From the Research
Meropenem (Merrem) does not have a direct oral equivalent, and due to its poor oral bioavailability, it is only available in intravenous (IV) form. The carbapenem structure of meropenem would be degraded by stomach acid and would not be absorbed effectively through the gastrointestinal tract 1, 2, 3, 4, 5. If a patient requires carbapenem coverage but needs an oral option, the most common approach is to use a different class of antibiotics based on culture results and susceptibility testing. Depending on the infection and sensitivity patterns, alternatives might include oral fluoroquinolones (like ciprofloxacin or levofloxacin), amoxicillin-clavulanate, or trimethoprim-sulfamethoxazole.
Key Considerations
- The lack of an oral form of meropenem necessitates careful assessment of the infection and pathogen susceptibility to select an appropriate oral alternative when transitioning from IV to oral antibiotics.
- The choice of oral antibiotic should be guided by culture results and susceptibility testing to ensure effective treatment.
- Meropenem-vaborbactam, a combination of meropenem with a beta-lactamase inhibitor, has been approved for the treatment of complicated urinary tract infections, including acute pyelonephritis, but it is also only available in IV form 3, 5.
Clinical Implications
- Clinicians should be aware of the limitations of meropenem's formulation and plan accordingly for patients who require oral antibiotics.
- The selection of an oral antibiotic alternative to meropenem should prioritize the patient's specific infection, the suspected or confirmed pathogen, and its antimicrobial susceptibility profile.
- Ongoing monitoring of antimicrobial resistance patterns and the development of new antimicrobial agents will continue to shape the treatment of infections, including those requiring carbapenem coverage.