As a broad-spectrum carbapenem, meropenem is one of the most commonly used antibiotics for critically ill pediatric patients who have severe infections. The time-dependent bactericidal activity of is consistent with the possibility that this bactericidal activity can be optimized by continuous or prolonged infusion of the drug, which would keep the drug concentration above the MIC for longer. Despite the increasing use in adult critically ill patients, the use of this process is not widely utilized in pediatric ICUs (PICUs).

With the growing concern of antimicrobial resistance, especially in children, the need for well-demonstrated dosing strategies for antimicrobials has never been more critical. Extended infusions of meropenem may provide better therapeutic effects in children by using the maximum amount of drug exposure, as well as less selection of resistance. This trial was conducted to compare the efficacy of prolonged infusion of meropenem in the critically ill visiting pediatric population, aimed at generating evidence for dosing approach in PICU.

. Background and Rationale As a broad-spectrum carbapenem, meropenem is one of the most commonly used antibiotics for critically ill pediatric patients who have severe infections. The time-dependent bactericidal activity of is consistent with the possibility that this bactericidal activity can be optimized by continuous or prolonged infusion of the drug, which would keep the drug concentration above the MIC for longer. Despite the increasing use in adult critically ill patients, the use of this process is not widely utilized in pediatric ICUs (PICUs).

With the growing concern of antimicrobial resistance, especially in children, the need for well-demonstrated dosing strategies for antimicrobials has never been more critical. Extended infusions of meropenem may provide better therapeutic effects in children by using the maximum amount of drug exposure, as well as less selection of resistance. This trial was conducted to compare the efficacy of prolonged infusion of meropenem in the critically ill visiting pediatric population, aimed at generating evidence for dosing approach in PICU.

Objectives

Primary Objective:

• To evaluate the efficacy of prolonged infusion meropenem in comparison to standard infusion in critically ill pediatric patients admitted to the Pediatric Intensive Care Unit (PICU).

Secondary Objectives:

• To compare the clinical success rate between prolonged infusion and standard infusion of meropenem.
• To assess the infection clearance rate in patients receiving prolonged infusion versus standard infusion of meropenem.
• To determine the time to clinical improvement in critically ill pediatric patients treated with prolonged infusion compared to standard infusion.
• To evaluate the safety and tolerability of prolonged infusion meropenem in the PICU setting.

Inclusion Criteria:

• Age between 1 month and 16 years

Admitted to the Pediatric Intensive Care Unit (PICU) with suspected or confirmed bacterial infection

Prescribed intravenous meropenem

Informed written consent obtained from parent or legal guardian

Exclusion Criteria:

• Known allergy or hypersensitivity to carbapenem antibiotics

Severe renal impairment (eGFR < 30 mL/min/1.73 m²)

Concurrent use of other investigational antibiotics

Treatment terminated early or patient discharged against medical advice

Individual participant data (IPD) will not be shared due to institutional policies and ethical considerations regarding patient confidentiality. Access to patient-level data is restricted to the study team to ensure data privacy and compliance with local regulations.