What is the coverage of Meropenem?

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Last updated: September 17, 2025 • View editorial policy

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Meropenem Coverage

Meropenem is a broad-spectrum carbapenem antibiotic that provides excellent coverage against most Gram-positive, Gram-negative, and anaerobic bacteria, making it an important option for serious infections including complicated intra-abdominal infections, complicated skin and skin structure infections, and bacterial meningitis. 1

Antimicrobial Spectrum

Gram-Positive Coverage

  • Staphylococcus aureus (methicillin-susceptible isolates only)
  • Streptococcus pyogenes
  • Streptococcus agalactiae
  • Viridans group streptococci
  • Enterococcus faecalis (vancomycin-susceptible isolates only) 1

Gram-Negative Coverage

  • Pseudomonas aeruginosa
  • Escherichia coli
  • Klebsiella pneumoniae
  • Proteus mirabilis
  • Haemophilus influenzae
  • Neisseria meningitidis 1, 2

Anaerobic Coverage

  • Bacteroides fragilis
  • Bacteroides thetaiotaomicron
  • Peptostreptococcus species 1

Key Advantages

  1. Extended-Spectrum Beta-Lactamase (ESBL) Activity: Effective against ESBL-producing and AmpC chromosomal beta-lactamase-producing bacteria 2, 3

  2. Carbapenem-Resistant Enterobacterales (CRE): May be used in combination therapy for CRE infections when MIC is ≤8 mg/L, administered as extended infusion (3 hours) 4

  3. CNS Penetration: Unlike other carbapenems, meropenem has a low propensity for inducing seizures, making it suitable for treating bacterial meningitis 2

  4. No Renal Dehydropeptidase Inhibitor Required: Unlike imipenem, meropenem does not require co-administration of cilastatin 3, 5

Clinical Applications

FDA-Approved Indications 1

  • Complicated skin and skin structure infections (adults and pediatric patients ≥3 months)
  • Complicated intra-abdominal infections (adults and pediatric patients)
  • Bacterial meningitis (pediatric patients ≥3 months)

Additional Common Uses

  • Nosocomial pneumonia
  • Septicemia
  • Febrile neutropenia
  • Complicated urinary tract infections
  • Severe community-acquired pneumonia 2

Dosing Recommendations

Adult Dosing 1

  • Complicated skin and skin structure infections: 500 mg IV every 8 hours
  • When treating Pseudomonas aeruginosa: 1 gram IV every 8 hours
  • Intra-abdominal infections: 1 gram IV every 8 hours
  • Administration: 15-30 minute infusion or 3-5 minute bolus injection

Renal Adjustment 1

  • CrCl >50 mL/min: Standard dose every 8 hours
  • CrCl 26-50 mL/min: Standard dose every 12 hours
  • CrCl 10-25 mL/min: Half recommended dose every 12 hours
  • CrCl <10 mL/min: Half recommended dose every 24 hours

Limitations and Resistance

Not Effective Against

  • MRSA (methicillin-resistant Staphylococcus aureus)
  • VRE (vancomycin-resistant Enterococci)
  • Carbapenem-resistant organisms with MIC >8 mg/L 4

Resistance Mechanisms

  • Metallo-beta-lactamases (MBLs) such as NDM, VIM, or IMP
  • Certain OXA-type carbapenemases
  • Porin mutations combined with other resistance mechanisms 4

Combination Therapy Considerations

  • For carbapenem-resistant Acinetobacter baumannii: Evidence does not support polymyxin-meropenem or polymyxin-rifampin combinations 4

  • For carbapenem-resistant Enterobacterales: Extended-infusion meropenem (1g IV q8h over 3 hours) may be used in combination with other agents when MIC is ≤8 mg/L 4

  • For critically ill patients with suspected multidrug-resistant infections: Combination therapy may be warranted until susceptibility results are available 4

Safety Profile

  • Most common adverse events (occurring in <3% of patients): diarrhea (2.5%), rash (1.4%), and nausea/vomiting (1.2%) 6

  • CNS adverse events: Very low incidence of seizures (0.07%) in non-meningitis infections 6

  • Contraindications: Known hypersensitivity to product components or anaphylactic reactions to β-lactams 1

Clinical Pearls

  1. Meropenem is more active against gram-negative pathogens and somewhat less active against gram-positive pathogens compared to imipenem 3

  2. For serious infections caused by Pseudomonas aeruginosa, the higher dose of 1 gram every 8 hours is recommended 1

  3. Extended infusion (over 3 hours) is recommended when treating organisms with higher MICs (≥8 mg/L) 4

  4. Meropenem has excellent bladder penetration, making it a good option for complicated urinary tract infections 7

  5. Meropenem is well tolerated in both adult and pediatric populations with an acceptable safety profile 6

References

3
Research

Update on the efficacy and tolerability of meropenem in the treatment of serious bacterial infections.

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2008

4
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

7
Guideline

Urinary Tract Infections

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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