What is the use of Meropenem (Carbapenem antibiotic)?

From the Guidelines

Meropenem is a recommended treatment option for severe infections caused by multidrug-resistant gram-negative bacilli, including carbapenem-resistant Enterobacterales (CRE), and should be used at a dose of 1 gram administered intravenously every 8 hours, with adjustments made for renal impairment and severity of infection, as supported by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines 1.

Key Points

• Meropenem is effective against many gram-positive, gram-negative, and anaerobic bacteria, including multidrug-resistant organisms.
• The typical adult dose is 1 gram administered intravenously every 8 hours, with adjustments for renal impairment and severity of infection.
• Meropenem should be used cautiously in patients with known beta-lactam allergies and CNS disorders or renal impairment.
• Treatment duration typically ranges from 5-14 days depending on the infection site and severity, but should be determined by clinical response.

Clinical Use

• Meropenem is recommended for the treatment of bloodstream infections, complicated urinary tract infections, and complicated intra-abdominal infections caused by CRE, as outlined in the Journal of Microbiology, Immunology and Infection guidelines 1.
• The choice of treatment should be based on susceptibility testing and clinical response, with combination therapy considered for severe infections.
• Meropenem should be used in conjunction with other antibiotics, such as metronidazole, for the treatment of complicated intra-abdominal infections.

Important Considerations

• Dosage reduction is necessary in patients with renal impairment, and extended-infusion of meropenem may be suggested for patients with meropenem MIC ≥ 8 mg/L 1.
• Meropenem should be reserved for serious infections where narrower-spectrum antibiotics would be insufficient, due to concerns about antimicrobial resistance.
• Clinicians should be aware of the potential for seizures and other adverse effects, especially in patients with CNS disorders or renal impairment.

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 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.

Indications and Efficacy

• Meropenem 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.
• Meropenem 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 showed greater efficacy than ceftazidime or piperacillin/tazobactam in febrile neutropenia, and greater efficacy than ceftazidime plus amikacin or tobramycin in patients with nosocomial pneumonia 2.

Safety and Tolerability

• Meropenem is well tolerated and has an acceptable safety profile, with the most common adverse events being diarrhoea, rash, nausea/vomiting, and inflammation at the injection site 5, 4.
• Meropenem has a low propensity for inducing seizures, making it suitable for treating bacterial meningitis, and is the only carbapenem approved in this indication 2, 5.
• The incidence of seizures considered by investigators to be related to meropenem treatment was 0.07% in infections other than meningitis 5.