From the Guidelines
Meropenem is a recommended treatment option for serious bacterial infections, particularly for patients with infections caused by multidrug-resistant gram-negative bacilli, including carbapenem-resistant Enterobacterales (CRE) and carbapenem-resistant Pseudomonas aeruginosa (CRPA), as evidenced by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines 1.
Key Considerations for Meropenem Use
- The typical adult dose of meropenem is 1 gram intravenously every 8 hours, though this may be adjusted based on the severity of the infection and renal function.
- Meropenem works by inhibiting bacterial cell wall synthesis, and it is effective against many gram-positive, gram-negative, and anaerobic bacteria, including multidrug-resistant organisms.
- Common side effects include headache, nausea, diarrhea, injection site reactions, and rash, while serious adverse effects may include seizures, Clostridium difficile-associated diarrhea, and allergic reactions.
Recommendations for Specific Infections
- For patients with severe infections due to CRE, meropenem-vaborbactam is suggested as a first-line treatment option, along with ceftazidime-avibactam, based on the Italian Society of Infection and Tropical Diseases (SIMIT) guidelines 1.
- For patients with non-severe infections due to CRE, the use of an old antibiotic, chosen from among the in vitro active on an individual basis and according to the source of infection, is considered good clinical practice.
- For patients with severe infections due to CRPA, ceftolozane-tazobactam is suggested as a treatment option if active in vitro, with insufficient evidence available for imipenem-relebactam, cefiderocol, and ceftazidime-avibactam.
Important Considerations
- Dosage adjustment is necessary for patients with renal impairment, and treatment duration typically ranges from 5-14 days depending on the infection type and severity.
- Meropenem should be used cautiously in patients with a history of seizures or allergies to beta-lactam antibiotics.
- The emergence of resistance to ceftazidime/avibactam in KPC-producing isolates should be considered when choosing a treatment option, and local epidemiology should guide the selection of antibiotics.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Meropenem Overview
- Meropenem is a broad-spectrum antibacterial agent of the carbapenem family, used for empirical therapy prior to the identification of causative organisms, or for disease caused by single or multiple susceptible bacteria in both adults and children with a broad range of serious infections 2.
- It is approved for use in complicated intra-abdominal infection (cIAI), complicated skin and skin structure infection (cSSSI) and bacterial meningitis (in pediatric patients aged > or = 3 months) in the US, and in most other countries for nosocomial pneumonia, cIAI, septicaemia, febrile neutropenia, cSSSI, bacterial meningitis, complicated urinary tract infection (UTI), obstetric and gynaecological infections, in cystic fibrosis patients with pulmonary exacerbations, and for the treatment of severe community-acquired pneumonia (CAP) 2.
Efficacy and Safety
- Meropenem 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 2, 3.
- It has similar efficacy to comparator antibacterial agents, including imipenem/cilastatin, clindamycin plus tobramycin or gentamicin, cefotaxime plus metronidazole, cefepime and ceftazidime plus amikacin, and ceftazidime, clarithromycin plus ceftriaxone or amikacin 2, 4.
- Meropenem is well tolerated and has an acceptable safety profile, with the most common adverse events reported being diarrhoea, rash, and nausea/vomiting 5.
- The incidence of seizures considered by investigators to be related to meropenem treatment was 0.07% in infections other than meningitis 5.
Comparative Studies
- Meropenem has been compared to imipenem/cilastatin in several studies, with similar clinical and bacteriological response rates 2, 3, 4.
- A multicenter, randomized, double-blind comparative study found that meropenem had comparable safety and efficacy to imipenem-cilastatin for the treatment of hospitalized patients with complicated skin and skin structure infections 4.
- Meropenem has also been compared to other antibacterial agents, including clindamycin/tobramycin, cefotaxime plus metronidazole, and ceftazidime, with similar or greater efficacy in some cases 2, 3.