Does Meropenem (Meropenem) provide coverage against Pseudomonas?

From the Guidelines

Meropenem provides excellent coverage against Pseudomonas aeruginosa and is an appropriate choice for serious infections caused by this organism, with a recommended dosage of 1 gram intravenously every 8 hours, which can be increased to 2 grams every 8 hours for severe infections, as suggested by 1.

Key Points

• Meropenem has a broad spectrum of activity that includes most gram-negative, gram-positive, and anaerobic bacteria, making it effective against Pseudomonas aeruginosa 1.
• The drug works by inhibiting bacterial cell wall synthesis through binding to penicillin-binding proteins and has better stability against beta-lactamases compared to many other beta-lactam antibiotics 1.
• For patients with risk factors for Pseudomonas aeruginosa, meropenem is preferred due to its ability to be dosed up to 3 · 2 g, offering advantages over imipenem 1.
• Combination therapy with an aminoglycoside or fluoroquinolone may be considered for severe Pseudomonas infections to prevent resistance development, especially in immunocompromised patients or those with severe infections 1.

Considerations

• Patients with renal impairment require dose adjustment based on creatinine clearance 1.
• Susceptibility testing is recommended when possible to monitor for resistance development 1.
• Common side effects include headache, nausea, diarrhea, and injection site reactions 1.
• The choice of meropenem should be based on the severity of the infection, the presence of risk factors for Pseudomonas aeruginosa, and the potential for resistance development, as outlined in 1.

From the FDA Drug Label

Meropenem for injection is indicated for the treatment of complicated skin and skin structure infections (cSSSI) due to ... Pseudomonas aeruginosa, ... Meropenem for injection is indicated for the treatment of complicated appendicitis and peritonitis caused by ... Pseudomonas aeruginosa, ...

Meropenem has coverage against Pseudomonas aeruginosa.

• It is indicated for the treatment of complicated skin and skin structure infections and complicated intra-abdominal infections caused by Pseudomonas aeruginosa.
• The recommended dose for treating complicated skin and skin structure infections caused by P. aeruginosa is 1 gram every 8 hours 2.

From the Research

Meropenem Pseudomonas Coverage

• Meropenem is a broad-spectrum antibacterial agent effective against Pseudomonas aeruginosa, with studies demonstrating its efficacy in treating various infections caused by this pathogen 3, 4, 5.
• The optimal meropenem concentrations to treat multidrug-resistant Pseudomonas aeruginosa septic shock have been investigated, with one study suggesting that high meropenem dosage may be a valuable therapeutic option for infection due to multidrug-resistant strains 4.
• Meropenem has been shown to have 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.
• Combination therapy with meropenem and other antibiotics, such as amikacin, has been demonstrated to suppress the emergence of resistance in Pseudomonas aeruginosa infections 3, 6.
• The use of meropenem in combination with other antibiotics, such as beta-lactam/beta-lactamase inhibitors, has been studied in various indications of Pseudomonas aeruginosa infections, with promising results 7.

Mechanism of Resistance

• The mechanism of emergent resistance to meropenem in Pseudomonas aeruginosa has been identified as a network of porin loss, efflux upregulation, and increased expression of AmpC 3.
• The emergence of antimicrobial resistance during meropenem treatment for hospital-acquired pneumonia (HAP) caused by Pseudomonas aeruginosa is a significant concern, highlighting the need for strategies to mitigate this risk 3, 7.

Clinical Implications

• Meropenem is an important option for the empirical treatment of serious bacterial infections in hospitalized patients, including those caused by Pseudomonas aeruginosa 5, 7.
• The choice of antibiotic treatment for Pseudomonas aeruginosa infections should be guided by factors such as epidemiology, patient risk factors, site of infection, and available treatment options 7.
• Antimicrobial stewardship is essential to preserve the effectiveness of meropenem and other antibiotics, and to prevent the development of resistance 7.