Meropenem
Mechanism :
Meropenem is a broad-spectrum carbapenem antibiotic. It is active against Gram-positive and Gram-negative bacteria. The bactericidal activity of meropenem results from the inhibition of cell wall synthesis. Meropenem readily penetrates the cell wall of most Gram-positive and Gram-negative bacteria to reach penicillin-binding- protein (PBP) targets.
Indication :
- Wide spectrum antibiotic used to treat both Gram-positive and Gram-negative infections including pseudomonas spp. resistant to other antibiotics. Use to treat infections like meningitis, pneumonia and intra-abdominal infections, complicated skin/skin structure infections.
Contraindications :
Contraindicated in patients with known hypersensitivity to any component of this product or to other drugs in the same class or in patients who have demonstrated anaphylactic reactions to b-lactams.
Dosing :
Newborn:
<32 weeks of gestation and <14 days of life:
20 mg/kg IV every 12 hours.
<32 weeks of gestation and >14 days of life or >32 weeks of gestation and <14 days of life:
20 mg/kg IV every 8 hours.
>32 weeks of gestation and >14 days of life: 20 mg/kg IV every 8 hours.
Double the dose in meningitis and severe infection.
Children:
Urinary tract Infection, soft tissue infection and skin infections:
10 mg/kg/dose IV every 8 hours. Max: 500 mg/dose.
Pneumonia, peritonitis, neutropenia, septicemia:
20 mg/kg/dose every 8 hours. Max: 1 gm/dose.
Meningitis and life threatening infections:
40 mg/kg IV every 8 hours. Max: 2 gm/dose.
Adverse Effect :
Commonly seen adverse reactions are constipation, local irritation at injection site, rashes, diarrhea, pseudo-membranous colitis (rarely), reversible neutropenia, apnoea, glossitis, pruritus, thrombocytopenia, eosinophilia, and thrombocythemia. Elevated LFTs may occur, Adverse CNS effects such as seizures have been reported.
Interaction :
Probenecid: Competes with meropenem for active tubular secretion and thus inhibits the renal excretion of meropenem.
Valproic acid: There is evidence that meropenem may reduce serum levels of valproic acid to subtherapeutic levels.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | 500 mg – 2 g every 12 hours |
| 10-20 | 500 mg – 1 g every 12 hours or 500 mg every 8 hours |
| <10 | 500 mg – 1 g every 24 hours |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Dialysed. Dose as in GFR<10 mL/ min |
| HD | Dialysed. Dose as in GFR<10 mL/ min or 1–2 g post dialysis |
| HDF/High flux | Dialysed. Dose as in GFR<10 mL/ min |
| CAV/VVHD | Dialysed. 0.5–1 g every 8 hours or 1 g every 12 hours |
| CVVHDF | 1 g every 12 hours |
Hepatic Dose :
No dose adjustments are recommended.