Meropenem (Meronem) is a carbapenem antibiotic that has a broad spectrum of coverage against gram-negative and gram-positive infections.

Meropenem (Meronem) Uses:

• Intra-abdominal infections:

  • Used for treatment of complicated appendicitis and peritonitis in adult and pediatric patients caused by viridans group streptococci, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bacteroides fragilis, Bacteroides thetaiotaomicron, and Peptostreptococcus species.

• Bacterial Meningitis:

  • Treatment of bacterial meningitis in pediatric patients of age three months & older caused by H.influenzae, N. meningitidis, & penicillin-susceptible isolates of Streptococcus pneumoniae.

• Complicated Skin and skin structure infection:

  • Treatment of complicated skin & skin structure infections in adults & pediatric patients of age three months & older caused by Staphylococcus aureus (methicillin-susceptible isolates only), Streptococcus pyogenes, Streptococcus agalactiae, viridans group streptococci, Enterococcus faecalis (vancomycin-susceptible isolates only), P. aeruginosa, E. coli, Proteus mirabilis, B. fragilis, and Peptostreptococcus species.

• Off Label Use of Meropenem in Adults:

  • Anthrax
  • Bite wound infection, treatment, animal or human bite
  • Bloodstream infection (gram-negative bacteremia)
  • Brain abscess
  • Cystic fibrosis, acute pulmonary exacerbation
  • Diabetic foot infection, moderate to severe
  • Melioidosis (Burkholderia pseudomallei infection)
  • Neutropenic enterocolitis (typhlitis)
  • Neutropenic fever, high-risk cancer patients
  • Pneumonia
  • Prosthetic joint infection (pathogen-directed therapy for multidrug-resistant gram-negative bacilli, including P. aeruginosa)
  • Sepsis and septic shock (broad-spectrum empiric therapy, including P. aeruginosa)
  • Skin and soft tissue infection (moderate to severe infection, necrotizing infection, select surgical site infections [intestinal, GU tract]), broad-spectrum empiric coverage, including P. aeruginosa.
  • Urinary tract infection, complicated (including pyelonephritis)

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Meropenem (Meronem) Dose in Adults:

Note: Infusion method: Dosing is presented based on the traditional infusion method over 30 minutes unless otherwise specified.

Meropenem (Meronem) Usual dosage range:

• Traditional intermittent infusion method (over 30 minutes):

  • IV: 500 mg every 6 hours or 1 to 2 g every 8 hours; 500 mg every 6 hours achieves comparable pharmacokinetic and pharmacodynamic parameters to 1 g every 8 hours.

• Extended infusion method (off-label):

  • IV: 1 to 2 g every 8 hours over 3 hours.
  • May give a loading dose of 1 to 2 g over 30 minutes, especially when the rapid attainment of therapeutic drug concentrations is desired.

• Continuous infusion method (off-label):

  • IV: 2 g every 8 hours over 8 hours or 3 g every 12 hours over 12 hours.
  • May give a loading dose of 1 to 2 g over 30 minutes, especially when rapid attainment of therapeutic drug concentrations is desired (eg, sepsis).

Note:

• Extended & continuous infusion methods are based largely on pharmacokinetic and pharmacodynamic modeling data.
• With a prolonged infusion strategy, there is a greater likelihood of attaining pharmacokinetic/pharmacodynamic targets & may offer clinical benefit in patients with severe infections or less susceptible pathogens.
• Stability of Meropenem (admixed with NS at a concentration of 20 mg/mL) at room temperature for >1 hour or under refrigeration for >15 hours is not supported by the manufacturer.
• Data exist supporting stability for extended and continuous infusion when admixed with NS at a concentration of 14.3 mg/mL at room temperature for ≤7 hours and at a concentration of 20 mg/mL under refrigeration for ≤24 hours.
• Pharmacokinetic data support the use of an admixture of 10 mg/mL in NS as stable at room temperature for an infusion duration of ≤ 12 hours.

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Indication-specific dosing:

Meropenem (Meronem) Dose in the treatment of Anthrax (off-label):

Note:  For event-specific recommendations consult public health officials

• Systemic (meningitis excluded), treatment (alternative agent):

  • IV: 2 g every 8 hours as part of an appropriate combination regimen for 2 weeks or until clinically stable, whichever is longer.

Meropenem (Meronem) Dose in the treatment of Meningitis:

• IV: 2 g every 8 hours as part of an appropriate combination regimen for 2 to 3 weeks or until clinically stable, whichever is longer.

Note:

• Antitoxin administration should also be administered.
• Following the course of IV combination therapy for systemic anthrax infection (including meningitis), patients exposed to aerosolized spores require oral monotherapy to complete a total antimicrobial course of 60 days.

Meropenem (Meronem) Dose as an alternative agent in the treatment of Bite wound infection, animal or human bite (off-label):

• IV: 1 g every 8 hours;
• The duration of treatment for established infection (which may include oral step-down therapy) is typically 5 to 14 days and varies based on patient-specific factors, including the clinical response.

Meropenem (Meronem) Dose in the treatment of Bloodstream infection (gram-negative bacteremia).

For empiric therapy of known or suspected gram-negative organisms (including Pseudomonas aeruginosa) or pathogen-directed therapy for organisms resistant to other agents.

• IV: 1 g every 8 hours.
• For empiric treatment in patients with neutropenia, severe burns, sepsis, or septic shock, give as part of an appropriate combination regimen.

Note:

• For critical illness or infection with an organism with an elevated minimum inhibitory concentration (MIC), some experts prefer the extended or continuous infusion method and/or increasing the dose to 2 g every 8 hours.

• Duration of therapy:

  • The usual duration is 7 to 14 days depending on the source, pathogen, extent of the infection, & clinical response; for patients with uncomplicated Enterobacteriaceae infection who respond appropriately to antibiotic therapy, a 7-day duration is recommended.

Note:

• • If neutropenic, extend treatment until afebrile for 2 days and neutrophil recovery (ANC ≥500 cells/mm and increasing).
  • In neutropenic patients for Pseudomonas aeruginosa bacteremia, some experts treat for a minimum of 14 days & until recovery of neutrophils.

Meropenem (Meronem) Dose in the treatment of brain abscess (off-label):

• As a component of empiric or directed therapy in patients at risk for Pseudomonas aeruginosa or other resistant gram-negative bacteria (eg, neurosurgical or immunocompromised patients).
  • IV: 2 g every 8 hours as part of an appropriate combination regimen;
  • generally for a duration of 4 to 8 weeks, but some patients require a longer course.
  • The appropriate duration depends on the cultured pathogen(s) & patient-specific factors, including the clinical response.

Meropenem (Meronem) Dose in the treatment of acute pulmonary exacerbation of cystic fibrosis (off-label):

• For empiric or targeted therapy for Pseudomonas aeruginosa or other gram-negative bacilli.
  • IV: 2 g every 8 hours, most often given as part of an appropriate combination regimen.

Note:

• To optimize exposure some experts prefer the extended or continuous infusion method.

• Duration of therapy:

  • The optimal duration is not well defined & should be individualized based on clinical response.
  • Duration is usually 10 days to 3 weeks or longer.

Meropenem (Meronem) Dose in the treatment of moderate to severe Diabetic foot infection (off-label):

• As a component of empiric therapy in patients at risk for Pseudomonas aeruginosa (eg, significant water exposure, macerated wound) or other resistant gram-negative bacteria.
  •  IV: 1 g every 8 hours. Duration (which may include oral step-down therapy) is usually 2 to 4 weeks in the absence of osteomyelitis but varies based on patient-specific factors, including clinical response.

Meropenem (Meronem) Dose in the treatment of healthcare-associated or high-risk community-acquired Intra-abdominal infection:

Note:

• For community-acquired infection, reserve for severe infection or patients at high risk of adverse outcomes and/or resistance.
• As a component of empiric therapy in patients at risk for Pseudomonas aeruginosa or other resistant gram-negative bacteria.

• Acute Cholecystitis:

  • IV: 1 g every 8 hours; continue for 1 day after removal of the gallbladder or until clinical resolution in patients managed nonoperatively.

Meropenem (Meronem) Dose in the treatment of Other intra-abdominal infection (eg, cholangitis, perforated appendix, diverticulitis, and intraabdominal abscess):

• IV: 1 g every 8 hours.
• The total duration of therapy (which may include oral step-down therapy) is 4 to 7 days following adequate source control.
• For infections managed without surgical or percutaneous intervention, a longer duration may be necessary.

Note:

• For critically ill patients or at high risk for infection with drug-resistant pathogens, some experts favor the extended or continuous infusion method.

Meropenem (Meronem) Melioidosis (Burkholderia pseudomallei infection ) (off-label):

• Initial intensive therapy:

  • IV: 1 g every 8 hours for 10 to 14 days;
  • a longer duration may be necessary depending on disease severity and site of infection.
  • Some experts recommend 2 g every 8 hours for patients with neurological involvement & adding sulfamethoxazole & trimethoprim for patients with focal disease of the CNS, prostate, bone, joint, skin, or soft tissue.

Note:

• • Following the course of parenteral therapy, eradication therapy with oral antibiotics for ≥12 weeks is recommended.

Meropenem (Meronem) Dose in the treatment of Bacterial Meningitis:

• As a component of empiric therapy for healthcare-associated infections or infections in immunocompromised patients, or as pathogen-specific therapy for gram-negative bacteria resistant to other antibiotics (eg, Pseudomonas aeruginosa, Acinetobacter spp.).
  • IV: 2 g every 8 hours.
  • Treatment duration is 7 to 21 days depending on the causative pathogen(s) and clinical response; 10 to 14 days is the minimum duration for gram-negative bacilli, although some experts prefer ≥21 days.

Note:

• • For more resistant pathogens consider the use of an extended or continuous infusion.

Meropenem (Meronem) Dose as an alternative agent in the treatment of Neutropenic enterocolitis (typhlitis) (off-label):

Note: Reserve for patients colonized or infected with a resistant gram-negative bacillus, such as extended-spectrum beta-lactamase (ESBL)-producing organism (Wong Kee Song 2019).

• IV: 1 g every 8 hours;
• Continue until neutropenia is resolved and clinically improved, then switch to oral antibiotics.
• The total duration of antibiotics is generally 14 days following recovery from neutropenia.

Meropenem (Meronem) Dose as empiric therapy in the treatment of high-risk cancer patients with Neutropenic fever:

Note:

• High-risk patients are those expected to have an ANC ≤100 cells/mm³ for >7 days or an ANC ≤100 cells/mm³ for any expected duration if there are ongoing comorbidities (eg, sepsis, mucositis, significant hepatic or renal dysfunction)
• Some experts use an ANC cutoff of <500 cells/mm to define high-risk patients.
  • IV: 1 g every 8 hours until afebrile for ≥48 hours and resolution of neutropenia (ANC ≥500 cells/mm³ and increasing) or standard duration for the specific infection identified, if longer than the duration of neutropenia.
  • Additional agent(s) may be needed depending on clinical status.
  • Some experts prefer the extended or continuous infusion method, particularly in those who are critically ill.

Meropenem (Meronem) Dose in the treatment of Pneumonia (off-label):

• Community-acquired pneumonia, as a component of empiric therapy for inpatients at risk of infection with a multidrug-resistant gram-negative pathogen(s), including P. aeruginosa:

  • IV: 1 g every 8 hours as part of an appropriate combination regimen.
  • Total duration (which may include oral step-down therapy) is a minimum of 5 days & varies based on disease severity and response to therapy; a longer course may be required for severe or complicated infection or for Pseudomonas aeruginosa infection.
  • Patients should be clinically stable & afebrile for ≥48 hours prior to discontinuation.

• Hospital-acquired or ventilator-associated pneumonia, as empiric therapy or pathogen-specific therapy for multidrug-resistant gram-negative bacilli (eg, P. aeruginosa, Acinetobacter spp.):

  • IV: 1 g every 8 hours, as part of an appropriate combination regimen.
  • Duration of therapy varies based on disease severity and response to therapy; treatment is typically given for 7 days, but a longer course may be required for severe or complicated infection or for P. aeruginosa infection.

Note:

• Some experts reserve meropenem for patients at risk of infection with a multidrug-resistant (MDR) gram-negative pathogen(s), including P. aeruginosa (Klompas 2019).
• Some prefer the extended or continuous infusion method, particularly in those who are critically ill.

Meropenem (Meronem) Dose in the treatment of Prosthetic joint infection (pathogen-directed therapy for multidrug-resistant gram-negative bacilli, including P. aeruginosa) (off-label):

• IV: 1 g every 8 hours
• Duration varies but is generally 4 to 6 weeks for patients who undergo resection arthroplasty.

Meropenem (Meronem) Dose in the treatment of Sepsis and septic shock (broad-spectrum empiric therapy, including P. aeruginosa) (off-label):

• IV: 1 to 2 g every 8 hours in combination with other appropriate agents.
• Therapy should be initiated as soon as possible once there is recognition of sepsis or septic shock.
• The usual duration of treatment depends on the underlying source but is typically 7 to 10 days or longer depending upon clinical response.
•  If a noninfectious etiology is identified, consider discontinuation.

Note:

• Some experts prefer the extended or continuous infusion method.

Meropenem (Meronem) Dose in the treatment of moderate to severe skin and soft tissue infection (necrotizing infection and selected surgical site infections [intestinal, GU tract]), broad-spectrum empiric coverage, including P. aeruginosa:

• IV: 1 g every 8 hours as part of an appropriate combination regimen.
• Duration varies based on the extent of the infection, clinical response, and other patient-specific factors; for necrotizing infection, continue until further debridement is not necessary, the patient has clinically improved, and the patient is afebrile for ≥48 hours.

Meropenem (Meronem) Dose in the treatment of complicated Urinary tract infection (including pyelonephritis) (off-label):

• IV: 1 g every 8 hours; when used for empiric therapy, use alone or in combination with other appropriate agents.
• Once the patient has improvement in symptoms, switch to an appropriate oral regimen if culture and susceptibility results allow.
• The duration of therapy depends on the antimicrobial chosen to complete the regimen and ranges from 5 to 14 days.

Meropenem (Meronem) dose in the treatment of MDR-Typhoid fever:

• 1 gm IV 8 hourly for 10 - 14 days.
• It may be given in combination with azithromycin 500 mg OD.

Note:

• Reserve for critically ill patients or for patients with risk factor(s) for MDR pathogens, including ESBL producing organisms & P. aeruginosa.

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Meropenem (Meronem) Dose in Childrens:

Meropenem (Meronem) General dosing for susceptible infection (non-CNS):

• Infants, Children, and Adolescents:

  • IV: 20 mg/kg/dose every 8 hours;
  • The maximum dose: 1,000 mg/dose.

Meropenem (Meronem) Dose in the treatment of pulmonary exacerbation of Cystic fibrosis:

• Infants, Children, and Adolescents:

  • IV: 40 mg/kg/dose every 8 hours;
  • The maximum dose: 2,000 mg/dose.

Meropenem (Meronem) Dose as an empiric treatment in patients with Febrile neutropenia:

• Infants, Children, and Adolescents:

  • IV: 20 mg/kg/dose every 8 hours;
  • maximum dose: 1,000 mg/dose.

Meropenem (Meronem) Dose in the treatment of complicated Intra-abdominal infection:

Note:

• IDSA guidelines recommend a treatment duration of 4 to 7 days.

• Infants 1 to <3 months:

  • GA <32 weeks:
    • IV: 20 mg/kg/dose every 8 hours
  • GA ≥32 weeks:
    • IV: 30 mg/kg/dose every 8 hours

• Infants ≥3 months, Children, and Adolescents:

  • IV: 20 mg/kg/dose every 8 hours;
  • The maximum dose: 1,000 mg/dose

Meropenem (Meronem) Dose in the treatment of Meningitis:

• Infants (Limited data available <3 months of age), Children, and Adolescents:

  • IV: 40 mg/kg/dose every 8 hours;
  • The maximum dose: 2,000 mg/dose.
  • Duration of therapy depends upon pathogen:
    • N. meningitidis, H. influenza: 7 days
    • S. pneumoniae: 10 to 14 days
    • aerobic gram-negative bacilli: 21 days.

Meropenem (Meronem) Dose in the treatment of complicated skin and skin structure infection:

• Manufacturer's labeling:

  • Infants ≥3 months, Children, and Adolescents:
    • IV: 10 mg/kg/dose every 8 hours;
    • maximum dose: 500 mg/dose

Meropenem (Meronem) Dose in the treatment of Severe or necrotizing infections:

• Infants, Children, and Adolescents:

  • IV: 20 mg/kg/dose every 8 hours;
  • maximum dose: 1,000 mg/dose.

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Pregnancy Risk Category: B

• A human ex vivo perfusion model was used to determine that meropenem transplacental transfer was incomplete.
• We have limited information on the pregnancy use of meropenem

Meropenem use during breastfeeding:

• Breast milk contains Meropenem.
• Limited information is available on the use of Meropenem by breastfeeding women.
• According to the manufacturer, when deciding whether to breastfeed during therapy, you should consider the risks to infants, the benefits to breastfeeding for the mother, and the benefits to the infant.
• The antibiotics in breast milk can cause non-dose-related changes to the bowel flora.
• Monitor infants for GI disorders like thrush and diarrhea.

 

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Meropenem (Meronem) Dose in Kidney Disease:

• Manufacturer’s labeling:

  • CrCl >50 mL/minute:
    • No dosage adjustment is necessary.
  • CrCl 26 to 50 mL/minute:
    • Administer the recommended dose based on indication every 12 hours
  • CrCl 10 to 25 mL/minute:
    • Administer one-half recommended dose based on indication every 12 hours
  • CrCl <10 mL/minute:
    • Administer one-half recommended dose based on indication every 24 hours

• Alternative recommendations:

Note:

• Renally adjusted dose recommendations are based on doses of 1 to 2 g every 8 hours.
  • GFR 10 to 50 mL/minute:
    • Administer the recommended dose based on indication every 12 hours.
  • GFR <10 mL/minute:
    • Administer the recommended dose based on indication every 24 hours.
  • Intermittent hemodialysis (IHD) (administer after hemodialysis on dialysis days):
    • Meropenem and its metabolite are readily dialyzable: 500 mg every 24 hours.
  • Note:
    • Dosing dependent on the assumption of 3-times-weekly, complete IHD sessions.
• Peritoneal dialysis (off-label dose):
  • Administer the recommended dose (based on indication) every 24 hours.
• Continuous renal replacement therapy (CRRT).
  • Drug clearance is highly dependent on the method of renal replacement, filter type, and flow rate.
  • Appropriate dosing requires close monitoring of pharmacologic response, signs of adverse reactions due to drug accumulation, as well as drug concentrations in relation to target trough (if appropriate).
  • The following are general recommendations only (based on dialysate flow/ultrafiltration rates of 1 to 2 L/hour and minimal residual renal function) and should not supersede clinical judgment:
• CVVH:
  • Consider loading dose of 1 g followed by either 500 mg every 8 hours or 1 g every 8 to 12 hours
• CVVHD/CVVHDF:
  •  Consider loading dose of 1 g followed by either 500 mg every 6 to 8 hours or 1 g every 8 to 12 hours

Note:

• Consider giving patients receiving CVVHDF dosages of 750 mg every 8 hours or 1.5 g every 12 hours.
• Substantial variability exists in various published recommendations, ranging from 1 to 3 g daily in 2 to 3 divided doses.
• One gram every 12 hours achieves a target trough of ~4 mg/L.

Dose in Liver disease:

• No dosage adjustment required.

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Side Effects of Meropenem (Meronem):

• Cardiovascular:

  • Peripheral Vascular Disease
  • Shock
  • Bradycardia
  • Cardiac Arrest
  • Cardiac Failure
  • Chest Pain
  • Hypertension
  • Hypotension
  • Myocardial Infarction
  • Peripheral Edema
  • Pulmonary Embolism
  • Syncope
  • Tachycardia

• Central Nervous System:

  • Headache
  • Pain
  • Agitation
  • Anxiety
  • Chills
  • Confusion
  • Delirium
  • Depression
  • Dizziness
  • Drowsiness
  • Hallucination
  • Insomnia
  • Nervousness
  • Paresthesia
  • Seizure

• Dermatologic:

  • Skin Rash
  • Pruritus
  • Dermal Ulcer
  • Diaphoresis
  • Urticaria

• Endocrine & Metabolic:

  • Hypoglycemia
  • Hypervolemia

• Gastrointestinal:

  • Nausea
  • Diarrhea
  • Constipation
  • Vomiting
  • Oral Candidiasis
  • Gastrointestinal Disease
  • Glossitis
  • Abdominal Pain
  • Anorexia
  • Dyspepsia
  • Enlargement Of Abdomen
  • Flatulence
  • Intestinal Obstruction

• Genitourinary:

  • Dysuria
  • Pelvic Pain
  • Urinary Incontinence
  • Vulvovaginal Candidiasis

• Hematologic & Oncologic:

  • Anemia
  • Hypochromic Anemia

• Hepatic:

  • Cholestatic Jaundice
  • Hepatic Failure
  • Jaundice

• Infection:

  • Sepsis

• Local:

  • Inflammation At Injection Site

• Neuromuscular & Skeletal:

  • Asthenia
  • Back Pain

• Renal:

  • Renal Failure

• Respiratory:

  • Pharyngitis
  • Pneumonia
  • Apnea
  • Asthma
  • Cough
  • Dyspnea
  • Hypoxia
  • Pleural Effusion
  • Pulmonary Edema
  • Respiratory Tract Disease

• Miscellaneous:

  • Accidental Injury
  • Fever

Rare Side effects of Meropenem (Meronem):

• Endocrine & Metabolic:

  • Hypokalemia
  • Increased Lactate Dehydrogenase

• Genitourinary:

  • Hematuria

• Hematologic & Oncologic:

  • Decreased Hematocrit
  • Decreased Hemoglobin
  • Decreased Partial Thromboplastin Time
  • Decreased Prothrombin Time
  • Decreased White Blood Cell Count
  • Eosinophilia
  • Leukocytosis
  • Quantitative Disorders Of Platelets

• Hepatic:

  • Increased Serum Alanine Aminotransferase
  • Increased Serum Alkaline Phosphatase
  • Increased Serum Aspartate Aminotransferase
  • Increased Serum Bilirubin

• Renal:

  • Increased Blood Urea Nitrogen
  • Increased Serum Creatinine

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Contraindications to Meropenem (Meronem):

• Hypersensitivity to meropenem and other drugs of the same class or any component in the formulation
• Patients who experienced anaphylactic reactions due to beta-lactams

Warnings and precautions

• Anaphylaxis or hypersensitivity reactions

  • There have been reports of severe hypersensitivity reactions including anaphylaxis (some with no history of allergic reactions to beta-lactams).

• CNS effects

  • Carbapenems have been linked to CNS adverse effects such as confusion and myoclonic seizures.
  • Patients with CNS disorders (eg brain lesions or history of seizures) should be treated cautiously.
  • To avoid drug accumulation and increase seizure risk, adjust the dose for renal impairment.
  • Outpatient treatment can cause paresthesias, seizures, and/or headaches which can affect neuromotor function and alertness.
  • Patients shouldn't drive or operate machinery until meropenem has been approved for use.

• Dermatological effects

  • Severe cutaneous adverse reaction, including Stevens Johnson syndrome, toxic epidermal Necrolysis, toxic epidermal Neolysis, drug reaction with Eosinophilia, systemic symptoms, erythema multiflora, and acute generalized hyperanthematous pustulosis, have been reported
  • For severe reactions, discontinue use immediately

• Superinfection

  • Extended use can lead to fungal and bacterial superinfections, such as C. difficile-associated diarrhea(CDAD), or pseudomembranous collitis.
  • CDAD was observed for >2 months after antibiotic treatment.

• Renal impairment

  • Patients with impaired renal function should be cautious
  • Patients with creatinine clearance of =50mL/minute will need to adjust their dosage.
  • Patients with renal impairment have reported an increase in seizure risk and thrombocytopenia.

Meropenem: Drug Interaction

Risk Factor C (Monitor therapy)
BCG Vaccine (Immunization)	Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization).
Lactobacillus and Estriol	Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol.
Risk Factor D (Consider therapy modification)
Sodium Picosulfate	Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic.
Typhoid Vaccine	Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Vaccination with live attenuated typhoid vaccine (Ty21a) should be avoided in patients being treated with systemic antibacterial agents. Use of this vaccine should be postponed until at least 3 days after cessation of antibacterial agents.
Valproate Products	Carbapenems may decrease the serum concentration of Valproate Products. Management: Concurrent use of carbapenem antibiotics with valproic acid is generally not recommended. Alternative antimicrobial agents should be considered, but if a concurrent carbapenem is necessary, consider additional anti-seizure medication.
Risk Factor X (Avoid combination)
BCG (Intravesical)	Antibiotics may diminish the therapeutic effect of BCG (Intravesical).
Cholera Vaccine	Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics.
Probenecid	May increase the serum concentration of Meropenem.

 

Monitoring parameters:

• Prior to initiating therapy perform culture and sensitivity testing.
• Monitor for signs of anaphylaxis during the first dose.
• During prolonged therapy, monitor renal function, liver function, CBC.

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How to administer Meropenem (Meronem)?

• IV:
  • Administer IV infusion over 15 to 30 minutes
  • IV bolus injection (5 to 20 mL) over 3 to 5 minutes
• Extended infusion administration (off-label method):
  • Administer over 3 hours.

Note:

• • Must consider meropenem's limited room temperature stability if using extended infusions.
• Continuous infusion method (off-label method):
  • IV: Administer every 8 hours over 8 hours or every 12 hours over 12 hours.

Note:

• • Must consider meropenem's limited room temperature stability if using extended infusions.

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Mechanism of action of Meropenem (Meronem):

 

• It blocks bacterial cell wall synthesis through binding to several penicillin-binding proteins.
• These in turn inhibit the final step of peptidoglycan transpeptidation in bacterial cell walls. This, in turn, inhibits cell wall biosynthesis
• Bacteria eventually lyse because of ongoing activity by cell wall autolytic enzymes (autolysins, murein hydrolases), while cell wall assembly becomes blocked.

Distribution:

• Permeates into most tissues and body fluids, including the urinary tract, peritoneal liquid, bone, bile and lung, bronchial mucosa and muscle tissue (Craig 1997) and CSF (CSF penetrate: Infants and Neonatals =3 Months: 70%).

Protein binding:

• ~2%

Metabolism:

• Hepatic; hydrolysis of beta-lactam bond to open beta-lactam form (inactive).

Half-life elimination:

• Neonates and Infants ≤3 months: Median: 2.7 hours; range: 1.6 to 3.8 hours.
• Infants and Children 3 months to 2 years: 1.5 hours
• Children 2 to 12 years and adults: 1 hour

Time to peak:

• Tissue: ~1 hour following infusion except in bile, lung, and muscle
• CSF: 2 to 3 hours with inflamed meninges

Excretion:

• Urine (~70% as unchanged drug; ~28% inactive metabolite)
• feces (2%)

Clearance:

• Neonates and Infants ≤3 months: 0.12 L/hour/kg (Smith 2011)
• Infants and Children: 0.26 to 0.37 L/hour/kg (Blumer 1995)

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International Brands of Meropenem:

• Merrem
• Accurem
• Archifar
• Aris
• Bestinem
• Bironem
• Elpenem
• Enem
• Eradix
• Grambiot
• Haizheng Meite
• Lanmer
• Mabapenem
• Madiba
• Mapenem
• Mecapem
• Meflupin
• Melopen
• Menem IV
• Mepem
• Mepenam
• Mero
• Merobac I.V.
• Merofen
• Merogram
• Meromax
• Meronem
• Meronia
• Merop
• Meropemed
• Meropen
• Meropevex
• Meroponia
• Merosan
• Merostarkyl
• Merovex
• Meroxi
• Merozan
• Merozen
• Merrem
• Mirage
• Monan
• Monem
• Myron
• Newropenem
• Opimer
• Optinem
• Penem
• Penembact
• Penomer
• Pisapem
• Pospenem
• Propenem
• Romenem
• Ronem
• Ropen
• Tripenem
• Zaxter
• Zeropenem

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Meropenem Brand Names in Pakistan:

Meropenem Injection 1 Gm
Carnem	Laderly Bio-Tech Pharma
Cilipenem	Ipram International
Merocon	Continental Ph
Penro	Bosch Pharmaceuticals (Pvt) Ltd.
Xepime	Macter International (Pvt) Ltd.

 

Meropenem Injection 1 Gm
Demonem	Rotex Medica Pakistan (Pvt) Ltd
Demonem	Rotex Medica Pakistan (Pvt) Ltd
Merem	Global Pharmaceuticals

 

Meropenem Injection 500 Mg
Carnem	Laderly Bio-Tech Pharma
Cilipenem	Ipram International
Demonem	Rotex Medica Pakistan (Pvt) Ltd
Demonem	Rotex Medica Pakistan (Pvt) Ltd
Merem	Global Pharmaceuticals
Merocin	Jinnah Pharmaceuticals
Merocon	Continental Ph

 

Meropenem Injection 1 Gm
Meronem	ICI Pakistan Ltd.

 

Meropenem Injection 500 Mg
Meronem	ICI Pakistan Ltd.
Xepime	Macter International (Pvt) Ltd.

 

Meropenem Injection 500 Mg
Meronem	ICI Pakistan Ltd.
Xepime	Macter International (Pvt) Ltd.