Pharmacy Preceptors Guild of the Philippines

HOSPITAL PHARMACY VIRTUAL INTERNSHIP PROGRAM

CLINICAL PHARMACY – Drug Information using Critical Appraisal format
ACTIVITY ASSIGNMENT – 41

Name of Student: Mary Kathleen Estrada Valencia

School: World Citi Colleges Quezon City

Objective:

● Able to perform correct literature search related to the drug inquiry.

● Able to apply critical appraisal to clinical practice.
● Able to provide direct and accurate information based on the question ask by the healthcare
team.

Case Scenario:

● You are assigned as a pharmacist in the ward.

● A new Infectious Disease Consultant (just finished subspecialty training) is a newly hired
consultant in your institution. She made her rounds, and this is what she wrote in the patient’s
chart:

● After the IDS consultant wrote her order, the nurse-in-charge approaches you and asks for your
recommendation regarding the doctor’s order on Meropenem preparation and infusion.

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 Pharmacy Preceptors Guild of the Philippines
HOSPITAL PHARMACY VIRTUAL INTERNSHIP PROGRAM
CLINICAL PHARMACY – Drug Information using Critical Appraisal format
ACTIVITY ASSIGNMENT – 41

Instruction:

To properly answer the question, please answer first the following questions:

1. Can Meropenem be given as prolonged infusion? If yes or no, provide only ONE reference. The
reference must be Randomized Controlled Trial on Meropenem infusion.

YES. Meropenem be given as prolonged infusion

Klugman, K. P., & Dagan, R. (1995). Randomized comparison of meropenem with cefotaxime for
treatment of bacterial meningitis. Meropenem Meningitis Study Group. Antimicrobial agents
and chemotherapy, 39(5), 1140–1146. https://doi.org/10.1128/AAC.39.5.1140
*IF the reference you want have retrieved ONLY has an abstract available:
- highlight and copy the DOI number of the abstract.
- Please inform your preceptor if you’re not able to get the whole journal (for assistance).
2. Perform critical appraisal using the questions provided (see below).
3. Provide accurate and correct answer of the drug inquiry.

4.
APPRAISAL FORM FOR THERAPY
I. APPRAISING DIRECTNESS  
  Does the study provide a direct enough  Yes. pgs. 1141, 1140
answer to your clinical question in terms
of type of patients (P),
exposure/intervention (E) and outcome
(O)?
II. APPRAISING VALIDITY  
1. Were patients randomly assigned to  Yes. pg. 1141
treatment groups?
2. Was allocation concealed?  No. pg. 1141

3. Were baseline characteristics similar at  Yes. pg. 1141

the start of the trial?
4. Were patients blinded to treatment  No pg.1141
assignment?
5. Were caregivers blinded to treatment  No pg. 1141
assignment?
6. Were outcome assessors blinded to  No. pg. 1141
treatment assignment?

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 Pharmacy Preceptors Guild of the Philippines
HOSPITAL PHARMACY VIRTUAL INTERNSHIP PROGRAM
CLINICAL PHARMACY – Drug Information using Critical Appraisal format
ACTIVITY ASSIGNMENT – 41

7 Were all patients analyzed in the groups  Yes. pg. 1141

to which they were originally randomized?
8 Was follow-up rate adequate?  Yes. pg. 1144

III. APPRAISING RESULTS  

1. How large was the effect of treatment?  Eight of 17 meropenem-treated patients
with preexisting neurological abnormalities
(47%) had abnormal neurological findings at
their final follow-up. There were five
cefotaxime-treated patients with
neurological abnormalities on admission, of
which one (20%) had neurological
abnormalities at follow-up. pg. 1143
2. How precise was the estimate of the  Meropenem penetrates into the
treatment effect? cerebrospinal fluid (CSF), and intravenous
single doses of 20 and 40 mg of
meropenem per kg of body weight in
humans with inflamed meninges were well
tolerated pg. 1140
IV ASSESSING APPLICABILITY:  
.
1. Are there biologic issues that may affect  Yes
applicability of treatment? (Consider the
pg. 1146
influence of sex, co-morbidity, race, age
and pathology)
2. Are there socio-economic issues affecting Yes. pg. 1146. 1140 
applicability of treatment?

V. INDIVIDUALIZING THE RESULTS:  

1. What is the likely effect of the treatment
on your individual patient? (Estimate the
individualized NNT for your patient)
2. Would you offer the treatment to your
patients?
 Administration by continuous infusion
would most effectively allow for
maximization and control of the T>MIC in
achieving a target of 100%. The T>MIC of
meropenem achieved in the patient’s serum
and CSF was 100%, and she will recover
from her infection.
YES

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 Pharmacy Preceptors Guild of the Philippines
HOSPITAL PHARMACY VIRTUAL INTERNSHIP PROGRAM
CLINICAL PHARMACY – Drug Information using Critical Appraisal format
ACTIVITY ASSIGNMENT – 41

ANSWER TO THE DRUG INQUIRY: “How to Dissolve 2 g Meropenem in 250 ml 0.9%

prepare meropenem for infusion of 3 hours?” sodium chloride solution, for injection. Keep
infusion rate at 1 g/h Meropenem (40 mg/kg
every 8 h) pg. 1141

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