From the Guidelines
Meropenem should be used with caution due to its potential side effects and contraindications, and its use should be guided by the most recent and highest quality evidence, such as the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines 1.
Common Side Effects and Contraindications
Meropenem is a broad-spectrum carbapenem antibiotic that can cause several side effects, including:
- Diarrhea
- Nausea
- Vomiting
- Headache
- Rash
- Injection site reactions More serious but less common side effects include:
- Seizures (especially in patients with CNS disorders or renal impairment)
- Clostridium difficile-associated diarrhea
- Thrombocytopenia
- Neutropenia
- Allergic reactions ranging from mild rash to severe anaphylaxis Meropenem is contraindicated in patients with known hypersensitivity to carbapenems or with a history of severe immediate hypersensitivity reactions to beta-lactam antibiotics.
Dose Adjustment and Monitoring
Dose adjustment is necessary in patients with renal impairment, with specific dosing based on creatinine clearance 1. Meropenem should be used cautiously in patients with CNS disorders due to the increased risk of seizures. During treatment, monitoring of renal function, complete blood count, and liver function tests is recommended, especially for prolonged therapy.
Clinical Use
The ESCMID guidelines recommend meropenem as a targeted therapy for patients with bloodstream infections and severe infections due to third-generation cephalosporin-resistant Enterobacterales (3GCephRE) 1. However, the guidelines also emphasize the importance of antibiotic stewardship and the need to consider the potential risks and benefits of meropenem use.
Key Considerations
- Meropenem should be used judiciously and with careful consideration of its potential side effects and contraindications.
- Dose adjustment and monitoring are crucial to minimize the risk of adverse effects.
- The ESCMID guidelines provide a framework for the use of meropenem in clinical practice, but clinicians should always consider the individual patient's needs and circumstances.
From the FDA Drug Label
Meropenem for injection is contraindicated in patients with known hypersensitivity to any component of this product or to other drugs in the same class or in patients who have demonstrated anaphylactic reactions to beta(β)-lactams. Serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported in patients receiving therapy with β-lactams. Severe cutaneous adverse reactions (SCAR) such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), erythema multiforme (EM) and acute generalized exanthematous pustulosis (AGEP) have been reported in patients receiving meropenem for injection. Seizures and other adverse CNS experiences have been reported during treatment with meropenem for injection.
The main side effects of Meropenem include:
- Hypersensitivity reactions
- Severe cutaneous adverse reactions (SCAR)
- Seizures and other adverse CNS experiences The main contraindications of Meropenem are:
- Known hypersensitivity to any component of the product or to other drugs in the same class
- Demonstrated anaphylactic reactions to beta(β)-lactams 2 2
From the Research
Meropenem Side Effects
- The most commonly reported meropenem-related adverse events were diarrhoea (2.3%) 3, rash (1.4%) 3, 4, nausea/vomiting (1.4%) 3, and injection site inflammation (1.1%) 3.
- The most commonly reported meropenem-related laboratory adverse events were thrombocytosis (1.6%) 3 and increased hepatic enzymes (1.5-4.3%) 3.
- In patients with meningitis, the incidence of seizures was low and none were drug related 3, 4.
- In patients with infections other than meningitis, the incidence of seizures considered by the investigators to be related to meropenem was 0.08% 3 and 0.07% 4.
Meropenem Contraindications
- There is no specific information on contraindications in the provided studies, but it is known that meropenem is contraindicated in patients with a history of hypersensitivity to any component of the product or to other carbapenems 5.
- Meropenem should be used with caution in patients with a history of seizures or neurological disorders, as well as in patients with impaired renal function 6, 5.
- It is essential to monitor patients for signs of adverse reactions, such as allergic reactions, seizures, or gastrointestinal disturbances, and to adjust the dosage or discontinue treatment if necessary 3, 6, 4, 5.