Meropenem

Indications

Meropenem is used for: Cystic fibrosis, Intra-abdominal infections, Meningitis, Skin and skin structure infections, Diabetic foot infection

Adult Dose

Intravenous Intra-abdominal infections Adult: 1 g 8 hrly via IV inj over approx 3-5 min or infused over approx 15-30 min. Skin and skin structure infections Adult: 500 mg 8 hrly via IV inj over approx 3-5 min or infused over approx 15-30 min. Cystic fibrosis, Meningitis Adult: 2 g 8 hrly infused over approx 15-30 min. Susceptible infections Adult: 0.5-1 g 8 hrly via IV inj over approx 3-5 min or infused over approx 15-30 min. Hepatic impairment: No dosage adjustment needed.

Child Dose

Children: IV 60 mg/kg/day, max 3 g/day q8h 120 mg/kg/day meningitis, max 6 g/day q8h Intravenous Intra-abdominal infections Child: >3mth ?50 kg: 20 mg/kg 8 hrly via IV inj over approx 3-5 min or infused over approx 15-30 min. Max: 1000 mg. Skin and skin structure infections Child: >3 mth ?50 kg: 10 mg/kg 8 hrly via IV inj over approx 3-5 min or infused over approx 15-30 min. Max: 500 mg. Cystic fibrosis, Meningitis Child: >3 mth ?50 kg: 40 mg/kg 8 hrly via IV inj over approx 3-5 min or infused over approx 15-30 min. Max: 2 g. Susceptible infections Child: >3 mth ?50 kg: 10 or 20 mg/kg 8 hrly via IV inj over approx 3-5 min or infused over approx 15-30 min.

Renal Dose

Renal impairment: CrCl (ml/min) 26-50 Usual dose 12 hrly. 10-25 Half the usual dose 12 hrly. <10 Half the usual dose 24 hrly.

Administration

IV Administration Administer IV infusion over 15-30 minutes; administer IV bolus over 3-5 minutes

Contra Indications

Hypersensitivity to meropenem, other carbapenems. History of anaphylactic reaction to β-lactams (e.g. penicillins, cephalosporins).

Precautions

Patient w/ underlying CNS disorders (e.g. brain lesions, history of seizures. Not recommended for treatment of MRSA. Renal impairment. Childn. Pregnancy and lactation. Monitoring Parameters Monitor for signs of anaphylaxis during 1st dose. Periodically assess renal, hepatic, and haematopoietic functions during prolonged therapy. Lactation: Unknown whether drug is excreted in breast milk; use with caution

Pregnancy-Lactation

Pregnancy There are insufficient human data to establish whether there is a drug-associated risk of major birth defects or miscarriages with meropenem in pregnant women Animal data No fetal toxicity or malformations were observed in pregnant rats and Cynomolgus monkeys administered intravenous meropenem during organogenesis at doses up to 2.4 and 2.3 times the maximum recommended human dose (MRHD) based on body surface area comparison, respectively; in rats administered intravenous meropenem in late pregnancy and during lactation period, there were no adverse effects on offspring at doses equivalent to approximately 3.2 times the MRHD based on body surface area comparison Lactation Drug has been reported to be excreted in human milk; no information is available on effects of drug on breast-fed child or on milk production; the developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and any potential adverse effects on breast-fed child from therapy or from the underlying maternal condition

Interactions

Increased plasma concentration w/ probenecid. May decrease plasma levels of valproic acid thus, increasing the risk of seizures.

Side Effects

Side effects of Meropenem : 1-10% Constipation (1-7%), Diarrhea (4-5%), Nausea or vomiting (1-4%), Rash (2-3%; includes diaper-area moniliasis in pediatric patients), Headache (2%), Inflammation at injection site (2%), Sepsis (2%), Oral moniliasis (≤2% in pediatric patients), Bleeding (1.2%), Apnea (1%), Constipation (1%), Glossitis (1%), Injection-site reaction (1%), Phlebitis or thrombophlebitis (1%), Pruritus (1%), Septic shock (1%) <1% Agranulocytosis, Angioedema, Erythema multiforme, Hypersensitivity reaction, Hypokalemia, Leukopenia, Neutropenia, Pleural effusion, Stevens-Johnson syndrome, Toxic epidermal necrolysis disorders or renal impairment. Potentially Fatal: Anaphylaxis; pseudomembranous colitis; Stevens-Johnsons sydrome.

Mode of Action

Meropenem is a synthetic carbapenem beta-lactam antibiotic that exerts its bactericidal activity by inhibiting bacterial cell wall synthesis in gm+ve and gm-ve bacteria through binding to several penicillin-binding proteins (PBPs).