Does meropenem (Meropenem) cover cellulitis?

From the Guidelines

Meropenem is an effective option for covering cellulitis, particularly in severe or complicated cases, as it provides broad-spectrum coverage against both gram-positive and gram-negative bacteria, including Staphylococcus aureus and Streptococcus species, as recommended by the Infectious Diseases Society of America guidelines 1.

Key Points to Consider

• Meropenem is a broad-spectrum carbapenem antibiotic that targets a wide range of bacteria commonly causing cellulitis.
• For adult cellulitis, meropenem is typically administered at 500 mg to 1 gram intravenously every 8 hours, with dosage adjustments needed for patients with renal impairment, as indicated in the guidelines 1.
• The recommended duration of antimicrobial therapy is 5 days, but treatment should be extended if the infection has not improved within this time period, according to the guidelines 1.
• Meropenem is generally reserved for severe infections, complicated cases, or situations involving resistant organisms, as it's considered overly broad for typical uncomplicated cellulitis, as suggested by the guidelines 1.

Important Considerations

• First-line treatments for uncomplicated cellulitis often include narrower-spectrum antibiotics like cephalexin, dicloxacillin, or clindamycin.
• Vancomycin plus either piperacillin-tazobactam or imipenem-meropenem is recommended as a reasonable empiric regimen for severe infections, as stated in the guidelines 1.
• The choice of antibiotic should be guided by the severity of the infection, the presence of systemic signs of infection, and the potential for resistant organisms, as emphasized in the guidelines 1.

From the FDA Drug Label

Meropenem for injection is indicated for the treatment of complicated skin and skin structure infections (cSSSI) due to Staphylococcus aureus(methicillin-susceptible isolates only), Streptococcus pyogenes, Streptococcus agalactiae, viridans group streptococci, Enterococcus faecalis(vancomycin-susceptible isolates only), Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis,Bacteroides fragilis,and Peptostreptococcusspecies.

Cellulitis is a type of skin and skin structure infection. The FDA drug label for meropenem indicates that it is used to treat complicated skin and skin structure infections (cSSSI). However, it does not explicitly state that it covers cellulitis. Since cellulitis can be considered a type of skin and skin structure infection, but the label does not directly mention it, a conservative clinical decision would be to say that the information provided by the FDA label does not directly answer the question. The FDA drug label does not answer the question.

From the Research

Meropenem Coverage for Cellulitis

• Meropenem is a broad-spectrum antibacterial agent of the carbapenem family, indicated for empirical therapy prior to the identification of causative organisms, or for disease caused by single or multiple susceptible bacteria in both adults and children with a broad range of serious infections 2.
• It has a broad spectrum of in vitro activity against Gram-positive and Gram-negative pathogens, including extended-spectrum beta-lactamase (ESBL)- and AmpC-producing Enterobacteriaceae 2, 3.
• Meropenem is approved for use in complicated skin and skin structure infection (cSSSI) in the US, and in most other countries for nosocomial pneumonia, cIAI, septicaemia, febrile neutropenia, cSSSI, bacterial meningitis, complicated urinary tract infection (UTI), obstetric and gynaecological infections, in cystic fibrosis patients with pulmonary exacerbations, and for the treatment of severe community-acquired pneumonia (CAP) 2, 3.
• Cellulitis is a clinical diagnosis based on the history of present illness and physical examination and lacks a gold standard for diagnosis, and the majority of non-purulent, uncomplicated cases of cellulitis are caused by β-hemolytic streptococci or methicillin-sensitive Staphylococcus aureus 4.
• Meropenem has shown efficacy in the treatment of complicated skin and skin-structure infections, which includes cellulitis, and is a suitable option for the empirical treatment of serious bacterial infections in hospitalized patients 2, 5, 3.

Specific Use of Meropenem for Cellulitis

• Meropenem monotherapy was as effective as imipenem/cilastatin in 4 comparative trials in terms of satisfactory clinical and bacteriological responses, and meropenem monotherapy was significantly more effective than ceftazidime-based combination treatments in 2 trials in patients with nosocomial lower respiratory tract infections (LRTIs) in terms of both clinical and bacteriological responses 5.
• Meropenem is well tolerated and has the advantage of being suitable for administration as an intravenous bolus or infusion, and its low propensity for inducing seizures means that it is suitable for treating bacterial meningitis and is the only carbapenem approved in this indication 2, 5.
• The daily dose of meropenem commonly ranged from 3 to 6 g/day, and therapeutic drug monitoring (TDM) of meropenem can help to maximize the clinical outcomes of the treatment with meropenem, and improve patient care by providing suitable levels of meropenem, guiding the most appropriate dose regimens 6.