Class: Carbapenem antibiotic
- Injection, powder for solution 500 mg
- Injection, powder for solution 1 g
Inhibits bacterial cell wall synthesis.
T max is approximately 1 h after start of infusion. Mean C max for a 30-min infusion is 23 mcg/mL (500 mg dose) and 49 mcg/mL (1 g dose). Mean C max for a 5-min bolus injection is 45 mcg/mL (500 mg dose) and 112 mcg/mL (1 g dose).
Protein binding is approximately 2% and penetrates well into most body fluids and tissues, including CSF.
There is 1 metabolite that is inactive.
Approximately 70% is excreted in urine unchanged over 12 h. Elimination half-life is approximately 1 h.
Special PopulationsRenal Function Impairment
Cl correlates with CrCl in patients with renal function impairment. Dosage adjustments may be necessary.Hepatic Function Impairment
Hepatic function impairment does not affect the pharmacokinetics.Elderly
A reduction in plasma Cl correlates with age-associated reduction in CrCl.Children
The half-life in children 3 mo to 2 y of age is approximately 1.5 h.
Indications and Usage
Single-agent treatment of complicated skin and skin structure infections, complicated intra-abdominal infections (ie, appendicitis, peritonitis), and bacterial meningitis when caused by susceptible microorganisms.
Empiric therapy in febrile neutropenic patients; community-acquired pneumonia (if Pseudomonas is a concern); hospital-acquired pneumonia (including ventilator-associated pneumonia and health care- associated pneumonia).
Hypersensitivity to any component of this product or to other drugs in the same class; anaphylactic reactions to beta-lactams.
Dosage and AdministrationIntra-Abdominal Infections
IV 1 g every 8 h.Children (3 mo and older) Weighing more than 50 kg
IV 1 g every 8 h.Weighing 50 kg or less
IV 20 mg/kg every 8 h.Max dose
IV 1 g every 8 hBacterial Meningitis
Children (3 mo and older) Weighing more than 50 kg
IV 2 g every 8 h.Weighing 50 kg or less
IV 40 mg/kg every 8 h.Max dose
IV 2 g every 8 h.Complicated Skin and Skin Structure Infections
IV 500 mg every 8 h.Children (3 mo and older) Weighing more than 50 kg
IV 500 mg every 8 h.Weighing 50 kg or less
IV 10 mg/kg every 8 h.Max dose
IV 500 mg every 8 h.Renal Function Impairment
Adults CrCl greater than 25 to 50 mL/min
Recommended dose every 12 h.CrCl 10 to 25 mL/min
50% of recommended dose every 12 h.CrCl less than 10 mL/min
50% of recommended dose every 24 h.Continuous renal replacement therapy
1 to 2 g every 12 h. Alternative recommendations assume ultrafiltration and dialysis flow rates of 1 to 2 L/h.Loading dose
IV 1 g.Maintenance dose Continuous venovenous hemofiltration
500 mg to 1 g IV every 12 h or 500 mg IV every 8 h.Continuous venovenous hemodialysis or continuous venovenous hemodiafiltration
500 mg to 1 g IV every 8 to 12 h or 500 mg IV every 6 to 8 h.Peritoneal Dialysis
100% of the recommended dose every 24 h.Intermittent Hemodialysis
500 mg IV every 24 h after dialysis.Off-Label Dosing
Community-Acquired Pneumonia Adults
Empirically, 500 mg every 8 h for a minimum of 5 days, used in combination with a fluoroquinolone.Empiric Therapy in Febrile Neutropenic Patients Adults
IV 1 g every 8 h.Hospital-Acquired Pneumonia Adults
IV 1 g every 8 h. Duration of treatment is 7 to 8 days for uncomplicated hospital-acquired pneumonia infections.Neonates
IV 15 to 20 mg/kg every 12 h.
For neonates 7 days and older who weigh more than 2 kg, a dosage of IV 20 mg/kg every 8 h has been suggested. Administer dose over 15 to 30 min.
- For IV bolus (doses of 1 g) or infusion only. Not for intradermal, subcutaneous, IM, or intra-arterial administration. Do not use a flexible container in series connections.
- Administer IV infusion over approximately 15 to 30 min. Administer IV bolus (5 to 20 mL) over approximately 3 to 5 min.
- Do not mix with or physically add to solutions containing other drugs.
Store dry powder between 68° and 77°F. Stability of reconstituted meropenem is dependent on diluent and container (eg, syringe, infusion vial, minibag). Refer to manufacturer's package insert for guidelines.
Inhibits renal excretion of meropenem. Coadministration is not recommended.Valproic acid and derivatives
Meropenem may decrease valproic acid levels to subtherapeutic levels, resulting in a loss of seizure control. Monitor valproic acid plasma concentrations and observe the patient for seizure activity. Consider adjusting the valproic acid dose as needed or using an alternative antibiotic. If meropenem therapy is necessary, consider supplemental anticonvulsant therapy.
Bradycardia, cardiac arrest, heart failure, hypertension, hypotension, MI, pulmonary embolus, syncope, tachycardia (1% or less).
Headache (8%); agitation/delirium, anxiety, asthenia, confusion, depression, dizziness, hallucinations, insomnia, nervousness, paresthesia, seizures, somnolence (1% or less).
Diaper rash, rash (3%); pruritus (1%); skin ulcer, sweating, urticaria (1% or less); angioedema, erythema multiforme, Stevens-Johnson syndrome, TEN (postmarketing).
Pharyngitis (at least 1%).
Nausea (8%); constipation, diarrhea (7%); vomiting (4%); oral moniliasis (2%); GI disorder (at least 1%); GI hemorrhage, glossitis (1%); abdominal pain/enlargement, anorexia, dyspepsia, flatulence, ileus, intestinal obstruction (1% or less).
Dysuria, kidney failure, urinary incontinence, vaginal moniliasis (1% or less); presence of RBC in urine.
Anemia (6%); hypochromic anemia (1% or less); agranulocytosis, hemolytic anemia, leukopenia, neutropenia, positive direct and indirect Coombs test (postmarketing).
Cholestatic jaundice, hepatic failure, jaundice (1% or less).
Decreased Hct, Hgb, platelets, and WBC; increased alkaline phosphatase, ALT, AST, bilirubin, BUN, creatinine, eosinophils, LDH, and platelets; hypokalemia, leukocytosis, shortened PT/PTT.
Inflammation at injection site (2%); injection-site reaction, phlebitis/thrombophlebitis (1%).
Hypoglycemia (at least 1%); hypovolemia, hypoxia, peripheral edema (1% or less).
Pneumonia (at least 1%); apnea (1%); asthma, cough increased, dyspnea, lung edema, pleural effusion, respiratory disorder (1% or less).
Pain (5%); sepsis (2%); peripheral vascular disorder (at least 1%); shock (1%); back pain, chest pain, chills, fever, pelvic pain (1% or less).
Monitor patient's response to therapy; periodically monitor renal, hepatic, and hematopoietic function during prolonged therapy.
Category B . Placental transfer to the fetus may occur.
Undetermined. Excretion into breast milk may occur.
Safety and efficacy in children 3 mo and younger not established.
Use care in dose selection because elderly patients are more likely to have decreased renal function; monitor renal function.
Serious and occasionally fatal anaphylactic reactions have been reported with beta-lactam therapy. Patients with sensitivity to multiple allergens are at greatest risk. Use with caution in penicillin-sensitive patients.
Adjust dose downward accordingly in patients with CrCl of 50 mL/min or less. Thrombocytopenia without bleeding has been observed.
May result in bacterial or fungal overgrowth of nonsusceptible organisms.
Seizures and other CNS adverse reactions have been reported. Use with caution in patients with CNS disorders, meningitis, or renal function impairment.
Clostridium difficile – associated diarrhea
Consider possibility in patients with diarrhea.
- Advise patient, family, or caregiver to immediately report any of the following to health care provider: black, furry tongue; difficulty breathing or unexplained shortness of breath; foul-smelling, watery, or bloody stools; hives; rash; vaginal itching or discharge; white patches in mouth.
- Warn patient, family, or caregiver that if diarrhea containing blood or pus develops after discharge, it may be a sign of a serious disorder. Instruct patient to seek medical care if noted and not to treat at home.
- Advise patient to inform health care provider if they are taking valproic acid or divalproex sodium for seizures. Therapy modifications may be needed.
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