Meropenem

ADMINISTRATION ROUTES:

IV

ALTERNATIVE NAMES:

Merrem

ICU INDICATIONS:

1. Treatment of infections caused by susceptible organisms
2. Broad spectrum cover of hospital-acquired infections (particularly in the setting of intra-abdominal sepsis)

PRESENTATION AND ADMINISTRATION:

IV:

500 mg and 1 gm vials of white powder

Add 10 mL of water for injection to 500 mg vial or 20 mL of water for injection to a 1 gm vial. Shake vigorously until liquid is clear (approximately 3 minutes). The reconstituted solution has an approximate concentration of 50 mg/mL. Inject required dose slowly over 5 minutes.

Initial reconstitution should be prepared as soon as possible before use although solutions reconstituted with water for injection are stable for 8 hours at 25 degrees or 24 hours at 4 degrees.

Can be added to 50-200 mL of compatible IV fluid for administration by infusion over 15-30 minutes.

Compatible with the following IV fluids:

Normal saline, 5% or 10% glucose , Glucose and sodium chloride 2.5% or 10%, mannitol 5%, glucose and 0.15% KCl

Store at room temperature

DOSAGE:

IV:

1 gm TDS

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

Dose in renal impairment

Dose in renal replacement therapy

DOSAGE IN PAEDIATRICS:

IV:

20-40 mg/kg TDS

CLINICAL PHARMACOLOGY:

Meropenem is a carbapenem antibiotic. The bactericidal activity of meropenem results from the inhibition of cell wall synthesis. Meropenem has been shown to be active against most isolates of the following microorganisms, both in vitro and in clinical infections:

Aerobes, Gram-Positive:

• Enterococcus faecalis (excluding vancomycin-resistant isolates)
• Staphylococcus aureus (beta-lactamase and non-beta-lactamase producing, methicillin- susceptible isolates only)
• Streptococcus agalactiae
• Streptococcus pneumoniae (penicillin-susceptible isolates only)
• Streptococcus pyogenes
• Viridans group streptococci.

Aerobes, Gram-Negative:

• Escherichia coli
• Haemophilus influenzae (beta-lactamase and non-beta-lactamase-producing)
• Klebsiella pneumoniae
• Neisseria meningitidis
• Pseudomonas aeruginosa
• Proteus mirabilis.

Anaerobes:

• Bacteroides fragilis
• Bacteroides thetaiotaomicron
• Peptostreptococcus species

CONTRAINDICATIONS:

1. Hypersensitivity to carbapenems

WARNINGS:

Serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported in patients receiving therapy with beta-lactams. These reactions are more apt to occur in patients with a history of sensitivity to multiple allergens.

There have been reports of patients with a history of penicillin hypersensitivity who have experienced severe hypersensitivity reactions when treated with another beta-lactam. Before initiating therapy with meropenem, careful inquiry should be made concerning previous hypersensitivity reactions to penicillins, cephalosporins, other beta-lactams, and other allergens.

PRECAUTIONS:

General:

Seizures and other adverse CNS experiences have been reported during treatment with meropenem. These experiences have occurred most commonly in patients with CNS disorders (e.g. brain lesions or history of seizures) or with bacterial meningitis and/or compromised renal function. This risk of seizures is lower than the risk with imipenem. In patients with renal dysfunction, thrombocytopaenia has been observed but no clinical bleeding reported.

Laboratory Tests:

No tests in addition to routine ICU tests are required

Drug/Laboratory Test Interactions:

None noted

IMPORTANT DRUG INTERACTIONS IN ICU:

There is evidence that meropenem may reduce serum levels of valproic acid to subtherapeutic. Monitor levels in patients receiving sodium valproate and meropenem at the same time.

ADVERSE REACTIONS:

Body as a Whole:

Pain, abdominal pain, chest pain, fever, back pain, abdominal enlargement, chills, pelvic pain

Cardiovascular:

Heart failure, heart arrest, tachycardia, hypertension, myocardial infarction, pulmonary embolus, bradycardia, hypotension, syncope

Gastrointestinal

Oral moniliasis, anorexia, diarrhoea, nausea/vomiting, cholestatic jaundice/jaundice, flatulence, ileus, hepatic failure, dyspepsia, intestinal obstruction

Haematological:

Anaemia, hypochromic anaemia, hypervolemia

Metabolic/Nutritional:

Peripheral oedema, hypoxia

Nervous system:

Insomnia, agitation/delirium, confusion, dizziness, seizure (see PRECAUTIONS), nervousness, paraesthesia, hallucinations, somnolence, anxiety, depression, asthenia

Respiratory:

Respiratory disorder, dyspnoea, pleural effusion, asthma, increased cough, pulmonary oedema

Skin and appendages:

Urticaria, sweating, skin ulceration

Urogenital system:

Dysuria, kidney failure, vaginal moniliasis, urinary incontinence