Meropenem

1
Meropenem
Brands

DEA Class; Rx

Common Brand Names; Merrem IV

  • Carbapenems

IV carbapenem antibiotic
Used for complicated intraabdominal and skin and skin structure infections and bacterial meningitis
May have a lower incidence of ADRs than imipenem

Indicated as a single agent therapy for the treatment of complicated skin and skin structure infections due to Staphylococcus aureus (methicillin-susceptible isolates only), Streptococcus pyogenes, Streptococcus agalactiae, viridans group streptococci, Enterococcus faecalis (vancomycin-susceptible isolates only), Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis, Bacteroides fragilis, and Peptostreptococcus species

Indicated as a single agent therapy for the treatment of complicated appendicitis and peritonitis caused by viridans group streptococci, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bacteroides fragilis, B. thetaiotaomicron, and Peptostreptococcus species

Also indicated for Community-Acquired Pneumonia (Off-label), Febrile Neutropenia (Off-label)

Hypersensitivity to IV components, beta-lactams, or other drugs in this class

  • 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%)
  • Agranulocytosis
  • Angioedema
  • Erythema multiforme
  • Hypersensitivity reaction
  • Hypokalemia
  • Leukopenia
  • Neutropenia
  • Pleural effusion
  • Stevens-Johnson syndrome
  • Toxic epidermal necrolysis

Hypersensitivity reactions have been reported, including fatalities; these reactions are more likely to occur in individuals with history of sensitivity to multiple allergens

Seizures have been reported, most commonly in patients with CNS disorders (eg, brain lesions, history of seizures) or with bacterial meningitis or compromised renal function

Seizures, headaches, or paresthesias may occur, potentially interfering with mental alertness or causing motor impairment

Clostridium difficile-associated diarrhea has been reported

To avoid development of drug resistance, drug should be used only in proven or strongly suspected bacterial infections or a prophylactic indication

Prolonged use may result in overgrowth of nonsusceptible organisms

Thrombocytopenia has been reported in patients with renal impairment

Co-administration of meropenem IV with valproic acid or divalproex sodium reduces serum concentrations of valproic acid potentially increasing risk of breakthrough seizures

Severe cutaneous adverse reactions (SCAR) such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), erythema multiforme (EM) and acute generalized exanthematous pustulosis (AGEP) reported; if signs and symptoms suggestive of these reactions appear, therapy should be withdrawn immediately and an alternative treatment considered

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

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

Adults

1 gm IV every 8 hours; doses of 2 g IV every 8 hours have been used for meningitis.

Geriatric

1 gm IV every 8 hours; doses of 2 g IV every 8 hours have been used for meningitis.

Adolescents

40 mg/kg/dose, not to exceed 2 g IV every 8 hours.

Children

40 mg/kg/dose, not to exceed 2 g IV every 8 hours.

Infants

3 months and older: 40 mg/kg/dose IV every 8 hours.
Younger than 3 months: 30 mg/kg/dose IV every 8 hours is FDA-approved maximum dosage for complicated intra-abdominal infections; however, doses up to 40 mg/kg/dose IV every 8 hours have been used off-label for the treatment of meningitis.

Neonates

Neonates 32 weeks gestational age and older and 14 days postnatal age and older: 30 mg/kg/dose IV every 8 hours is FDA-approved maximum dosage for complicated intra-abdominal infections; however, doses up to 40 mg/kg/dose IV every 8 hours have been used off-label for the treatment of meningitis.
Neonates 32 weeks gestational age and older and younger than 14 days postnatal age: 20 mg/kg/dose IV every 8 hours is FDA-approved maximum dosage for complicated intra-abdominal infections; however, doses up to 40 mg/kg/dose IV every 8 hours have been used off-label for the treatment of meningitis.
Premature neonates younger than 32 weeks gestational age and 14 days postnatal age and older: 20 mg/kg/dose IV every 8 hours is FDA-approved maximum dosage for complicated intra-abdominal infections; however, doses up to 40 mg/kg/dose IV every 8 hours have been used off-label for the treatment of meningitis.
Premature neonates younger than 32 weeks gestational age and younger than 14 days postnatal age: 20 mg/kg/dose IV every 12 hours is FDA-approved maximum dosage for complicated intra-abdominal infections; however, doses up to 40 mg/kg/dose IV every 8 hours have been used off-label for the treatment of meningitis.

Meropenem

powder for injectable solution

  • 500mg/vial
  • 1g/vial
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