A carbapenem antibiotic with broad spectrum protection against both gram-negative and gram-positive infections is meropenem (Meronem).

Meropenem (Meronem) Uses:

• Intra-abdominal infections:

  • Used to treat difficult appendicitis and peritonitis in adult and paediatric patients brought on by Peptostreptococcus species, Bacteroides fragilis, Bacteroides thetaiotaomicron, Escherichia coli, Klebsiella pneumoniae, and members of the viridans group streptococci.

• Bacterial Meningitis:

  • Treatment of Streptococcus pneumoniae isolates susceptible to penicillin-induced bacterial meningitis in paediatric patients aged three months and older.

• Complicated Skin and skin structure infection:

  • Treatment of complicated skin and skin structure infections in adults and children three months of age and older caused by Staphylococcus aureus (methicillin-susceptible isolates only), Streptococcus pyogenes, Streptococcus agalactiae, viridans group streptococci, Enterococcus faecalis 

• Off Label Use of Meropenem in Adults:

  • Anthrax
  • Bite wound infection, treatment, animal or human bite
  • Bloodstream infection (gram-negative bacteremia)
  • Brain abscess
  • Cystic fibrosis, acute pulmonary exacerbation
  • Diabetic foot infection, moderate to severe
  • Melioidosis (Burkholderia pseudomallei infection)
  • Neutropenic enterocolitis (typhlitis)
  • Neutropenic fever, high-risk cancer patients
  • Pneumonia
  • Prosthetic joint infection (pathogen-directed therapy for multidrug-resistant gram-negative bacilli, including P. aeruginosa)
  • Sepsis and septic shock (broad-spectrum empiric therapy, including P. aeruginosa)
  • Skin and soft tissue infection 
  • Urinary tract infection, complicated (including pyelonephritis)

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Meropenem (Meronem) Dose in Adults:

Note:Unless otherwise stated, dosing is reported using the conventional infusion method over 30 minutes.

Meropenem (Meronem) Usual dosage range:

• Traditional intermittent infusion method (over 30 minutes):

  • IV: Achieving comparable pharmacokinetic and pharmacodynamic results to 1 g every 8 hours is 500 mg every 6 hours or 1 to 2 g every 8 hours.

• Extended infusion method (off-label):

  • IV: 1–2 g every 8 hours in 3 hours.
  • Give a loading dosage of 1 to 2 g spread out over 30 minutes, especially if you want your therapeutic medication concentrations to reach them quickly.

• Continuous infusion method (off-label):

  • IV: 2 g every eight hours or 3 g every twelve hours 
  • Especially when quick achievement of therapeutic drug concentrations is sought, a loading dose of 1 to 2 g over 30 minutes may be administered (eg, sepsis).

Note:

• The foundation of extended and continuous infusion techniques is data from pharmacokinetic and pharmacodynamic modelling.
• A prolonged infusion technique increases the possibility that pharmacokinetic/pharmacodynamic targets will be met and may be clinically advantageous for individuals with severe infections or microorganisms that are less sensitive.
• The manufacturer does not support Meropenem's ability to remain stable at room temperature for more than an hour or under refrigeration for more than 15 hours when combined with NS at a concentration of 20 mg/mL.
• It has been shown to be stable for prolonged and continuous infusion when mixed with NS at concentrations of 14.3 mg/mL for 7 hours at room temperature and 20 mg/mL for 24 hours under refrigeration.
• The use of an admixture of 10 mg/mL in NS is supported by pharmacokinetic studies as stable at room temperature.

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Indication-specific dosing:

Meropenem (Meronem) Dose in the treatment of Anthrax (off-label):

Note:  For event-specific recommendations consult public health officials

• Systemic (meningitis excluded), treatment (alternative agent):

  • IV: 2 g every 8 hours for two weeks or until clinical stable, whichever comes first, as part of an appropriate combination regimen.

Meropenem (Meronem) Dose in the treatment of Meningitis:

• IV: 2 g every 8 hours for 2 to 3 weeks, or until clinical stable, whichever comes first, as part of an appropriate combination regimen.

Note:

• Administration of an antitoxin should also be done.
• Patients exposed to aerosolized spores need to finish a 60-day antimicrobial treatment after completing a course of IV combination therapy for systemic anthrax infection (including meningitis).

Meropenem (Meronem) Dose as an alternative agent in the treatment of Bite wound infection, animal or human bite (off-label):

• IV: 1 g in 8 hours
• Treatment for established infections normally lasts 5 to 14 days and varies depending on the patient, including the clinical response and patient-specific factors such oral step-down medication.

Meropenem (Meronem) Dose in the treatment of Bloodstream infection (gram-negative bacteremia).

For pathogen-directed therapy or empiric treatment of gram-negative pathogens known or suspected to exist, such as Pseudomonas aeruginosa.

• IV: 1 g in 8 hours.
• Give as part of a suitable combination regimen for empiric treatment in patients with neutropenia, severe burns, sepsis, or septic shock.

Note:

• Some experts favour the longer or continuous infusion approach and/or increasing the dose to 2 g every 8 hours for serious illnesses or infections caused by organisms with elevated minimum inhibitory concentrations (MIC).

• Duration of therapy:

  • According to the source, pathogen, severity of the infection, and clinical response, the typical duration is 7 to 14 days; for patients with simple Enterobacteriaceae infection who react appropriately to antibiotic therapy, a 7-day duration is advised.

Note:

• • If neutropenic, continue therapy until 2 days of afebrile state and neutrophil recovery (ANC 500 cells/mm and rising).
  • Some doctors recommend treating Pseudomonas aeruginosa bacteremia in neutropenic patients for a minimum of 14 days and until neutrophil recovery.

Meropenem (Meronem) Dose in the treatment of brain abscess (off-label):

• In individuals at risk for Pseudomonas aeruginosa or other resistant gram-negative bacteria as part of empiric or guided therapy (eg, neurosurgical or immunocompromised patients).
  • IV: As part of a suitable combination regimen, 2 g every 8 hours
  • typically for 4 to 8 weeks, while some patients need a longer course.
  • The proper time frame is determined by the cultured pathogen(s) and patient-specific elements, such as the clinical outcome.

Meropenem (Meronem) Dose in the treatment of acute pulmonary exacerbation of cystic fibrosis (off-label):

• For the treatment of Pseudomonas aeruginosa or other gram-negative bacilli using an empiric or focused approach.
  • IV: Most frequently given as a part of a proper combination regimen, 2 g every 8 hours.

Note:

• Some experts favour the longer or continuous infusion strategy to maximise exposure.

• Duration of therapy:

  • The ideal time frame should be determined individually based on the clinical outcome.
  • Typically, duration ranges from 10 days to 3 weeks or more.

Dose for treating moderate to severe Diabetic foot infection (off-label):

• As a part of empiric therapy in individuals at risk for Pseudomonas aeruginosa or other resistant gram-negative bacteria (e.g., extensive water exposure, macerated wound).
  •  IV: 1 g each eight hours. In the absence of osteomyelitis, the duration (which may include oral step-down therapy) is typically 2 to 4 weeks, but it can vary depending on the patient, including the clinical response.

Dose for treating healthcare-associated or high-risk community-acquired Intra-abdominal infection:

Note:

• Reserve community-acquired infections for individuals at high risk of complications or resistance, or for infections that are severe.
  in patients who are susceptible to Pseudomonas aeruginosa or other resistant gram-negative bacteria as part of empiric therapy.

• Acute Cholecystitis:

  • IV: 1 g every 8 hours, for 1 day following gallbladder ectomy, or for patients handled nonoperatively, until clinical resolution.

Meropenem (Meronem) Dose in the treatment of Other intra-abdominal infection (eg, cholangitis, perforated appendix, diverticulitis, and intraabdominal abscess):

• IV: 1 g each eight hours.
• Following sufficient source control, therapy (which may include oral step-down therapy) lasts for a total of 4 to 7 days.
• A longer time frame can be required for infections treated without surgical or percutaneous intervention.

Note:

• Some medical professionals prefer the extended or continuous infusion approach for patients who are critically ill or who are at high risk of contracting a pathogen that is drug-resistant.

Meropenem (Meronem) Melioidosis (Burkholderia pseudomallei infection ) (off-label):

• Initial intensive therapy:

  • IV: 1 g every eight hours for 10 to 14 days
  • A longer period may be required depending on the severity of the illness and the location of the infection.
  • Some experts advise adding sulfamethoxazole and trimethoprim for individuals with localised disease of the CNS, prostate, bone, joint, skin, or soft tissue, as well as 2 g every 8 hours for those with neurological involvement.

Note:

• • It is advised to use oral antibiotics for eradication for 12 weeks after the parenteral therapy has finished.

Meropenem (Meronem) Dose in the treatment of Bacterial Meningitis:

• When used as a part of empiric treatment for infections brought on by healthcare providers or acquired by immunocompromised individuals, or when used as pathogen-specific therapy for gram-negative bacteria resistant to other antibiotics (eg, Pseudomonas aeruginosa, Acinetobacter spp.).
  • IV: 2 g each eight hours.
  • Treatment lasts 7 to 21 days depending on the pathogen(s) involved and the patient's reaction; for gram-negative bacilli, the minimum time frame is 10 to 14 days, however some experts prefer 21 days.

Note:

• • Consider using a prolonged or continuous infusion for infections that are more resistant.

Meropenem (Meronem) Dose as an alternative agent in the treatment of Neutropenic enterocolitis (typhlitis) (off-label):

Note: Keep aside for patients who have been colonised or infected with a gram-negative bacillus that is resistant, such as an extended-spectrum beta-lactamase (ESBL)-producing organism. (Wong Kee Song 2019).

• IV: 1 g each eight hours;
• Continue until clinical improvement and resolution of neutropenia are achieved, then move to oral antibiotics.
• Following neutropenia recovery, an antibiotic course typically lasts 14 days.

Meropenem (Meronem) Dose as empiric therapy in the treatment of high-risk cancer patients with Neutropenic fever:

Note:

• Patients at high risk are those who are anticipated to have an ANC 100 cells/mm3 for more than 7 days or for any anticipated duration if they have persistent comorbidities (eg, sepsis, mucositis, significant hepatic or renal dysfunction)
• To identify patients at high risk, some experts employ an ANC cutoff of 500 cells per millimetre.
  • IV: 1 g every eight hours until the neutropenia has resolved for at least 48 hours and the ANC has increased to at least 500 cells per millilitre, or, if the infection has persisted for a longer period of time than the neutropenia, for the normal duration for that infection.
  • Depending on the clinical situation, additional agent(s) may be required.
  • Some doctors favour the extended or continuous infusion technique, especially for treating seriously ill patients.

Meropenem (Meronem) Dose in the treatment of Pneumonia (off-label):

• A component of empiric treatment for inpatients at risk of infection with a multidrug-resistant gram-negative bacteria, such as P. aeruginosa, is community-acquired pneumonia.:

  • IV: As part of an appropriate combination regimen, take 1 g every 8 hours.
  • A longer course may be necessary for severe or complicated infections, as well as infections caused by Pseudomonas aeruginosa.
  • The total duration (which may include oral step-down therapy), is at least 5 days long and varies depending on the severity of the disease and the patient's response to treatment.
  • Before stopping treatment, patients should be clinically stable and afebrile for at least 48 hours.

• As an empiric treatment or pathogen-specific therapy for multidrug-resistant gram-negative bacilli, hospital acquired or ventilator-associated pneumonia (eg, P. aeruginosa, Acinetobacter spp.):

  • IV: As part of an appropriate combination treatment, 1 g every 8 hours.
  • Treatment is normally administered for seven days, although a longer course may be necessary for severe or complicated
  • infections, depending on the severity of the illness and the patient's reaction to the treatment.

Note:

• Meropenem is only prescribed to patients at risk of infection with gram-negative pathogens that are multidrug resistant (MDR), such as P. aeruginosa (Klompas 2019).
• Some people prefer the extended or continuous infusion technique, especially when someone is seriously ill.

Meropenem (Meronem) Dose in the treatment of Prosthetic joint infection (pathogen-directed therapy for multidrug-resistant gram-negative bacilli, including P. aeruginosa) (off-label):

• IV: 1 g each eight hours
• Resection arthroplasty patients typically experience a recovery period of 4 to 6 weeks, though this can vary.

Meropenem (Meronem) Dose in the treatment of Sepsis and septic shock (broad-spectrum empiric therapy, including P. aeruginosa) (off-label):

• IV: 1 to 2 g every eight hours when combined with other suitable agents
• Once sepsis or septic shock has been diagnosed, therapy should begin as quickly as feasible.
• Depending on the underlying cause, the average course of treatment can last anywhere between 7 and 10 days, or even longer, depending on the patient's clinical response.
• If a noninfectious cause is found, cessation may be an option.

Note:

• The extended or continuous infusion approach is preferred by certain specialists.

Meropenem (Meronem) Dose in the treatment of moderate to severe skin and soft tissue infection (necrotizing infection and selected surgical site infections [intestinal, GU tract]), broad-spectrum empiric coverage, including P. aeruginosa:

• IV: As part of an appropriate combination regimen, take 1 g every 8 hours.
• The length of time depends on the severity of the infection, the patient's response, and other patient-specific factors. For necrotizing infections, keep treating the patient until further debridement is not required, the patient has shown improvement in their condition, and the patient has been afebrile for at least 48 hours.

Meropenem (Meronem) Dose in the treatment of complicated Urinary tract infection (including pyelonephritis) (off-label):

• IV: 1 g every 8 hours; for empiric therapy, use either by itself or in conjunction with other suitable medications.
• If culture and susceptibility results permit, transition to an appropriate oral treatment once the patient's symptoms have improved.
• Therapy might last anywhere from 5 to 14 days, depending on the final antibiotic chosen for the regimen.

Meropenem (Meronem) dose in the treatment of MDR-Typhoid fever:

• 10 to 14 days, 1 gramme IV 8 hourly.
• It may be administered along with 500 mg of azithromycin OD.

Note:

• Reserve for patients who are critically ill or who have a risk factor for MDR infections, such as P. aeruginosa and ESBL-producing organisms.

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Meropenem (Meronem) Dose in Children:

Meropenem (Meronem) General dosing for susceptible infection (non-CNS):

• Infants, Children, and Adolescents:

  • IV: Every eight hours, 20 mg/kg of the maximum dose of 1,000 mg is administered.

Meropenem (Meronem) Dose for treating pulmonary exacerbation of Cystic fibrosis:

• Infants, Children, and Adolescents:

  • IV: The maximal dose is 2,000 mg/dose, given as 40 mg/kg/dose every eight hours.

Meropenem (Meronem) Dose as an empiric treatment in patients with Febrile neutropenia:

• Infants, Children, and Adolescents:

  • IV: Maximum dosage: 1,000 mg/dose; 20 mg/kg/dose given every 8 hours.

Meropenem (Meronem) Dose for treating complicated Intra-abdominal infection:

Note:

• According to IDSA recommendations, treatments should last 4 to 7 days.

• Infants 1 to <3 months:

  • GA <32 weeks:
    • IV: 20 mg per kg per dose every 8 hours
  • GA ≥32 weeks:
    • IV: 30 mg per kg per dose every 8 hours

• Infants ≥3 months, Children, and Adolescents:

  • IV: 20 mg per kg per dose every 8 hours;
  • The maximum dose: 1,000 mg per dose

Dose for Meningitis:

• Infants (Limited data available <3 months of age), Children, and Adolescents:

  • IV: 40 mg per kg per dose every 8 hours;
  • The maximum dose: 2,000 mg per dose.
  • Duration of therapy depends upon pathogen:
    • N. meningitidis, H. influenza: 7 days
    • S. pneumoniae: 10 to 14 days
    • aerobic gram-negative bacilli: 21 days.

Dose for complicated skin and skin structure infection:

• Manufacturer's labeling:

  • Infants ≥3 months, Children, and Adolescents:
    • IV: 10 mg per kg per dose every 8 hours;
    • maximum dose: 500 mg/dose

Dose for Severe or necrotizing infections:

• Infants, Children, and Adolescents:

  • IV: 20 mg per kg per dose every 8 hours;
  • maximum dose: 1,000 mg/dose.

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Pregnancy Risk Category: B

• A human ex vivo perfusion model was used to determine that meropenem transplacental transfer was incomplete.
• On the usage of meropenem during pregnancy, little is known.

Meropenem use during breastfeeding:

• Breast milk contains Meropenem.
• There isn't much information on Meropenem use by nursing mothers.
• The company advises that you weigh the advantages of nursing for the mother as well as the advantages to the baby when determining whether to breastfeed while undergoing therapy.
• The antibiotics in breast milk can cause non-dose-related changes to the bowel flora.
• Monitor infants for GI disorders like thrush and diarrhea.

 

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Meropenem (Meronem) Dose in Kidney Disease:

• Manufacturer’s labeling:

  • CrCl >50 mL/minute:
    • Dosage adjustment not necessary.
  • CrCl 26 to 50 mL/minute:
    • Every 12 hours, provide the prescribed dose based on the indication.
  • CrCl 10 to 25 mL/minute:
    • Every 12 hours, administer half the prescribed dose based on the indication.
  • CrCl <10 mL/minute:
    • Every 24 hours, administer half the prescribed dose based on the indication.

• Alternative recommendations:

Note:

• Recommendations for renally adjusted dosages are based on doses of 1 to 2 g per 8 hours.
  • GFR 10 to 50 mL/minute:
    • Every 12 hours, administer the dose that is advised based on the indication.
  • GFR <10 mL/minute:
    • Every 24 hours, administer the dose that is advised based on the indication.
  • Intermittent hemodialysis (IHD) (administer after hemodialysis on dialysis days):
    • 500 mg of meropenem and its metabolite can be dialyzed every 24 hours.
  • Note:
    • Dosing is based on the presumption of three full IHD sessions per week.
• Peritoneal dialysis (off-label dose):
  • Every 24 hours, provide the prescribed dose (depending on the indication).
• Continuous renal replacement therapy (CRRT).
  • The technique of renal replacement, the type of filter, and the flow rate all have a significant impact on drug clearance.
  • Close monitoring of the pharmacologic response, warning indicators of drug accumulation, and drug concentrations in respect to the target trough are all necessary for proper dosing (if appropriate).
  • The following suggestions should not replace clinical judgement and are simply general advice (based on dialysate flow/ultrafiltration rates of 1 to 2 L/hour and limited residual renal function):
• CVVH:
  • Think about using a 1 g loading dosage, followed by 500 mg every 8 hours or 1 g every 8 to 12 hours.
• CVVHD/CVVHDF:
  •  Think about using 1 g as a loading dosage, then 500 mg every 6 to 8 hours or 1 g every 8 to 12 hours.

Note:

• Think about administering 750 mg every 8 hours or 1.5 g every 12 hours to individuals undergoing CVVHDF.
• The different published recommendations, which range from 1 to 3 g daily in 2 to 3 split dosages, include a significant amount of variation.
• Using one gramme every 12 hours, a goal trough of 4 mg/L is reached.

Dose in Liver disease:

• Dosage adjustment not required.

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Side Effects of Meropenem (Meronem):

• Cardiovascular:

  • Peripheral Vascular Disease
  • Shock
  • Bradycardia
  • Cardiac Arrest
  • Cardiac Failure
  • Chest Pain
  • Hypertension
  • Hypotension
  • Myocardial Infarction
  • Peripheral Edema
  • Pulmonary Embolism
  • Syncope
  • Tachycardia

• Central Nervous System:

  • Headache
  • Pain
  • Agitation
  • Anxiety
  • Chills
  • Confusion
  • Delirium
  • Depression
  • Dizziness
  • Drowsiness
  • Hallucination
  • Insomnia
  • Nervousness
  • Paresthesia
  • Seizure

• Dermatologic:

  • Skin Rash
  • Pruritus
  • Dermal Ulcer
  • Diaphoresis
  • Urticaria

• Endocrine & Metabolic:

  • Hypoglycemia
  • Hypervolemia

• Gastrointestinal:

  • Nausea
  • Diarrhea
  • Constipation
  • Vomiting
  • Oral Candidiasis
  • Gastrointestinal Disease
  • Glossitis
  • Abdominal Pain
  • Anorexia
  • Dyspepsia
  • Enlargement Of Abdomen
  • Flatulence
  • Intestinal Obstruction

• Genitourinary:

  • Dysuria
  • Pelvic Pain
  • Urinary Incontinence
  • Vulvovaginal Candidiasis

• Hematologic & Oncologic:

  • Anemia
  • Hypochromic Anemia

• Hepatic:

  • Cholestatic Jaundice
  • Hepatic Failure
  • Jaundice

• Infection:

  • Sepsis

• Local:

  • Inflammation At Injection Site

• Neuromuscular & Skeletal:

  • Asthenia
  • Back Pain

• Renal:

  • Renal Failure

• Respiratory:

  • Pharyngitis
  • Pneumonia
  • Apnea
  • Asthma
  • Cough
  • Dyspnea
  • Hypoxia
  • Pleural Effusion
  • Pulmonary Edema
  • Respiratory Tract Disease

• Miscellaneous:

  • Accidental Injury
  • Fever

Rare Side effects of Meropenem (Meronem):

• Endocrine & Metabolic:

  • Hypokalemia
  • Increased Lactate Dehydrogenase

• Genitourinary:

  • Hematuria

• Hematologic & Oncologic:

  • Decreased Hematocrit
  • Decreased Hemoglobin
  • Decreased Partial Thromboplastin Time
  • Decreased Prothrombin Time
  • Decreased White Blood Cell Count
  • Eosinophilia
  • Leukocytosis
  • Quantitative Disorders Of Platelets

• Hepatic:

  • Increased Serum Alanine Aminotransferase
  • Increased Serum Alkaline Phosphatase
  • Increased Serum Aspartate Aminotransferase
  • Increased Serum Bilirubin

• Renal:

  • Increased Blood Urea Nitrogen
  • Increased Serum Creatinine

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Contraindications to Meropenem (Meronem):

• Intolerance to meropenem, other medications in the same class, or any ingredient in the formulation
• Beta-lactam-related anaphylaxis responses in patients

Warnings and precautions

• Anaphylaxis or hypersensitivity reactions

  • There have been reports of severe hypersensitivity reactions including anaphylaxis (some with no history of allergic reactions to beta-lactams).

• CNS effects

  • The use of carbapenems has been associated with negative CNS consequences such disorientation and myoclonic convulsions.
  • Patients who have CNS conditions (such as brain lesions or a history of seizures) should be handled with caution.
  • To avoid drug accumulation and increase seizure risk, adjust the dose for renal impairment.
  • Paresthesias, seizures, and/or headaches brought on by outpatient treatment may impair neuromotor function and awareness.
  • Patients should refrain from using machinery or driving until meropenem has been given the all-clear.

• Dermatological effects

  • Stevens Johnson syndrome, toxic epidermal necrolysis, toxic epidermal neolysis, drug reaction with eosinophilia, systemic symptoms, erythema multiflora, and acute widespread hyperanthematous pustulosis are only a few of the severe cutaneous adverse reactions that have been documented.
  • Stop using right away if you experience any serious reactions.

• Superinfection

  • Extended use may result in bacterial and fungal superinfections like pseudomembranous collitis or C. difficile-associated diarrhoea (CDAD).
  • Several months after receiving antibiotics, CDAD was monitored.

• Renal impairment

  • Patients with deteriorated renal function need to exercise caution.
  • Patients with creatinine clearance of =50mL/minute will need to adjust their dosage.
  • Patients who have kidney disease have reported having a higher incidence of seizures and thrombocytopenia.

Meropenem: Drug Interaction

Risk Factor C (Monitor therapy)
BCG Vaccine (Immunization)	Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization).
Lactobacillus and Estriol	Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol.
Risk Factor D (Consider therapy modification)
Sodium Picosulfate	Antibiotics may reduce Sodium Picosulfate's therapeutic impact. Management: If a patient previously used or is currently using an antibiotic, think about utilising an alternative product for bowel cleansing prior to a colonoscopy.
Typhoid Vaccine	The Typhoid Vaccine's therapeutic benefits may be reduced by antibiotics. The only strain impacted is the live attenuated Ty21a strain. Treatment: Patients receiving systemic antibacterial drugs should refrain from receiving the live attenuated typhoid vaccination (Ty21a). It is recommended to wait at least 3 days following the last dose of antibacterial medication before administering this vaccine.
Valproate Products	The serum concentration of valproate products may drop when using carbapenems. Treatment: It is generally not advised to take valproic acid and carbapenem antibiotics at the same time. Alternative antibacterial agents ought to be looked into, but if concurrent carbapenem administration is required, look into additional anti-seizure medications.
Risk Factor X (Avoid combination)
BCG (Intravesical)	Antibiotics may diminish the therapeutic effect of BCG (Intravesical).
Cholera Vaccine	Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics.
Probenecid	Meropenem serum levels can rise.

 

Monitoring parameters:

• Prior to initiating therapy perform culture and sensitivity testing.
• During the initial dose, keep an eye out for any anaphylactic symptoms.
• Maintain CBC, liver, and renal function monitoring during prolonged therapy.

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How to administer Meropenem (Meronem)?

• IV:
  • Give an IV infusion throughout a 15- to 30-minute period.
  • 5 to 20 mL IV bolus over the course of 3 to 5 minutes
• Extended infusion administration (off-label method):
  • Consume over 3 hours.

Note:

• • If using prolonged infusions, one must take into account the poor room temperature stability of meropenem.
• Continuous infusion method (off-label method):
  • IV: Administer every eight hours or every twelve hours, whichever comes first.

Note:

• • If using prolonged infusions, one must take into account the poor room temperature stability of meropenem.

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Mechanism of action of Meropenem (Meronem):

 

• Through interactions with several penicillin-binding proteins, it prevents the formation of bacterial cell walls.
• These in turn prevent the bacterial cell walls' last stage of peptidoglycan transpeptidation. In turn, this prevents the biosynthesis of cell walls.
• Bacteria gradually lyse as a result of the continued activity of cell wall autolytic enzymes (autolysins, murein hydrolases), whereas cell wall synthesis is obstructed.

Distribution:

• Most human tissues and bodily fluids are penetrated, including the urinary system, peritoneal fluid, bone, bile, lung, bronchial mucosa, and muscle tissue (Craig 1997), as well as the CSF (in infants and newborns aged 3 months and less, 70% of the CSF is penetrated).

Protein binding:

• ~2%

Metabolism:

• Hepatic; beta-lactam bond hydrolysis to open beta-lactam form (inactive).

Half-life elimination:

• Neonates and Infants ≤3 months: Median: 2.7 hours; range: 1.6 to 3.8 hours.
• Infants and Children 3 months to 2 years: 1.5 hours
• Children 2 to 12 years and adults: 1 hour

Time to peak:

• Tissue: ~1 hour following infusion except in bile, lung, and muscle
• CSF: 2 to 3 hours with inflamed meninges

Excretion:

• Urine (~70% as unchanged drug; ~28% inactive metabolite)
• feces (2%)

Clearance:

• Neonates and Infants ≤3 months: 0.12 L/hour/kg (Smith 2011)
• Infants and Children: 0.26 to 0.37 L/hour/kg (Blumer 1995)

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International Brands of Meropenem:

• Merrem
• Accurem
• Archifar
• Aris
• Bestinem
• Bironem
• Elpenem
• Enem
• Eradix
• Grambiot
• Haizheng Meite
• Lanmer
• Mabapenem
• Madiba
• Mapenem
• Mecapem
• Meflupin
• Melopen
• Menem IV
• Mepem
• Mepenam
• Mero
• Merobac I.V.
• Merofen
• Merogram
• Meromax
• Meronem
• Meronia
• Merop
• Meropemed
• Meropen
• Meropevex
• Meroponia
• Merosan
• Merostarkyl
• Merovex
• Meroxi
• Merozan
• Merozen
• Merrem
• Mirage
• Monan
• Monem
• Myron
• Newropenem
• Opimer
• Optinem
• Penem
• Penembact
• Penomer
• Pisapem
• Pospenem
• Propenem
• Romenem
• Ronem
• Ropen
• Tripenem
• Zaxter
• Zeropenem

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Meropenem Brand Names in Pakistan:

Meropenem Injection 1 Gm
Carnem	Laderly Bio-Tech Pharma
Cilipenem	Ipram International
Merocon	Continental Ph
Penro	Bosch Pharmaceuticals (Pvt) Ltd.
Xepime	Macter International (Pvt) Ltd.

 

Meropenem Injection 1 Gm
Demonem	Rotex Medica Pakistan (Pvt) Ltd
Demonem	Rotex Medica Pakistan (Pvt) Ltd
Merem	Global Pharmaceuticals

 

Meropenem Injection 500 Mg
Carnem	Laderly Bio-Tech Pharma
Cilipenem	Ipram International
Demonem	Rotex Medica Pakistan (Pvt) Ltd
Demonem	Rotex Medica Pakistan (Pvt) Ltd
Merem	Global Pharmaceuticals
Merocin	Jinnah Pharmaceuticals
Merocon	Continental Ph

 

Meropenem Injection 1 Gm
Meronem	ICI Pakistan Ltd.

 

Meropenem Injection 500 Mg
Meronem	ICI Pakistan Ltd.
Xepime	Macter International (Pvt) Ltd.

 

Meropenem Injection 500 Mg
Meronem	ICI Pakistan Ltd.
Xepime	Macter International (Pvt) Ltd.