There is some clinical and laboratory evidence of partial cross-allergenicity between other carbapenems and β-lactam antibiotics, penicillins and cephalosporins. As with all β-lactam antibiotics, rare hypersensitivity reactions have been reported (see Adverse Reactions). Before initiating therapy with meropenem, careful inquiry should be made concerning previous hypersensitivity reactions to β-lactam antibiotics. Meronem should be used with caution in patients with such a history. If an allergic reaction to meropenem occurs, the drug should be discontinued and appropriate measures taken.
Use of Meronem in patients with hepatic disease should be made with careful monitoring of transaminase and bilirubin levels.
As with other antibiotics, overgrowth of nonsusceptible organisms may occur; therefore, continuous monitoring of each patient is necessary.
Use in infections caused by methicillin-resistant staphylococci is not recommended.
Rarely, pseudomembranous colitis has been reported on Meronem as with practically all antibiotics and may vary in severity from slight to life-threatening. Therefore, antibiotics should be prescribed with care for individuals with a history of gastrointestinal complaints, particularly colitis.
It is important to consider the diagnosis of pseudomembranous colitis in the case of patients who develop diarrhoea in association with the use of Meronem. Although studies indicate that a toxin produced by Clostridium difficile is one of the main causes of antibiotic-associated colitis, other causes should be considered.
The co-administration of Meronem with potentially nephrotoxic drugs should be considered with caution (see Dosage & Administration).
Effects on the Ability to Drive or Operate Machinery: No data are available, but it is not anticipated that Meronem will affect the ability to drive or operate machinery.
Use in pregnancy and lactation: The safety of Meronem in human pregnancy has not been evaluated. Animal studies have not shown any adverse effect on the developing foetus. The only adverse effect observed in animal reproductive studies was an increased incidence of abortions in monkeys at 13 times the expected exposure in man. Meronem should not be used in pregnancy unless the potential benefit justifies the potential risk to the foetus. In every case, it should be used under the direct supervision of the physician.
Meropenem is detectable at very low concentrations in animal breast milk. It should not be used in breastfeeding women unless the potential benefit justifies the potential risk to the baby.
Use in children: Efficacy and tolerability in infants <3 months have not been established. Therefore, Meronem is not recommended for use below this age. There is no experience in children with altered hepatic or renal function.