CRRT terms, with adult, human, and English-language limits.
Thirteen reports representing 12 unique studies (2 randomized, 10 non-randomized) reporting meropenem concentration data during CRRT were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2 or ROBINS-I.
Total clearance ranged from 3.60 to 6.6 L/h. Lower or primary PK/PD target non-attainment ranged from 0% to 26.7%, while aggressive-target non-attainment ranged from 0% to 53.3% in most analyses and reached 93% in 1 study when a minimum inhibitory concentration (MIC) of 8 mg/L was assumed. Continuous or prolonged infusion may facilitate sustained exposure, but comparative evidence was limited. Four used routine TDM; only 2 implemented protocolized TDM-guided dose adjustment. Low exposure was associated with higher mortality in 1 adjusted observational analysis, but evidence for clinical outcomes was of very low certainty.
Standardized meropenem regimens cannot be assumed to provide consistent exposure during CRRT. Optimized infusion and timely, protocolized TDM may support individualized dosing when multidisciplinary expertise is available.
Available evidence supports a shift from standardized empirical dosing toward individualized, measurement-guided meropenem therapy in patients receiving CRRT.

PMID:
42897879
Bibliographic data and abstract were imported from PubMed on 20 Oct 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.