Meropenem is a carbapenem that works by inhibiting the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls by binding to one or more of the penicillin-binding proteins (PBPs), thus inhibiting cell wall biosynthesis resulting to bacterial lysis.

Distribution
Widely distributed into body tissues and fluids; CSF; bile.

Metabolism
More stable to renal dehydropeptidases; converted to one inactive metabolite.

Excretion
Via urine within 12 hours by glomerular filtration and tubular secretion (70% unchanged). Elimination half-life: 1 hour. Removed by dialysis.

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Diarrhoea, nausea, vomiting, abdominal pain; headache; constipation; rash, pruritus, uticaria; apnoea; phlebitis, thrombophlebitis, swelling and pain at inj site; disturbances in LFTs (may cause increases in serum transaminases, alkaline phosphatase, lactic dehydrogenase). Rarely: erythema multiforme; eosinophilia, thrombocytopenia, leucopenia, neutropenia; seizures and CNS effects reported in patients with underlying CNS disorders or renal impairment.

Potentially Fatal: Anaphylaxis; pseudomembranous colitis; Stevens-Johnsons sydrome.

Monitor
Monitor patient's response to therapy; periodically monitor renal, hepatic, and hematopoietic function during prolonged therapy.

Overdosage
Treatment: symptomatic. In normal patients, rapid renal elimination will occur. In patients with renal impairment, haemodialysis will remove meropenem and metabolite.

History of hypersensitivity to carbapenem, pencillins or other β-lactam antibiotics; infants <3 months; renal insufficiency; neurological disorders; pregnancy, lactation. Not recommended for use in MRSA.

Serum levels may be increased by probenecid. May reduce serum valproic acid levels; sub-therapeutic levels may be reached in some patients.

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Intravenous
Susceptible infections
Adult: 0.5-1 g every 8 hours.
Child: Neonate: <7 days: 20 mg/kg 12 hourly (severe infection 40 mg/kg 12 hourly); 7-28 days: 20 mg/kg 8 hourly (severe infection 40 mg/kg 8 hourly). 1-3 months: 10 mg/kg 8 hourly; >3 month and <50 kg: 10-20 mg/kg 8 hourly.

Renal impairment: Haemodialysis: Usual dose after dialysis session.
CrCl (ml/min)    Dosage Recommendation
26-50               Normal dose 12 hourly.
10-25               Half normal dose 12 hourly.
<10                  Half normal dose 24 hourly.

Intravenous
Meningitis
Adult: 2 g every 8 hours.
Child: >3 months and <50 kg: 40 mg/kg every 8 hours.

Renal impairment: Haemodialysis: Usual dose after dialysis session.
CrCl (ml/min)    Dosage Recommendation
26-50               Normal dose 12 hourly.
10-25               ½ normal dose 12 hourly.
<10                  ½ normal dose 24 hourly

Intravenous
Cystic fibrosis
Adult: Up to 2 g every 8 hours.
Child: 4-18 years: 25-40 mg/kg every 8 hours.

Renal impairment: Haemodialysis: Usual dose after dialysis session.
CrCl (ml/min)    Dosage Recommendation
26-50               Normal dose 12 hourly.
10-25               ½ normal dose 12 hourly
<10                  ½ normal dose 24 hourly

Intravenous
Skin and skin structure infections
Adult: 500 mg every 8 hours
Child: ≥3 months: <50 kg: 10 mg/kg (max: 500 mg) every 8 hours; >50 kg: 500 mg every 8 hours.

Renal impairment: Haemodialysis: Usual dose after dialysis session.
CrCl (ml/min)    Dosage Recommendation
26-50               Normal dose 12 hourly.
10-25               Half normal dose 12 hourly.
<10                  Half normal dose 24 hourly.

Intravenous
Diabetic foot infection
Adult: 1 g every 8 hours.
Child: ≥3 months: <50 kg: 20 mg/kg (max: 1 g) every 8 hours; >50 kg: 1 g every 8 hours.

Renal impairment: Haemodialysis: Usual dose after dialysis session.
CrCl (ml/min)    Dosage Recommendation
26-50               Normal dose 12 hourly.
10-25               Half normal dose 12 hourly.
<10                  Half normal dose 24 hourly.

Intravenous
Intra-abdominal infections
Adult: 1 g every 8 hours.
Child: ≥3 months: <50 kg: 20 mg/kg (max: 1 g) every 8 hours; >50 kg: 1 g every 8 hours.

Renal impairment: Haemodialysis: Usual dose after dialysis session.
CrCl (ml/min)    Dosage Recommendation
26-50               Normal dose 12 hourly.
10-25               Half normal dose 12 hourly.
<10                  Half normal dose 24 hourly.


Reconstitution
Direct injection or infusion: add 10 ml of sterile water to 500 mg or 20 ml of sterile water to 1 g. Can be further diluted with compatible IV solution (50-200 ml).

Incompatibility
Admixture: Amphotericin B, metronidazole and multivitamins. Y-site: Amphotericin B, diazepam and metronidazole. Syringe: Pantoprazole.

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Caution when used during pregnancy

Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters).

Caution when used during lactation

Safety and efficacy in children 3 months of age and younger not established.

Use care in dose selection because elderly patients are more likely to have decreased renal function; monitor renal function.

Hypersensitivity

Intravenous
Once reconstituted, up to 2 hours at 15-25°C or up to 12 hours at 4°C.

Information Not Available