Meropenem

Indications
Intravenous
Susceptible infections
Adult: 0.5-1 g every 8 hr.
Child: Neonate: <7 days: 20 mg/kg 12 hrly (severe infection 40 mg/kg 12 hrly); 7-28 days: 20 mg/kg 8 hrly (severe infection 40 mg/kg 8 hrly). 1-3 mth: 10 mg/kg 8 hrly; >3 mth and <50 kg: 10-20 mg/kg 8 hrly.
Renal impairment: Haemodialysis: Usual dose after dialysis session.
CrCl (ml/min)Dosage Recommendation
26-50Normal dose 12 hrly.
10-25Half normal dose 12 hrly.
<10Half normal dose 24 hrly.

Intravenous
Meningitis
Adult: 2 g every 8 hr.
Child: >3 mth and <50 kg: 40 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Usual dose after dialysis session.
CrCl (ml/min)Dosage Recommendation
26-50Normal dose 12 hrly.
10-25½ normal dose 12 hrly.
<10½ normal dose 24 hrly

Intravenous
Cystic fibrosis
Adult: Up to 2 g every 8 hr.
Child: 4-18 yr: 25-40 mg/kg every 8 hr.
Renal impairment: Haemodialysis: Usual dose after dialysis session.
CrCl (ml/min)Dosage Recommendation
26-50Normal dose 12 hrly.
10-25½ normal dose 12 hrly
<10½ normal dose 24 hrly

Intravenous
Skin and skin structure infections
Adult: 500 mg every 8 hr.
Child: ≥3 mth: <50 kg: 10 mg/kg (max: 500 mg) every 8 hr; >50 kg: 500 mg every 8 hr.
Renal impairment: Haemodialysis: Usual dose after dialysis session.
CrCl (ml/min)Dosage Recommendation
26-50Normal dose 12 hrly.
10-25Half normal dose 12 hrly.
<10Half normal dose 24 hrly.

Intravenous
Intra-abdominal infections
Adult: 1 g every 8 hr.
Child: ≥3 mth: <50 kg: 20 mg/kg (max: 1 g) every 8 hr; >50 kg: 1 g every 8 hr.
Renal impairment: Haemodialysis: Usual dose after dialysis session.
CrCl (ml/min)Dosage Recommendation
26-50Normal dose 12 hrly.
10-25Half normal dose 12 hrly.
<10Half normal dose 24 hrly.

Intravenous
Diabetic foot infection
Adult: 1 g every 8 hr.
Child: ≥3 mth: <50 kg: 20 mg/kg (max: 1 g) every 8 hr; >50 kg: 1 g every 8 hr.
Renal impairment: Haemodialysis: Usual dose after dialysis session.
CrCl (ml/min)Dosage Recommendation
26-50Normal dose 12 hrly.
10-25Half normal dose 12 hrly.
<10Half normal dose 24 hrly.


Special Populations: Renal impairment: CrCl: 26-50 mL/min: Usual dose every 12 hrs; 10-25 mL/min: ½the usual dose every 12 hrs; <10 mL/min: ½ the usual dose every 24 hrs.

Reconstitution: Direct inj 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.
Contraindications
Hypersensitivity.
Warnings / Precautions
History of hypersensitivity to carbapenem, pencillins or other β-lactam antibiotics; infants <3 mth; renal insufficiency; neurological disorders; pregnancy, lactation. Not recommended for use in MRSA.
Adverse Reactions
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.
Overdose Reactions
Treatment: symptomatic. In normal patients, rapid renal elimination will occur. In patients with renal impairment, haemodialysis will remove meropenem and metabolite.
Drug Interactions
Serum levels may be increased by probenecid. May reduce serum valproic acid levels; sub-therapeutic levels may be reached in some patients.
See Below for More meropenem Drug Interactions
Mechanism of Actions
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 hr by glomerular filtration and tubular secretion (70% unchanged). Elimination half-life: 1 hr. Removed by dialysis.
Storage Conditions
Intravenous: Once reconstituted, up to 2 hr at 15-25°C or up to 12 hr at 4°C.
ATC Classification
J01DH02 - meropenem ; Belongs to the class of carbapenems. Used in the systemic treatment of infections.
Storage
Intravenous: Once reconstituted, up to 2 hr at 15-25°C or up to 12 hr at 4°C.
Available As
  • Meropenem 1 gm
  • Meropenem 1000 mg
  • Meropenem 125 mg
  • Meropenem 250 mg
  • Meropenem 500 mg
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