meropenem

Action and Spectrum

Actions and Spectrum: 

• meropenem is a broad-spectrum antibiotic that belongs to the carbapenem class of antibiotics. It works by inhibiting bacterial cell wall synthesis, ultimately leading to cell death. 
• meropenem has a broad spectrum of activity against many gram-positive and gram-negative bacteria, including those resistant to other antibiotics. It is particularly effective against aerobic and anaerobic gram-negative bacteria, such as Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. It also has activity against gram-positive bacteria such as Streptococcus pneumoniae, Staphylococcus aureus (including methicillin-resistant S. aureus, or MRSA), and Enterococcus faecalis. 
• meropenem is given intravenously and is commonly used to treat a wide variety of bacterial infections, including complicated intra-abdominal infections, complicated skin and soft tissue infections, bacterial meningitis, and community-acquired pneumonia. It is also used to treat sepsis and febrile neutropenia in immunocompromised patients. 

Drug Interaction

Adverse Reaction

Frequency defined 

1-10% 

Diarrhea (4-5%) 

Rash (2-3%)  

Inflammation at the injection site (2%) 

Oral moniliasis (≤2% in pediatric patients) 

Apnea (1%) 

Glossitis (1%) 

Injection-site reaction (1%) 

Pruritus (1%) 

Constipation (1-7%) 

Nausea or vomiting (1-4%) 

Headache (2%) 

Sepsis (2%) 

Bleeding (1.2%) 

Constipation (1%) 

Phlebitis or thrombophlebitis (1%) 

Septic shock (1%)  

<1% 

Angioedema 

Hypersensitivity reaction 

Leukopenia 

Pleural effusion 

Toxic epidermal necrolysis 

Agranulocytosis 

Erythema multiforme 

Hypokalemia 

Neutropenia 

Stevens-Johnson syndrome  

Post-marketing reports 

Toxic epidermal necrolysis 

Stevens-Johnson syndrome 

Erythema multiforme and acute generalized exanthematous pustulosis 

Drug reaction with eosinophilia and systemic symptoms (DRESS) 

Black Box Warning

Contraindication / Caution

Contraindications/caution: 

Contraindications: 

meropenem is generally considered safe and well-tolerated, but some situations may be contraindicated or should be used cautiously. meropenem is contraindicated in patients with known hypersensitivity to carbapenems or beta-lactam antibiotics. It should also be used cautiously in patients with a history of allergic reactions to other beta-lactam antibiotics, such as penicillins or cephalosporins. 

Caution: 

• Seizure Disorders: meropenem may lower the seizure threshold and increase the risk of seizures, especially in patients with a history of seizure disorders. The drug should be used with caution in such patients. 
• Gastrointestinal Issues: meropenem use can cause gastrointestinal issues such as diarrhea, nausea, vomiting, and abdominal pain. Patients with a history of the gastrointestinal disease should be monitored closely. 
• Superinfection: The prolonged use of antibiotics like meropenem can lead to the overgrowth of nonsusceptible organisms, including fungi. The patient should be monitored for signs of superinfection. 
• Coagulation disorders: meropenem use can cause coagulation disorders such as bleeding and clotting. Patients with a history of coagulation disorders should be monitored closely. 
• Renal impairment: Patients with renal impairment require close monitoring of renal function. Dose adjustment may be necessary for these patients. 
• Central Nervous System (CNS) toxicity: meropenem has been associated with CNS toxicity, including encephalopathy and seizures, especially in patients with renal impairment. The drug should be used with caution in such patients. 
• Antibiotic Resistance: meropenem is a broad-spectrum antibiotic that can contribute to the development of antibiotic-resistant bacteria. Careful use of the drug is essential to minimize this risk. 

Pregnancy / Lactation

Pregnancy consideration: Insufficient data available. 

meropenem is also not recommended during pregnancy unless the potential benefits outweigh the potential risks 

Lactation: Excretion of the drug in human breast milk is unknown, so caution should be exercised when administering the drug to nursing mothers. 

Pregnancy category: 

Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester.   

Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data available with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category 

Pharmacology

Pharmacology: 

meropenem is a beta-lactam antibiotic that belongs to the carbapenem class of antibiotics. It works by inhibiting bacterial cell wall synthesis, ultimately leading to cell death.  

meropenem is a bactericidal antibiotic that is effective against a broad spectrum of gram-positive and gram-negative bacteria. It is more stable to degradation by bacterial enzymes than other carbapenems, allowing for greater efficacy against some resistant bacteria. 

Pharmacodynamics: 

• The pharmacodynamics of meropenem involve its concentration-dependent bactericidal activity against a broad spectrum of gram-positive and gram-negative bacteria. The drug works by inhibiting bacterial cell wall synthesis, ultimately leading to cell death. 
• meropenem exhibits concentration-dependent killing, meaning the higher the drug concentration, the greater the bacterial killing activity. This characteristic allows for once-daily dosing in many situations as long as the drug concentration remains above the minimum inhibitory concentration (MIC) for the target bacteria. 
• The bactericidal activity of meropenem is enhanced by prolonged infusion times, allowing sustained drug concentrations above the MIC. This has led to extended infusion dosing regimens, which have been shown to improve clinical outcomes in certain types of infections, such as sepsis. 

Pharmacokinetics: 

Absorption 

meropenem is administered intravenously, and it is well-absorbed after intravenous infusion.  

Distribution 

meropenem has a large volume of distribution, which is approximately 15-20 L in adults and 0.3-0.4 L/kg in children. It penetrates well into most body fluids and tissues, including the cerebrospinal fluid, whose concentrations approximate those in plasma. The drug is minimally protein bound, with approximately 2% bound to plasma proteins.  

Metabolism 

meropenem is metabolized in the liver to an inactive open beta-lactam form, excreted in the urine.  

Elimination and Excretion 

 The drug has a relatively short half-life of approximately 1-1.5 hours in patients with normal renal function. Its elimination depends on renal function, and approximately 25% of meropenem is excreted unchanged in the urine, with the remainder excreted as inactive metabolites. The drug is cleared primarily by glomerular filtration, and dose adjustments are necessary for patients with renal impairment. 

Adminstartion

Administration: 

• meropenem is administered intravenously by a healthcare professional. The dose and duration of treatment depend on the type and severity of the infection, as well as the patient’s age, weight, and renal function. The drug is typically administered over 30 minutes to 2 hours. 
• For most infections, meropenem is given every 8 hours. However, the dosing frequency may be adjusted in certain situations, such as severe infections or when the extended infusion is used. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: meropenem 

Why do we use meropenem? 

meropenem is a broad-spectrum antibiotic that is used to treat a wide range of bacterial infections, including: 

• Intra-abdominal infections 
• Skin and soft tissue infections 
• Pneumonia, including hospital-acquired and ventilator-associated pneumonia 
• Meningitis 
• Urinary tract infections 
• Septicemia 
• Bone and joint infections 
• Endocarditis 
• Empirical treatment of febrile neutropenia