Meropenem

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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

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

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 abx-associated colitis

Adverse Reactions

Serious

Common

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

Antibiotic Sensitivities[1]

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

References

  1. Sanford Guide to Antimicrobial Therapy 2014