From the Guidelines
Meropenem is typically dosed at 1 gram intravenously every 8 hours for ESBL-producing E. coli infections. This recommendation is based on the most recent and highest quality study available, which suggests that meropenem is an effective treatment option for ESBL-producing Enterobacteriaceae, including E. coli 1.
Key Considerations
- For severe infections, the dose may be increased to 2 grams every 8 hours, but this should be done with caution and close monitoring of renal function and potential side effects.
- Treatment duration generally ranges from 7 to 14 days depending on the site and severity of infection, with longer courses needed for complicated infections like bacteremia or deep-seated infections.
- Dose adjustments are necessary for patients with renal impairment:
- for creatinine clearance 26-50 mL/min, give 1 gram every 12 hours;
- for 10-25 mL/min, give 500 mg every 12 hours;
- and for <10 mL/min, give 500 mg every 24 hours.
Mechanism of Action and Side Effects
- Meropenem is effective against ESBL-producing organisms because it's a carbapenem antibiotic that remains stable against the beta-lactamase enzymes produced by these bacteria.
- The drug works by binding to penicillin-binding proteins to inhibit bacterial cell wall synthesis, ultimately causing cell death.
- Monitor renal function during therapy and be aware of potential side effects including headache, nausea, diarrhea, and rarely seizures in patients with CNS disorders or renal dysfunction.
Clinical Guidelines
- The 2022 guidelines from the Journal of Microbiology, Immunology and Infection recommend meropenem as a treatment option for carbapenem-resistant Enterobacterales (CRE) infections, including those caused by ESBL-producing E. coli 1.
- The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines also recommend meropenem as a treatment option for CRE infections, including those caused by ESBL-producing E. coli 1.
From the FDA Drug Label
Meropenem for injection is indicated for the treatment of complicated skin and skin structure infections (cSSSI) due to ... Escherichia coli, The recommended dose of meropenem for injection is 500 mg given every 8 hours for skin and skin structure infections and 1 gram given every 8 hours for intra-abdominal infections.
The dose of Meropenem for ESBL E. coli is 1 gram every 8 hours for intra-abdominal infections and 500 mg every 8 hours for skin and skin structure infections, as the label does not specify a different dose for ESBL-producing E. coli 2.
From the Research
Merooenem Dose for ESBL E. coli
- The recommended dose of meropenem for the treatment of ESBL E. coli infections is not explicitly stated in the provided studies.
- However, according to the study 3, meropenem is one of the recommended drugs for the treatment of ESBL bloodstream infections, particularly in critically ill patients or in infections with high bacterial loads or elevated β-lactam minimum inhibitory concentrations.
- The study 4 mentions that meropenem was used as a comparator in a clinical trial for the treatment of complicated urinary tract infections and intra-abdominal infections caused by ESBL-producing E. coli and Klebsiella pneumoniae, with a dose of 1 g every 8 hours.
- It is essential to note that the dosage of meropenem may vary depending on the specific clinical scenario, the severity of the infection, and the patient's renal function, among other factors.
- The studies 5, 6, and 7 do not provide specific information on the dose of meropenem for ESBL E. coli infections.
Treatment Considerations
- The choice of antibiotic and dosage should be guided by the results of susceptibility testing and the severity of the infection 3, 4, 6.
- Carbapenems, such as meropenem, are generally considered the most reliable antibiotics for severe infections caused by ESBL-producing Enterobacteriaceae 3, 6.
- However, the overuse of carbapenems has led to an increase in drug resistance, and alternative treatments, such as ceftolozane/tazobactam and ceftazidime/avibactam, are being developed 4, 6.