Compared with intermittent dosing in critically ill patients, “continuous administration of meropenem did not improve the composite outcome of mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28,” investigators in the MERCY trial conclude.
At 26 hospitals in 4 countries (Croatia, Italy, Kazakhstan, and Russia) in 2018–2022, critically ill patients with sepsis or septic shock were randomized to equal doses of meropenem by either continuous administration (n = 303) or intermittent administration (n = 304).
Based on a primary outcome of a composite of all-cause mortality and the emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28, the investigators found: “All 607 patients (mean age, 64 [SD, 15] years; 203 were women [33%]) were included in the measurement of the 28-day primary outcome and completed the 90-day mortality follow-up. The majority (369 patients, 61%) had septic shock. The median time from hospital admission to randomization was 9 days (IQR, 3-17 days) and the median duration of meropenem therapy was 11 days (IQR, 6-17 days). Only 1 crossover event was recorded. The primary outcome occurred in 142 patients (47%) in the continuous administration group and in 149 patients (49%) in the intermittent administration group (relative risk, 0.96 [95% CI, 0.81-1.13], P = .60). Of the 4 secondary outcomes, none was statistically significant. No adverse events of seizures or allergic reactions related to the study drug were reported. At 90 days, mortality was 42% both in the continuous administration group (127 of 303 patients) and in the intermittent administration group (127 of 304 patients).”