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Antimicrobial Stewardship — SCE Infectious Diseases MCQ

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ModerateAntimicrobial StewardshipAntimicrobial StewardshipSCE Infectious Diseases

A 42-year-old woman is prescribed Meropenem 1 g TDS for hospital-acquired pneumonia. The microbiology registrar suggests switching to Meropenem 1 g TDS as a prolonged (3-hour) infusion instead of the standard 30-minute infusion. What is the pharmacological rationale?

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Correct answer: E — Meropenem exhibits time-dependent killing; prolonged infusion maximises time above MIC

Beta-lactams (including Meropenem) exhibit time-dependent bactericidal activity — efficacy correlates with the percentage of time the free drug concentration exceeds the MIC (%fT>MIC). Prolonged or continuous infusions maximise %fT>MIC without increasing total daily dose. This is particularly beneficial for organisms with higher MICs (e.g. Pseudomonas with MIC 4–8 mg/L). The BLING III trial demonstrated mortality benefit with continuous beta-lactam infusion in ICU patients with sepsis.

Reference: BSAC 2023 – Beta-lactam optimisation; BLING III trial 2022 – JAMA