Attitude and Practice of Indian Clinicians on Usage Pattern of Meropenem: A Pan India Survey

BACKGROUND: Meropenem, a carbapenem antibiotic with broad-spectrum bactericidal activity, plays a critical role in managing bacterial infections, particularly in intensive care unit (ICU).(1) Use of meropenem has become crucial in treating serious infections in patients. Despite its widespread use, clinical practices for meropenem administration vary significantly.(2) This is further complicated by local antibiogram of the hospital. This comprehensive expert survey aimed to elucidate current clinical perspectives, pReferences:, and evidence-based approaches to meropenem therapy. METHODOLOGY: Our survey included 17 questions which assessed attitude and prescribing pattern of meropenem among clinicians (Internal medicine and Surgeons) across india. Convenience sampling technique was used to reach out to minimum 100 clinicians. Survey was distributed though Google forms. 117 clinicians completed the survey (69% Internal medicine and 31% surgeons). RESULTS: Among 117 clinicians response, almost half (57%) use Meropenem in 1–3 patients/week followed by 27% use in 4–6 patients/week. 57% clinicians use meropenem both in wards and ICU. Most common bacterial flora in clinical setting was Klebsiella pneumoniae (42%) followed by E. coli (32%) & Pseudomonas aeruginosa (24.6%). Meropenem is commonly prescribed for conditions llike Sepsis (73.8%), LRTI (50.8%), UTI (48.4%) and ABSSSIs (40.2%). According to prescribers meropenem is used as both empirical and targeted therapy. Among empirical usage, Meropenem was commonly prescribed for patients with sepsis/septic shock (70%) followed by acute bacterial meningitis (50%) and patients with ABSSSIs (40.2%). Almost 45% practitioners prefer to give intravenous meropenem as short infusion followed by prolonged infusion and bolus in 36.9% and 18.9% as a administration method, respectively. 82% believe that prolonged intravenous infusion helps to achieve better bacterial eradication & survival. Among all practitioners, 63.9% prefer to use meropenem in three divided doses/day followed by 30.3% prefers to use meropenem in two divided doses/day. About 50% prefer to use meropenem 2 gm in Nosocomial meningitis and Bronchopulmonary infections with cystic fibrosis (in pseudomonas or acinetobacter infection with high MIC values for meropenem). Almost half (49%)of practitioners prefer to use Meropenem + Salbactum combination therapy in patients with previous antibiotic exposure. Almost ¾ (71%) practitioners believe that borosillicate glass vial provides better thermal & hydrolytic stability, reduction in product degradation & preservation of quality. CONCLUSION: Our survey reveals that meropenem is being used in both ICU and wards as both empirical and targeted therapy. It is being used most commonly for sepsis/septic shock. Borosilicate glass vial is perceived to be better for drug stability/quality. Though; majorly clinicians believe that prolonged IV infusion help to achieve better outcomes, a limited number are practicing this. Hence, awareness and implementation of prolonged infusion can further improve outcomes with meropenem therapy.