Meropenem


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IV Susceptible gram-positive infections; Susceptible gram-negative infections In cases of severe pneumonia, complicated UTI, complicated intra-abdominal infections, complicated skin and skin structure infections, gynaecological infections: 0.5-1 g 8 hourly via infusion over approx 15-30 minutes or via bolus inj over approx 3-5 minutes. Exacerbation of respiratory tract infections in cystic fibrosis; Bacterial meningitis 2 g 8 hourly via infusion over approx 15-30 minutes.
Dosage Details
Intravenous
Lower respiratory tract infections
Adult: Exacerbation in patients with cystic fibrosis: 2 g 8 hourly via infusion over approx 15-30 minutes.
Child: ≥3 months weighing ≤50 kg: 40 mg/kg 8 hourly via infusion over approx 15-30 minutes; >50 kg: Same as adult dose.

Intravenous
Susceptible Gram-negative infections, Susceptible Gram-positive infections
Adult: In cases of severe pneumonia, complicated UTI, complicated intra-abdominal infections, complicated skin and skin structure infections, gynaecological infections: 0.5-1 g 8 hourly via infusion over approx 15-30 minutes or via bolus inj over approx 3-5 minutes.
Child: ≥3 months weighing ≤50 kg: 10-20 mg/kg 8 hourly via infusion over approx 15-30 minutes or via bolus inj over approx 3-5 minutes; >50 kg: Same as adult dose.

Intravenous
Bacterial meningitis
Adult: 2 g 8 hourly via infusion over approx 15-30 minutes.
Child: ≥3 months weighing ≤50 kg: 40 mg/kg 8 hourly via infusion over approx 15-30 minutes; >50 kg: Same as adult dose.
Renal Impairment
CrCl (mL/min) Dosage
<10 Half the usual dose 24 hourly.
10-25 Half the usual dose 12 hourly.
26-50 Usual dose 12 hourly.
Reconstitution
Reconstitute vial labelled as containing 500 mg or 1 g with 10 mL or 20 mL of sterile water for inj, respectively, to provide a final concentration of 50 mg/mL. May dilute further with a compatible solution for infusion (e.g. 0.9% NaCl, dextrose 5%) to a final concentration ranging from 1-20 mg/mL.
Contraindications
Hypersensitivity to meropenem or other carbapenems. History of anaphylactic reaction to β-lactams (e.g. penicillins, cephalosporins).
Special Precautions
Patient with CNS disorder (e.g. brain lesions, history of seizures). Renal and hepatic impairment. Children. Pregnancy and lactation.
Adverse Reactions
Significant: Confusional states and seizure; severe cutaneous reactions (e.g. Stevens-Johnson syndrome [SJS], toxic epidermal necrolysis [TEN], drug reaction with eosinophilia and systemic symptoms [DRESS], erythema multiforme, acute generalised exanthematous pustulosis); fungal or bacterial superinfection including C. difficile-associated diarrhoea.
Blood and lymphatic system disorders: Thrombocythaemia, anaemia.
Gastrointestinal disorders: Diarrhoea, vomiting, nausea, abdominal pain, constipation.
General disorders and administration site conditions: Injection site inflammation, pain.
Investigations: Increased transaminases, increased alkaline phosphatase, increased lactate dehydrogenase.
Nervous system disorders: Headache.
Skin and subcutaneous tissue disorders: Rash, pruritus.
Potentially Fatal: Hypersensitivity reactions (e.g. anaphylaxis), antibiotic-associated or pseudomembranous colitis.
IV/Parenteral: B
Patient Counseling Information
This drug may cause seizure, headache, paraesthesia, and delirium, if affected, do not drive or operate machinery.
MonitoringParameters
Perform culture and sensitivity testing prior to initiation of therapy. Monitor renal function, LFT, CBC (prolonged use). Monitor for signs of anaphylaxis during 1st dose.
Drug Interactions
Increased plasma concentration and prolonged elimination half-life with probenecid. May decrease plasma levels of valproic acid, thus increasing the risk of seizures. May enhance anticoagulant effect of warfarin.
Lab Interference
May give positive direct or indirect Coombs test.
Action
Description: Meropenem is a β-lactam antibiotic. It inhibits bacterial cell wall synthesis by binding to several penicillin-binding proteins (PBPs) in gram-negative and gram-positive bacteria resulting in cell wall assembly arrest and eventually bacterial cell lysis.
Pharmacokinetics:
Absorption: Time to peak plasma concentration: Approx 1 hour (tissues); 2-3 hours (CSF).
Distribution: Widely distributed into body tissues and fluids including peritoneal fluid, urinary tract, lung, bronchial mucosa, muscle tissue, CSF, and bile. Enters breast milk (small amounts). Volume of distribution: 15-20 L (adult); approx. 0.3-0.4 L/kg (children). Plasma protein binding: Approx 2%.
Metabolism: Metabolised in the liver via hydrolysis into inactive form.
Excretion: Mainly via urine (approx 70% as unchanged drug; approx 28% as inactive metabolite); faeces (2%). Elimination half-life: Approx 1 hour.
Chemical Structure

Chemical Structure Image
Meropenem

Source: National Center for Biotechnology Information. PubChem Database. Meropenem, CID=441130, https://pubchem.ncbi.nlm.nih.gov/compound/Meropenem (accessed on Jan. 22, 2020)

Storage
Store between 20-25°C. Reconstituted solution: Store up to 3 hours at 25°C or 12 hours between 2-8°C. Do not freeze.
MIMS Class
ATC Classification
J01DH02 - meropenem ; Belongs to the class of carbapenems. Used in the systemic treatment of infections.
References
Anon. Meropenem. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 14/04/2020.

Anon. Meropenem. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 06/12/2019.

Buckingham R (ed). Meropenem. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/12/2019.

Joint Formulary Committee. Meropenem. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 14/04/2020.

Meropenem Injection (Sandoz Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 06/12/2019.

Disclaimer: This information is independently developed by MIMS based on Meropenem from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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