Interacción entre meropenem y ácido valproico: A propósito de dos casos pediátricos / Pharmacological interaction between meropenem and valproic acid: a report of two cases

The pharmacological interaction between meropenem and valproic acid is potentially serious, especially in critically ill patients, resulting in low plasmatic levels of the anticonvulsant. However, to our knowledge, this interaction between meropenem and reduced valproic acid plasma levels has not been reported in the pediatric chilean population. We present two clinical cases of chilean children, thus reporting that this interaction is present in our population, with an aim at educating physicians about the possibility of such interaction.

La interacción farmacológica entre meropenem y ácido valproico en pacientes críticos es potencialmente grave, reflejándose en una disminución del fármaco anticonvulsivante mayor a 70%. Se desconocen estrategias efectivas que la reviertan. Esta interacción no ha sido descrita en pacientes chilenos pediátricos. A través de la presentación de dos casos clínicos alertamos que la interacción puede suceder en nuestra población y educamos a los pediatras que indican meropenem sobre la posibilidad de este evento.

Carbapenem resistance in gram-negative bacilli isolates in an Iranian 1000-bed tertiary hospital

Carbapenems are beta-lactamase antibiotics, presently considered as most potent agents for treatment of infections caused by Gram-negative bacilli. The aim of this study was to determine resistance of Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumonniae as prevalent nosocomial agents to commonly used antibiotics including carbapenems such as imipenem and meropenem. A total of 202 gram-negative bacilli including K. pneumoniae, P aeruginosa and A. baumannii isolated from hospitalized patients in Milad hospital of Tehran were subject for susceptibility testing. Susceptibility testing was performed by disk diffusion and MIC methods as recommended by Clinical Laboratory Standards Institute [CLSI]. All isolates of K. pneumonia were susceptible to imipenem and meropenem. Resistance in non-fermenting gram-negative bacilli [NFGB] was prevalent. P. aeruginosa isolates exhibited 7.5% and 40.2% resistance to imipenem and meropenem respectively. The majority isolates of Acinetobacter baumannii were multi-drug resistant and resistance of this organism to imipenem and meropenem was 27.7% and 38.5% respectively. Our study revealed that in spite of resistance of K. pneumoniae to commonly used antibiotics, all isolates were susceptible to imipenem and meropeem. More than 80% isolates of A. bammanni were resistant to commonly used antibiotics. About 40.2% isolates of P. aeruginosa and [38.5%] isolates of A. baumannii were resistant to meropenem respectively

Efficacy and safety of meropenem as an empirical treatment for febrile neutropenia in children with cancer.

Meropenem is a promising carbapenem antibiotic as an empirical monotherapy in patients with febrile neutropenia (FN). With the limited data of the therapy in pediatric patients, the authors conducted this study to evaluate the efficacy and safety of meropenem as empirical antibiotic therapy in 30 pediatric cancer patients with FN (mean age = 7.5 years), who were admitted to King Chulalongkorn Memorial Hospital from May 2000 to December 2001. Meropenem 60 mg/kg/day was given intravenously every 8 hours. The efficacy of meropenem was assessed as successful, inconclusive and failure on days 3 and 5 of the therapy and compared to that of other empirical antibiotics used from January 1997 to April 2000. The study showed that six blood culture specimens (20%) grew organisms, half of which were considered to be contaminants, and six urine culture specimens (20%) grew gram negative rod bacteria. On day 3 and 5 of the therapy, the success rate of meropenem was higher than that of comparatives (30.0% vs 17.6% on day 3, 50.0% vs 39.3% on day 5). The use of meropenem appeared safe, with minimal side effects. In conclusion, the present study showed that meropenem was safe and tolerable in children. The efficacy as an empirical monotherapy in pediatric cancer patients with FN was satisfactory, with a failure rate of 23.3 per cent on day 5 of treatment.