From the Guidelines
Meropenem is started for UTIs when the infection is severe, complicated, or caused by bacteria resistant to first-line antibiotics, as recommended by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines 1.
Indications for Meropenem
The decision to start meropenem for a UTI is based on several factors, including:
- Severity of the infection
- Presence of complications, such as bacteraemia or septic shock
- Resistance patterns of the causative organism, particularly extended-spectrum beta-lactamase (ESBL) producing organisms, Pseudomonas aeruginosa, or multi-drug resistant bacteria
Dosage and Administration
The usual dose of meropenem for adults with normal renal function is 500mg to 1g intravenously every 8 hours, with treatment duration typically 7-14 days depending on infection severity 1.
Rationale for Use
Meropenem is a broad-spectrum carbapenem antibiotic that works by inhibiting bacterial cell wall synthesis, causing bacterial cell death. It is reserved for serious infections due to its potential to promote antibiotic resistance. The ESCMID guidelines recommend meropenem as targeted therapy for patients with bacteraemia and severe infection due to 3GCephRE, with moderate certainty of evidence 1.
Alternative Options
Other treatment options for UTIs include:
- Intravenous fosfomycin, which has high-certainty evidence for treatment of cUTI in patients without septic shock 1
- Aminoglycosides, which may be used for short durations of therapy in patients with cUTI without septic shock, with moderate certainty of evidence 1
- Piperacillin-tazobactam, amoxicillin/clavulanic acid, or quinolones, which may be used for low-risk, non-severe infections due to 3GCephRE, with moderate certainty of evidence 1
From the Research
Reasons for Starting Meropenem for UTI
- Meropenem is used to treat severe complicated urinary tract infections (UTIs) due to its efficacy against a wide range of bacteria, including Pseudomonas aeruginosa and E. agglomerans 2.
- The clinical and bacteriological efficacies of meropenem in the treatment of UTIs have been studied, with results showing satisfactory clinical and bacteriologic responses in 99% and 90% of cases, respectively 3.
- Meropenem is a safe and effective alternative to imipenem/cilastatin in the treatment of hospitalized patients with complicated UTIs 3.
- The combination of meropenem and vaborbactam has been approved for the treatment of adult patients with complicated UTIs, including acute pyelonephritis, and has shown excellent in vitro activity against Gram-negative clinical isolates, including KPC- and ESBL-producing Enterobacteriaceae 4, 5.
Bacterial Resistance and Meropenem
- The global threat of the spread of carbapenem resistance in Enterobacteriaceae has led to the search for new antibacterials, and meropenem/vaborbactam is a useful treatment option for patients with complicated UTIs 4.
- Meropenem/vaborbactam is effective against KPC-producing Enterobacteriaceae, which are resistant to many other antibiotics 4, 5.
- The use of meropenem/vaborbactam may be limited to cases caused by KPC-producing Enterobacteriaceae, and long-term safety data with this novel beta-lactamase inhibitor is still needed 5.
Treatment Options for UTIs
- Meropenem is one of the treatment options for UTIs caused by multidrug-resistant (MDR) Pseudomonas spp., along with other antibiotics such as fluoroquinolones, ceftazidime, and cefepime 6.
- Meropenem/vaborbactam is a treatment option for UTIs caused by carbapenem-resistant Enterobacteriaceae (CRE), along with other antibiotics such as ceftazidime-avibactam and cefiderocol 6.