What about Meropenem?

From the Guidelines

Meropenem is a broad-spectrum carbapenem antibiotic administered intravenously, typically at a dose of 500mg to 1g every 8 hours, with a maximum daily dose of 2g 1. The duration of treatment varies depending on the infection being treated, but is usually between 7 to 14 days. In patients with renal impairment, the dose may need to be adjusted, with a recommended dose reduction of 50% to 75% in patients with severe renal impairment.

Key Points

• Meropenem is often used to treat complicated skin and skin structure infections, intra-abdominal infections, and pneumonia, and is typically administered in combination with other antibiotics, such as vancomycin or metronidazole, for synergistic effect 1.
• For patients with severe infections due to carbapenem-resistant Enterobacterales (CRE), meropenem-vaborbactam is suggested as a first-line treatment option 1.
• Meropenem-vaborbactam may be considered as the first choice in specific types of infections, such as pneumonia, due to its high epithelial lining fluid (ELF) concentrations 1.
• Local epidemiology and the emergence of ceftazidime/avibactam resistance in KPC-producing isolates should be considered when choosing between meropenem-vaborbactam and ceftazidime/avibactam 1.
• In patients with infections caused by KPC-producing CRE, meropenem-vaborbactam or ceftazidime/avibactam are strongly recommended as first-line treatment options 1.

From the FDA Drug Label

No overall differences in safety or effectiveness were observed between these subjects and younger subjects; spontaneous reports and other reported clinical experience have not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out Meropenem is known to be substantially excreted by the kidney, and the risk of adverse reactions to this drug may be greater in patients with renal impairment. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function A pharmacokinetic study with meropenem for injection in elderly patients has shown a reduction in the plasma clearance of meropenem that correlates with age-associated reduction in creatinine clearance [see Clinical Pharmacology (12.3)]. 8.6 Patients with Renal Impairment Dosage adjustment is necessary in patients with creatinine clearance 50 mL/min or less [see Dosage and Administration (2. 2), Warnings and Precautions (5.8), and Clinical Pharmacology (12. 3)].

Meropenem is a carbapenem antibacterial for intravenous administration.

• The drug label provides information on the pharmacokinetics, pharmacodynamics, and safety of meropenem.
• Key points to consider when using meropenem include:
  • Dosage adjustment is necessary in patients with renal impairment.
  • Elderly patients may have decreased renal function, and care should be taken in dose selection.
  • Monitoring renal function may be useful in elderly patients.
  • The risk of adverse reactions may be greater in patients with renal impairment. 2

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 3.
• 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 3, 4.

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) 3.
• Meropenem has shown 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 3, 4.
• Meropenem has also shown greater efficacy than ceftazidime or piperacillin/tazobactam in febrile neutropenia, and greater efficacy than ceftazidime plus amikacin or tobramycin in patients with nosocomial pneumonia 3.

Pharmacokinetics and Safety

• Meropenem is predominately excreted unchanged in the urine, and thus dosage adjustments are necessary in patients with renal insufficiency and those undergoing intermittent haemodialysis (IHD) or various forms of continuous renal replacement therapy (CRRT) 5.
• The half-life of meropenem is prolonged up to 13.7 hours in anuric patients with end-stage renal disease, and is influenced by drug-specific factors as well as membrane and treatment modalities (IHD, CRRT or CAPD) 5.
• Meropenem is well tolerated and has an acceptable safety profile, with the most common adverse events reported being diarrhoea, rash, and nausea/vomiting 6.
• No adverse event occurred in more than 3% of patient exposures to meropenem, indicating a low overall frequency of adverse events as well as excellent gastrointestinal tolerability 6.