Meropenem

Meropenem

[1 gm vial $50.24]

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:
    500mg and 1gm vials of white powder
    Add 10ml of water for injection to 500mg vial or 20ml of water for injection to a 1gm vial. Shake vigorously until liquid is clear (approximately 3 minutes). The reconstituted solution has an approximate concentration of 50mg/ml. Inject required dose slowly over 5 minutes.
    Initial reconstitution should be prepared as soon as practicable 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 50-200ml 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:
    1g 8 hourly

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose in renal impairment [GFR (ml/min)]
    <10: 250mg-1g every 24 hours
    10-20: 250mg-1g every 12 hours or 500mg every 8 hours
    >20-50: 500mg-1g every 12 hours
  • Dose in renal replacement therapy
    CAPD: 250mg-1g every 24 hours
    HD: 250mg-1g every 24 hours
    CVVHDF: 250mg-1g every 12 hours or 500mg every 8 hours

DOSAGE IN PAEDIATRICS:

  • IV:
    20-40mg/kg 8 hourly

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

    Aerobic and Facultative Gram-Positive Microorganisms:
    - 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.

    Aerobic and Facultative Gram-Negative Microorganisms:
    - Escherichia coli.
    - Haemophilus influenzae (beta-lactamase and non-beta-lactamase-producing).
    - Klebsiella pneumoniae.
    - Neisseria meningitidis.
    - Pseudomonas aeruginosa.
    - Proteus mirabilis.

    Anaerobic Microorganisms:
    - 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 persons 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 IV, 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 (the risk of seizures is lower than the risk with imipenem). In patients with renal dysfunction, thrombocytopenia 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 FOR THE ICU

  • There is evidence that meropenem may reduce serum levels of valproic acid to subtherapeutic

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.
  • Digestive:
    Oral moniliasis, anorexia, diarrhoea, nausea/vomiting, cholestatic jaundice/jaundice, flatulence, ileus, hepatic failure, dyspepsia, intestinal obstruction. Haematological: Anaemia, hypochromic anemia, hypervolemia.
  • Metabolic/Nutritional:
    Peripheral oedema, hypoxia.
  • Nervous system:
    Insomnia, agitation/delirium, confusion, dizziness, seizure (see PRECAUTIONS), nervousness, paresthesia, hallucinations, somnolence, anxiety, depression, asthenia.
  • Respiratory:
    Respiratory disorder, dyspnea, pleural effusion, asthma, cough increased, lung edema.
  • Skin and appendages:
    Urticaria, sweating, skin ulcer.
  • Urogenital system:
    Dysuria, kidney failure, vaginal moniliasis, urinary incontinence.

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