From the Guidelines
Meropenem is a broad-spectrum carbapenem antibiotic that covers a wide range of bacteria, including most gram-positive organisms, nearly all gram-negative bacteria, and anaerobes, as stated in the guidelines by the European Society of Clinical Microbiology and Infectious Diseases 1.
Key Points
- Meropenem is effective against most gram-positive organisms (including Streptococcus species and methicillin-sensitive Staphylococcus aureus) and nearly all gram-negative bacteria (including Pseudomonas aeruginosa, Escherichia coli, Klebsiella, Enterobacter, Serratia, and Acinetobacter species), and anaerobes.
- It penetrates well into most body tissues and fluids, including the cerebrospinal fluid, making it useful for central nervous system infections.
- The typical adult dose is 1 gram intravenously every 8 hours, with adjustments needed for renal impairment, as recommended in the guidelines for the treatment of infections due to multidrug-resistant organisms 1.
- Meropenem is not effective against methicillin-resistant Staphylococcus aureus (MRSA), Enterococcus faecium, or organisms that produce carbapenemases like certain strains of Klebsiella pneumoniae carbapenemase (KPC) producers.
- Its mechanism of action involves binding to penicillin-binding proteins to inhibit bacterial cell wall synthesis, resulting in cell death.
- Due to its broad coverage, meropenem should be used judiciously to prevent the development of resistance, as emphasized in the European Society of Clinical Microbiology and Infectious Diseases guidelines 1.
Coverage and Usage
- Meropenem is recommended for the treatment of severe infections caused by third-generation cephalosporin-resistant Enterobacterales (3GCephRE) and carbapenem-resistant Enterobacterales (CRE) infections, as stated in the guidelines by the European Society of Clinical Microbiology and Infectious Diseases 1.
- It is also recommended for the treatment of complicated urinary tract infections and complicated intra-abdominal infections caused by multidrug-resistant gram-negative bacilli, as recommended in the guidelines for the treatment of infections due to multidrug-resistant organisms 1.
- The use of meropenem in combination with other antibiotics, such as polymyxin, is recommended for the treatment of CRE infections when the meropenem MIC is 8 mg/L, and high-dose extended-infusion meropenem is used, as stated in the guidelines for the diagnosis, treatment, prevention, and control of infections caused by carbapenem-resistant gram-negative bacilli 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. Meropenem for injection is indicated for the treatment of complicated appendicitis and peritonitis caused by viridans group streptococci, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bacteroides fragilis, B. thetaiotaomicron,and Peptostreptococcusspecies. Meropenem for injection is indicated for the treatment of bacterial meningitis caused by Haemophilus influenzae,Neisseria meningitidis and penicillin-susceptible isolates of Streptococcus pneumoniae.
The coverage of meropenem includes:
- Gram-positive bacteria:
- Staphylococcus aureus (methicillin-susceptible isolates only)
- Streptococcus pyogenes
- Streptococcus agalactiae
- Viridans group streptococci
- Enterococcus faecalis (vancomycin-susceptible isolates only)
- Gram-negative bacteria:
- Pseudomonas aeruginosa
- Escherichia coli
- Klebsiella pneumoniae
- Haemophilus influenzae
- Neisseria meningitidis
- Anaerobic bacteria:
From the Research
Coverage of Meropenem
The coverage of meropenem includes a broad range of serious bacterial infections, including:
- Complicated intra-abdominal infection (cIAI) 3
- Complicated skin and skin structure infection (cSSSI) 3
- Bacterial meningitis (in pediatric patients aged > or = 3 months) 3
- Nosocomial pneumonia 3, 4
- Septicaemia 3
- Febrile neutropenia 3
- Complicated urinary tract infection (UTI) 3
- Obstetric and gynaecological infections 3
- Cystic fibrosis patients with pulmonary exacerbations 3
- Severe community-acquired pneumonia (CAP) 3
Spectrum of Activity
Meropenem has a broad spectrum of in vitro activity against:
- Gram-positive pathogens 3, 5
- Gram-negative pathogens, including extended-spectrum beta-lactamase (ESBL)- and AmpC-producing Enterobacteriaceae 3
- Aerobic gram-negative bacilli, including Pseudomonas aeruginosa 5
- Anaerobes 5
Efficacy
Meropenem has shown similar efficacy to comparator antibacterial agents, including:
- Imipenem/cilastatin in cIAI, cSSSI, febrile neutropenia, complicated UTI, obstetric or gynaecological infections and severe CAP 3
- Clindamycin plus tobramycin or gentamicin in cIAI or obstetric/gynaecological infections 3
- Cefotaxime plus metronidazole in cIAI 3
- Cefepime and ceftazidime plus amikacin in septicaemia or febrile neutropenia 3
- Ceftazidime, clarithromycin plus ceftriaxone or amikacin in severe CAP 3
Special Considerations
Meropenem may be effective against multidrug-resistant Gram-negative bacteria, but the optimal clinical efficacy target value for meropenem in treating these infections is still being researched 6. High-dose meropenem may be considered as an empirical treatment in patients with severe infection due to reduction in SOFA and CPIS scores 7.