From the Guidelines
Meropenem is a suitable choice for empirical meningitis coverage, particularly in cases where resistance to other antibiotics is a concern, as it provides broad-spectrum activity against both gram-positive and gram-negative bacteria, including Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, and many gram-negative organisms 1.
Key Considerations
- Meropenem's ability to penetrate the blood-brain barrier, especially when the meninges are inflamed, makes it an effective option for treating bacterial meningitis 1.
- The recommended dose of meropenem for adults is 2 grams IV every 8 hours, and it is often combined with vancomycin (15-20 mg/kg IV every 8-12 hours) to ensure coverage against resistant pneumococci.
- In immunocompromised patients, adding ampicillin (2 grams IV every 4 hours) for Listeria coverage should be considered.
- Treatment duration typically ranges from 7-14 days, depending on the identified pathogen and clinical response.
- Meropenem works by inhibiting bacterial cell wall synthesis and is particularly valuable in healthcare settings with high rates of extended-spectrum beta-lactamase producing organisms.
Important Notes
- Dosage adjustment is necessary in patients with renal impairment, and therapeutic drug monitoring may be beneficial in critically ill patients to ensure optimal concentrations.
- Alternative antibiotic therapy approaches, such as carbapenems, may be useful in cases of allergy or increased antimicrobial resistance 1.
- The use of intraventricular antimicrobial agents is not indicated in the management of adult community-acquired bacterial meningitis, but may be useful in nosocomial meningitis associated with extra ventricular drains 1.
From the FDA Drug Label
Pediatric Patients with Bacterial Meningitis Meropenem for injection was studied in 321 pediatric patients (3 months to less than 17 years of age) with meningitis at a dosage of 40 mg/kg every 8 hours
The recommended dosage of meropenem for empirical meningitis coverage is 40 mg/kg every 8 hours in pediatric patients [@\1@].
From the Research
Empirical Meningitis Coverage with Meropenem
- Meropenem is a broad-spectrum antibacterial agent of the carbapenem family, indicated as empirical therapy for serious bacterial infections, including bacterial meningitis 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.
- Meropenem has shown similar efficacy to cefotaxime in pediatric and adult patients with bacterial meningitis 2, 3.
- A study comparing meropenem with cefotaxime or ceftriaxone for the treatment of bacterial meningitis in adults found that meropenem was effective and well-tolerated, with a clinical cure rate of 100% 3.
- Another study evaluated the therapeutic efficacy of meropenem for treatment of experimental penicillin-resistant pneumococcal meningitis and found that meropenem monotherapy may not be a suitable choice, while combination of meropenem and vancomycin could be a possible alternative 4.
- Meropenem has also been evaluated in experimental meningitis models, where it was found to be as active as comparator agents, including ceftriaxone, ceftazidime, and benzyl penicillin, against a range of pathogens 5.
- A quality registry study comparing meropenem with cefotaxime and ampicillin as empirical antibiotic treatment in adult bacterial meningitis found that meropenem was an effective empirical treatment option, with similar outcomes to cefotaxime plus ampicillin 6.
Key Findings
- Meropenem is effective against a broad range of pathogens, including those causing bacterial meningitis 2, 3, 5.
- Meropenem has similar efficacy to cefotaxime and other comparator agents in the treatment of bacterial meningitis 2, 3, 6.
- Combination of meropenem and vancomycin may be a possible alternative for the treatment of penicillin-resistant pneumococcal meningitis 4.
- Meropenem is well-tolerated and has a low propensity for inducing seizures, making it suitable for treating bacterial meningitis 2, 3.