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Meropenem

Pronouncation: (mare-oh-PEN-em)
Class: Carbapenem

Trade Names:
Merrem
- Powder for Injection 500 mg
- Powder for Injection 1 g

Pharmacology

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As a treatment for...	Avg User Ratings [?]
Skin Infection	Be the first to rate it 0 comments
Skin and Deeper Structure Infection	Be the first to rate it 0 comments
Meningitis	Be the first to rate it 0 comments

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Inhibits bacterial cell wall synthesis.

Pharmacokinetics

Absorption

T _max is approximately 1 h after start of infusion. Mean C _max for a 30-min infusion is 23 mcg/mL (500 mg) and 49 mcg/mL (1 g). Mean C _max for a 5-min injection is 45 mcg/mL (500 mg) and 112 mcg/mL (1 g).

Distribution

Protein binding is approximately 2% and penetrates well into most body fluids and tissues, including CSF.

Metabolism

There is 1 metabolite that is inactive.

Elimination

Approximately 70% is excreted in urine as unchanged over 12 h. Elimination t _½ is approximately 1 h.

Special Populations

Renal Function Impairment

Cl correlates with CrCl in patients with renal function impairment. Dosage adjustments may be necessary.

Children

The t _½ in children 3 mo to 2 yr of age is approximately 1.5 h.

Indications and Usage

Single agent treatment of skin and skin structure infections, intra-abdominal infections, and bacterial meningitis when caused by susceptible microorganisms.

Unlabeled Uses

Empiric therapy in febrile neutropenic patients, community-acquired pneumonia.

Contraindications

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.

Dosage and Administration

Intra-Abdominal Infections
Adults

IV 1 g IV every 8 h.

Children (at least 3 mo of age)

IV 20 mg/kg every 8 h.

Max dose

2 g every 8 h.

Meningitis
Children (at least 3 mo of age)

IV 40 mg/kg every 8 h.

Max dose

2 g every 8 h.

Skin and Skin Structure Infections
Adults

IV 500 mg every 8 h.

Children (at least 3 mo of age)

IV 10 mg/kg every 8 h. Max dose: 500 mg every 8 h.

Dosing Adjustments in Renal Failure
Adults

For CrCl 26 to 50 mL/min: recommended dose every 12 h; for CrCl 10 to 25 mL/min: 50% of recommended dose every 12 h; for CrCl less than 10 mL/min: 50% of recommended dose every 24 h.

General Advice

For IV bolus or infusion only. Not for intradermal, subcutaneous, IM, or intra-arterial administration.
Administer IV infusion over approximately 15 to 30 min. Administer IV bolus over approximately 3 to 5 min.
To prepare IV bolus: constitute 500 mg injection vial with 10 mL sterile water for injection; constitute 1 g injection vial with 20 mL sterile water for injection.
Shake to dissolve and let stand until clear. Final concentration is approximately 50 mg/mL.
To prepare IV infusion: add constituted injection solution to an IV container and further dilute with appropriate infusion fluid, or directly constitute with compatible infusion fluid.
Do not mix with or physically add to solutions containing other drugs.
If other drugs are being administered through same IV line, administer each medication separately.
Reconstituted meropenem solution is a clear, colorless to yellow solution. Do not administer if solution is cloudy, discolored, or contains particulate matter.

Storage/Stability

Store dry powder for reconstitution at controlled room temperature (68° to 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.

Drug Interactions

Probenecid

Inhibits renal excretion of meropenem. Coadministration is not recommended.

Valproic acid

Meropenem may decrease valproic acid levels, resulting in a loss of seizure control.

Incompatibility

Do not physically mix with solutions containing other drugs.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Bradycardia, cardiac arrest, heart failure, hypertension, hypotension, MI, pulmonary embolus, tachycardia.

CNS

Headache (8%); seizures.

Dermatologic

Rash (2%); pruritus (1%).

EENT

Pharyngitis (at least 1%).

GI

Nausea (8%); constipation, diarrhea (7%); vomiting (4%); GI disorder (at least 1%); intestinal obstruction.

Genitourinary

Kidney failure.

Hematologic-Lymphatic

Anemia (6%).

Hepatic

Cholestatic jaundice, hepatic failure, jaundice.

Local

Inflammation at injection site (2%).

Metabolic-Nutritional

Hypoglycemia (at least 1%).

Respiratory

Apnea (1%); pneumonia (at least 1%).

Miscellaneous

Pain (5%); sepsis (2%); shock (1%); accidental injury, peripheral vascular disorder (at least 1%).

Precautions

Warnings

Monitor patients response to therapy. Periodically monitor renal, hepatic, and hematopoietic function during prolonged therapy.

Pregnancy

Category B .

Lactation

Undetermined.

Children

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

Elderly

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

Hypersensitivity

Serious and potentially fatal anaphylactic reactions have been reported. Patients with sensitivity to multiple allergens are at greatest risk. Use with caution in penicillin sensitive patients because of possible cross reactivity.

Renal Function

Adjust dose downward accordingly in patients with CrCl less than 51 mL/min. Thrombocytopenia, without bleeding, has been observed.

Superinfection

May result in bacterial or fungal overgrowth of nonsusceptible organisms.

CNS

Seizures and other CNS adverse reactions have occurred. Use with caution in patients with CNS disorders, meningitis, or renal function impairment.

Pseudomembranous colitis

Consider possibility in patients with diarrhea.

Overdosage

Symptoms

Ataxia, convulsions, dyspnea, and mortality.

Patient Information

Advise patient, family, or caregiver that medication will be prepared and administered by health care professionals in a medical setting.
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 stools, hives, rash, vaginal itching or discharge, white patches in mouth.
Warn patient, family, or caregiver that diarrhea containing blood or pus, that develops after discharge, may be a sign of a serious disorder and to seek medical care if noted and not treat at home.