Optimizing meropenem therapy in critical infections: a review of pharmacokinetics/pharmacodynamics research and clinical practice

INTRODUCTION: Meropenem is a first-line antibiotic used in the treatment of severe infections. However, patients with critical infections often exhibit a notably low pharmacokinetic/pharmacodynamic (PK/PD) compliance rate, especially in cases involving multidrug-resistant gram-negative bacteria and in specific patient populations. AREAS COVERED: This article reviews the relevant literature on the use of meropenem in treating severe infections, with data primarily sourced from PubMed, Web of Science, Embase, and Cochrane databases before July 2024. The primary analysis focuses on determining the optimal clinical efficacy target value for meropenem in treating multidrug-resistant Gram-negative bacteria infection, exploring PK/PD research, individualizing drug regiments for special populations, and evaluating safety. EXPERT OPINION: Based on the PK/PD properties of meropenem across different special populations such as children and elderly patients, as well as its efficacy against severe infections and multidrug-resistant Gram-negative infections, prolonged and continuous infusion regimens of meropenem have already shown some clinical benefit. Personalized dosing of meropenem for critical infections should be guided by real-time therapeutic drug monitoring (TDM). However, there is a notable lack of sufficient data, highlighting the necessity for large-scale, multi-center clinical trials to validate the safety and effectiveness of meropenem in treating severe infections.