Submitted:
10 September 2026
Posted:
11 September 2026
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Abstract
Background: Intravenous meropenem and ceftazidime are the preferred antibiotics for the intensive phase treatment of melioidosis. Most patients receive intravenous ceftazidime via elastomeric infusers to complete treatment as outpatient parenteral antimicrobial therapy (OPAT). Concerns regarding meropenem’s stability in continuous infusion limit options when ceftazidime cannot be used. Methods: We reviewed all cases of melioidosis managed at Cairns Hospital from 2016 to 2026 and documented the rationale for patients receiving intravenous meropenem as a continuous infusion as OPAT. We recorded each Burkholderia pseudomallei isolate’s MIC for meropenem and the patients’ creatinine clearance, continuous infusion dose, serum meropenem concentrations, treatment duration and clinical course. Results: In 560 cases of melioidosis, 9 (2%) received meropenem as a continuous infusion as OPAT. This was due to an adverse drug reaction (ADR) to ceftazidime in 6/9 patients. The isolates’ median (range) MIC for meropenem was 1 (0.5-1) mg/L. All patients received twice daily elastomeric infusers; initial dosing was 1.5g 12-hourly in 5 patients and 3g 12-hourly in 4 patients. The initial median (range) meropenem random concentration was 6.5 (2.3-18.1) mg/L. The meropenem dose was increased in 2 patients following therapeutic drug monitoring (TDM). One patient was changed from meropenem to ceftazidime due to eosinophilia without end-organ sequelae; there were no other ADRs. All patients achieved clinical cure. Conclusion: Twice daily continuous meropenem infusions administered as OPAT are an alternative treatment option for select patients with melioidosis where ceftazidime cannot be used. The use of TDM can overcome concerns regarding stability and degradation in extended infusions.
Keywords:
OPAT
; melioidosis
; tropical infections
; antibiotic therapy
; therapeutic drug monitoring
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