From the Guidelines
Meropenem is effective for treating complicated urinary tract infections (UTIs) caused by multidrug-resistant organisms, but its use should be reserved for severe cases due to the risk of antibiotic resistance. The usual adult dose is 1 gram intravenously every 8 hours for 7-14 days, depending on infection severity 1. Meropenem is a broad-spectrum carbapenem antibiotic that should not be used as first-line therapy for uncomplicated UTIs, where narrower-spectrum antibiotics like nitrofurantoin, trimethoprim-sulfamethoxazole, or fluoroquinolones are more appropriate. Some key points to consider when using meropenem for UTIs include:
- Dosage adjustments for patients with renal impairment
- Common side effects such as headache, nausea, diarrhea, and injection site reactions
- The need for intravenous administration in a healthcare setting
- The importance of susceptibility testing to guide treatment decisions
- The potential for meropenem to be effective against extended-spectrum beta-lactamase (ESBL) producing organisms, as seen in studies such as the FOREST trial 1. It's also important to note that other treatment options, such as ceftazidime-avibactam and plazomicin, may be recommended for UTIs caused by multidrug-resistant organisms, depending on the specific circumstances of the case 1. Overall, the decision to use meropenem for a UTI should be based on a careful consideration of the potential benefits and risks, as well as the availability of alternative treatment options.
From the FDA Drug Label
The following in vitro data are available, but their clinical significance is unknown At least 90% of the following bacteria exhibit an in vitro minimum inhibitory concentration (MIC) less than or equal to the susceptible breakpoint for meropenem against isolates of similar genus or organism group. However, the efficacy of meropenem in treating clinical infections caused by these bacteria have not been established in adequate and well-controlled clinical trials Gram-negative bacteria Escherichia coli Haemophilus influenzae Klebsiella pneumoniae Neisseria meningitidis Proteus mirabilis Pseudomonas aeruginosa
The FDA drug label does not answer the question.
From the Research
Efficacy of Meropenem in Treating Urinary Tract Infections (UTIs)
- Meropenem has been shown to be effective in treating complicated UTIs, including acute pyelonephritis, with a clinical cure rate of 98.4% 2.
- A study comparing meropenem to imipenem/cilastatin found that meropenem produced satisfactory clinical and bacteriologic responses in 99% and 90% of cases, respectively 3.
- Meropenem has also been found to be effective in treating severe complicated UTIs, with a clinical efficacy rate of 100% and a bacteriological efficacy rate of 88.9% 4.
- The drug 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 5.
Comparison to Other Antibiotics
- Meropenem has been compared to plazomicin in the treatment of complicated UTIs, and was found to have a composite cure rate of 91.4% at day 5 and 70.1% at the test-of-cure visit 6.
- Meropenem-vaborbactam has been compared to piperacillin-tazobactam in the treatment of complicated UTIs, and was found to have a composite outcome of complete resolution or improvement of symptoms along with microbial eradication that met the noninferiority criterion 2.
- Meropenem has also been compared to imipenem/cilastatin, and was found to have similar efficacy and fewer drug-related adverse reactions 3.