Meropenem for Complicated Bacterial Infections
Meropenem is indicated for complicated bacterial infections with a recommended dosage of 1 gram IV every 8 hours for intra-abdominal infections and 500 mg IV every 8 hours for skin and skin structure infections in adults with normal renal function. 1
Indications
- Approved for complicated skin and skin structure infections (cSSSI) due to susceptible bacteria including methicillin-susceptible S. aureus, Streptococcus species, vancomycin-susceptible E. faecalis, P. aeruginosa, E. coli, and anaerobes 1
- Indicated for complicated intra-abdominal infections including appendicitis and peritonitis caused by various pathogens including E. coli, K. pneumoniae, P. aeruginosa, and anaerobes 1
- Effective as monotherapy for complicated intra-abdominal infections as recommended by the Surgical Infection Society 2
- Used in treatment of necrotizing infections of skin, fascia, and muscle requiring broad-spectrum coverage 3
- For pediatric patients ≥3 months, indicated for bacterial meningitis caused by H. influenzae, N. meningitidis, and penicillin-susceptible S. pneumoniae 1
Dosing Recommendations
Adult Dosing:
- For complicated skin and skin structure infections: 500 mg IV every 8 hours 1
- For complicated intra-abdominal infections: 1 gram IV every 8 hours 1
- For P. aeruginosa skin and skin structure infections: 1 gram IV every 8 hours 1
- For carbapenem-resistant Enterobacteriaceae (CRE) infections: 1 gram IV every 8 hours by extended infusion (3 hours) in combination therapy 2
Administration:
- Standard administration: IV infusion over 15-30 minutes 1
- 1 gram doses may also be administered as IV bolus over 3-5 minutes 1
- Extended infusion (3 hours) recommended for CRE infections or when meropenem MIC ≥8 mg/L 2
Renal Adjustment:
- CrCl >50 mL/min: Standard dose every 8 hours 1
- CrCl 26-50 mL/min: Standard dose every 12 hours 1
- CrCl 10-25 mL/min: Half recommended dose every 12 hours 1
- CrCl <10 mL/min: Half recommended dose every 24 hours 1
Pediatric Dosing:
- For children ≥3 months with normal renal function: 1
- cSSSI: 10 mg/kg (max 500 mg) every 8 hours
- Intra-abdominal infections: 20 mg/kg (max 1 gram) every 8 hours
- Meningitis: 40 mg/kg (max 2 grams) every 8 hours
- For P. aeruginosa cSSSI in pediatric patients: 20 mg/kg (max 1 gram) every 8 hours 1
- For infants <3 months with intra-abdominal infections: Dosing based on gestational and postnatal age (20-30 mg/kg every 8-12 hours) 1
Treatment Duration and Monitoring
- For complicated intra-abdominal infections, treatment duration typically 5-7 days, individualized based on infection site, source control, and clinical response 2
- Consider therapeutic drug monitoring in critically ill patients and those with impaired renal function to optimize therapy 4
- The Society of Critical Care Medicine suggests prolonged or continuous infusions for critically ill patients with healthcare-associated infections 2
Clinical Considerations
- Meropenem has a broad spectrum of activity against Gram-positive and Gram-negative pathogens, including ESBL and AmpC-producing Enterobacteriaceae 5
- Unlike imipenem, meropenem does not require co-administration with cilastatin (a renal dehydropeptidase inhibitor) due to its stability to human dehydropeptidase-I 6
- Has lower propensity to cause seizures compared to other carbapenems, making it suitable for treating bacterial meningitis 5
- For CRE infections, combination therapy is recommended 2
Common Pitfalls and Caveats
- To reduce development of drug-resistant bacteria, meropenem should only be used for proven or strongly suspected bacterial infections 1
- When culture and susceptibility data are available, they should guide therapy selection or modification 1
- Inadequate dosing can lead to therapeutic failure and increase the risk of antimicrobial resistance 4
- Limited data available for patients on hemodialysis or peritoneal dialysis 1
- Meropenem should not be mixed with or physically added to solutions containing other drugs 1