Outpatient parenteral antimicrobial therapy with carbapenems: A systematic review - 17/10/24

Doi : 10.1016/j.jinf.2024.106299

Z.T. Wolie ^a,^b, J.A. Roberts ^a,^c,^d,^e, Y.M. Wale ^a,^b, S. Unwin ^f, K. McCarthy ^g,^h, F.B. Sime ^a,^⁎
^a UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, QLD 4029, Australia
^b Department of Pharmacy, College of medicine and health Sciences,Debre Markos University, Debre Markos, Ethiopia
^c Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, QLD, Australia
^d Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia
^e Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, 30029 Nîmes, France
^f Infection Management Services, Metro South Health, Princess Alexandra Hospital, Brisbane, Australia
^g Royal Brisbane Clinical School, Faculty of Medicine, the University of QLD, Australia
^h Department of Infectious Diseases, Royal Brisbane and Women’s Hospital, Brisbane, Australia

^⁎Correspondence to: Building 71/918 RBWH Herston, Brisbane, QLD 4006, Australia.Building 71/918 RBWH HerstonBrisbaneQLD4006Australia

Summary

Objective

To review the literature on parenteral carbapenems in OPAT and present comprehensive evidence on their safety, efficacy, and stability.

Methods

A systematic review following PRISMA guidelines was conducted through 17 January 2024, using PubMed, Embase, Web of Science, Scopus, and the Cochrane Library to find relevant articles.

Results

Ertapenem (1 g QD) in OPAT showed high clinical (81–97%) and microbiological (67–90.9%) success rates. Ertapenem (1 g QD) was also comparable to piperacillin/tazobactam (3.375 g every 6 h) for complicated skin infections and superior to cefazolin (2 g every 8 h) and oxacillin (2 g every 4–6 h) for various infections. Ertapenem monotherapy, once daily, achieved an 81% clinical cure rate for urinary tract infections. Additionally, subcutaneous ertapenem in OPAT showed outcomes comparable to parenteral routes. Meropenem continuous infusion (CI) may also be considered safe and effective in selected patient populations; however, its use in OPAT as a CI is limited due to stability concerns.

Conclusion

Parenteral carbapenems are effective, and well-tolerated OPAT treatment options; nonetheless, further studies are warranted to optimize the stability and/or dosing regimens of meropenem and enable its wider use.

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Keywords : Carbapenems, Efficacy, OPAT, Safety, Stability

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Vol 89 - N° 5

Article 106299- novembre 2024 Retour au numéro

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Outpatient parenteral antimicrobial therapy with carbapenems: A systematic review - 17/10/24

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