Evaluation of meropenem doses prescribed in an adult intensive care unit at a large hospital in Serra Gaúcha

Objective: To evaluate the conformity of dose and/or posology of meropenem prescribed in the setting of kidney impairment, otherwise to evaluate the microbiological profile of the germs isolated in those patients. In addition, to measure the extra costs of non-adjusted prescriptions. Method: This work is a Drug Utilization Review. Were included charts of adult patients, of both sex, that had meropenem prescribed between 01/01/2021 and 06/30/2021, while admitted in the ICU regimen, in a large hospital in Serra Gaúcha. For dose analysis, UpToDate was used as guideline, prescriptions from patients on renal replacement therapy, as well as prescriptions from patients who did not have a creatinine result in the 24 hours prior to the prescription of meropenem, were excluded. Results: A total of 2044 prescriptions were evaluated, of which 667 were excluded because they did not meet the inclusion criteria. Of the 1377 prescriptions included, 1003 were considered adequate (73%) and 374 inadequate (27%). Of the doses considered inadequate, 54 were by underdose (14%) and 320 by overdose (86 %). The extra cost measured was US$1.835,21, equivalent to 993 vials of 500 mg. Microbiologically, there was a higher incidence of Gram-negatives: 81% (383/473). Of these, 54% resistant to meropenem (208/383), 5% (20/383) presumed sensitive, 3% (11/383) intrinsically resistant, and 38% (144/383) sensitive in vitro. Conclusion: The findings support the promotion of the service provided by the clinical pharmacist and stewardship programs, both for the promotion of health in intensive care and for the preservation of the financial health of a philanthropic institution.