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

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 PositiveStrep. Group A, B, C, GS
Strep. PneumoniaeS
Viridans strepS
Strep. anginosus gpS
Enterococcus faecalisI
Enterococcus faeciumR
MSSAS
MRSAR
CA-MRSAR
Staph. EpidermidisS
C. jeikeiumX1
L. monocytogenesS
Gram NegativesN. gonorrhoeaeX2
N. meningitidisS
Moraxella catarrhalisS
H. influenzaeS
E. coliS
Klebsiella spS
E. coli/Klebsiella ESBL+S
E coli/Klebsiella KPC+R
Enterobacter sp, AmpC negS
Enterobacter sp, AmpC posS
Serratia spS
Serratia marcescensX1
Salmonella spS
Shigella spS
Proteus mirabilisS
Proteus vulgarisS
Providencia sp.S
Morganella sp.S
Citrobacter freundiiS
Citrobacter diversusS
Citrobacter sp.S
Aeromonas spS
Acinetobacter sp.I
Pseudomonas aeruginosaS
Burkholderia cepaciaS
Stenotrophomonas maltophiliaR
Yersinia enterocoliticaX1
Francisella tularensisX1
Brucella sp.X1
Legionella sp.R
Pasteurella multocidaX1
Haemophilus ducreyiX1
Vibrio vulnificusX1
MiscChlamydophila spR
Mycoplasm pneumoniaeR
Rickettsia spX1
Mycobacterium aviumX1
AnaerobesActinomycesX1
Bacteroides fragilisS
Prevotella melaninogenicaS
Clostridium difficileX2
Clostridium (not difficile)S
Fusobacterium necrophorumS
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
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