Meropenem

General

• Type: Carbapenems
• Dosage Forms: IV
• Common Trade Names: Merrem

Adult Dosing

General

• 1.5-6g IV daily, divided q8 hours
• First Dose: 0.5-2g IV x 1

Indications by Disease

Disease	Dose	Context
Ascending cholangitis	1g IV q8hrs
Ludwig's angina	1 g IV q8 hrs	Immunocompromised
Neutropenic fever	1g IV q8hrs	Inpatient monotherapy
Peritonitis	1g (20mg/kg) IV q8hrs	Allergy/Prior exposure
Pneumonia (main)	1g q8h	ICU, Risk of Pseudomonas
Pneumonia (main)	1g q8h	HAP, High Risk
Pneumonia (main)	1g q8h	VAP, High Risk

Pediatric Dosing

General (≥3 Months)

• 30-120mg/kg/day IV divided q8 hours
• First Dose: 10-40mg/kg IV x 1
• Max: 6 g/day

Indications by Disease

Disease	Dose	Context
Ludwig's angina	20mg/kg IV q8hrs (max 1g)	Pediatric Immunocompromised
Neutropenic fever	20mg/kg IV q8hrs (max 1g)	Pediatric Inpatient
Peritonitis	20mg/kg IV q8hrs (max 1g)	Pediatric

Special Populations

• Pregnancy: B
• Lactation: Use caution
• Renal Dosing
  • Adult
    • CrCl 26-50: Give q12h
    • CrCl 10-25: Decrease dose 50%, give q12h
    • CrCl 10: Decrease dose 50%, give q24h
    • HD: Give dose after dialysis
    • PD: No supplement
  • Pediatric
    • CrCl 26-50: Give q12h
    • CrCl 10-25: Decrease dose 50%, give q12h
    • CrCl 10: Decrease dose 50%, give q24h
    • HD: Give dose after dialysis
    • PD: No supplement
• Hepatic Dosing
  • Adult
    • No adjustment
  • Pediatric
    • No adjustment

Contraindications

• Allergy to class/drug
• Anaphylactic reaction to beta-lactams
• Caution
  • Seizure disorder
  • CNS infection or lesion
  • Renal impairment
  • Recent antibiotic-associated colitis

Adverse Reactions

Serious

• Seizure
• Hypersensitivity reaction
• Anaphylaxis
• Stevens-Johnson Syndrome
• Erythema multiforme
• Toxic epidermal necrolysis
• Drug reaction with eosinophilia and systemic signs
• Superinfection
• C. diff associated diarrhea
• Thrombocytopenia
• Agranulocytosis
• Anemia, hemolytic
• Neutropenia
• Leukopenia
• Delirium

Common

• Injection site inflammation
• Diarrhea
• Nausea/vomiting
• Headache
• Rash
• Paresthesia

Pharmacology

• Half-life: 1.2h (10h in renal failure)
• Metabolism: Kidney minimally; OAT1 and OAT3 substrate
• Excretion: Urine, active secretion (70% unchanged)
• Mechanism of Action: Inhibits cell wall synthesis

Comments

• Has activity against ESBL organisms

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	S
	Strep. anginosus gp	S
	Enterococcus faecalis	I
	Enterococcus faecium	R
	MSSA	S
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	S
	C. jeikeium	X1
	L. monocytogenes	S
Gram Negatives	N. gonorrhoeae	X2
	N. meningitidis	S
	Moraxella catarrhalis	S
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	S
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	S
	Enterobacter sp, AmpC pos	S
	Serratia sp	S
	Serratia marcescens	X1
	Salmonella sp	S
	Shigella sp	S
	Proteus mirabilis	S
	Proteus vulgaris	S
	Providencia sp.	S
	Morganella sp.	S
	Citrobacter freundii	S
	Citrobacter diversus	S
	Citrobacter sp.	S
	Aeromonas sp	S
	Acinetobacter sp.	I
	Pseudomonas aeruginosa	S
	Burkholderia cepacia	S
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	X1
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
	Pasteurella multocida	X1
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	R
	Mycoplasm pneumoniae	R
	Rickettsia sp	X1
	Mycobacterium avium	X1
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	S
	Prevotella melaninogenica	S
	Clostridium difficile	X2
	Clostridium (not difficile)	S
	Fusobacterium necrophorum	S
	Peptostreptococcus sp.	S

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia

See Also

• Antibiotics (Main)