All about the antibiotic meropenem drug

1. Meropenem
Ph. Ayat Al-Ani

2. TABLE OF CONTENTS
01
02
03
04
Description
Indications
About it
Spectrum of activity

3. Description
01

4. Description
Meropenem for injection is a sterile, pyrogen-free, synthetic, carbapenem antibacterial drug for
intravenous administration. It belongs to Beta lactam antibiotics and exerts its bactericidal activity by inhibiting
bacterial cell wall synthesis in Gram-positive and Gram-negative bacteria through binding to penicillin-binding
proteins (PBPs).
Peak tissue time : 1 hr after infusion
Distribution : Meropenem has been shown to penetrate well into several body fluids and tissues: including lung,
bronchial secretions, bile, cerebrospinal fluid, gynecological tissues, skin, fascia, muscle, and peritoneal exudates.
Elimination : Meropenem is primarily ( 70%) excreted unchanged by the kidneys.
Half-Life : 1 – 1.5 hr in normal renal function
1.9 – 3.3 hr in Cr.cl. 30-80 ml/min
3.8 – 5.7 hr in Cr.Cl 2 – 30 ml/min

5. Spectrum of
activity
$ Species that show natural intermediate susceptibility
£ All methicillin-resistant staphylococci are resistant to meropenem
† Resistance rate≥ 50% in one or more EU countries.
02

6. Gram-positive aerobes
Enterococcus faecalis$
Staphylococcus aureus (methicillin-susceptible)£
Staphylococcus species (methicillin-susceptible)
including Staphylococcus epidermidis
Streptococcus agalactiae (Group B)
Streptococcus milleri group (S. anginosus, S.
constellatus, and S. intermedius)
Streptococcus pneumoniae
Streptococcus pyogenes (Group A)
Gram-negative aerobes
Citrobacter freundii
Citrobacter koseri
Enterobacter aerogenes
Enterobacter cloacae
Escherichia coli
Haemophilus influenzae
Klebsiella oxytoca
Klebsiella pneumoniae
Morganella morganii
Neisseria meningitides
Proteus mirabilis
Proteus vulgaris
Serratia marcescens

7. Gram-positive anaerobes
Clostridium perfringens
Peptoniphilus asaccharolyticus
Peptostreptococcus species
Gram-negative anaerobes
Bacteroides caccae
Bacteroides fragilis group
Prevotella bivia
Prevotella disiens

8. Species for which acquired
resistance may be a problem
Gram-positive aerobes
Enterococcus faecium $†
Gram-negative aerobes
Acinetobacter species
Burkholderia cepacia
Pseudomonas aeruginosa
Inherently resistant organisms
Gram-negative aerobes
Stenotrophomonas maltophilia
Legionella species
Other micro-organisms
Chlamydophila pneumoniae
Chlamydophila psittaci
Coxiella burnetii
Mycoplasma pneumonia

9. Indications
& dosing
03

10. 500mg – 1g q8hr 1g q8hr 2g q8hr
- Severe pneumonia including
hospital and ventilator-
associated pneumonia.
- Complicated UTIs
- Complicated intra-abdominal
infections
- Intra- and post-partum
infections
- Complicated skin and soft
tissue infections
Management of febrile
neutropenic patients
-Broncho-pulmonary infections
in cystic fibrosis
-Acute bacterial meningitis

11. Dose modification
according to Cr.Cl
10-25 half of one unit dose q 12 hr
half of one unit dose every 24 hours
one unit dose q 12 hr
<10
26-50

12. About it
Contraindications of meropenem :
1. Hypersensitivity to the active substance or to any of the excipients
2. Hypersensitivity to any other carbapenem or beta lactam antibacterial agent.
3. Contraindicated where the administration of sodium or chloride could be clinically
detrimental. (Each ml of reconstituted solution contains 50 mg Meropenem. )
Hepatic function monitoring
1. Hepatic function should be closely monitored during treatment with meropenem
due to the risk of hepatic toxicity (hepatic dysfunction with cholestasis and
cytolysis)
2. Use in patients with liver disease: patients with pre-existing liver disorders
should have liver function monitored during treatment with meropenem. There
is no dose adjustment necessary

13. Direct antiglobulin test (Coombs test) seroconversion
A positive direct or indirect Coombs test may develop during treatment with meropenem.
Drug-Drug interactions :
1. valproic acid/sodium valproate/valpromide
2. Probenecid
3. BCG , Typhoid , choera vaccines
Pregnancy
1. There are no or limited amount of data from the use of meropenem in pregnant women.
2. Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity

14. Stability :
Meropenem injection, powder, for solution :
Freshly prepared solutions of Meropenem should be used. However, re-constituted solutions of
Meropenem maintain satisfactory potency under the conditions described below. Solutions of
intravenous Meropenem should not be frozen.
1. Intravenous Bolus Administration: Meropenem injection vials re-constituted with sterile
Water for Injection for bolus administration (up to 50 mg/mL of Meropenem) may be
stored for up to 3 hours at up to 25°C (77°F) or for 13 hours at up to 5°C (41°F).
2. Intravenous Infusion Administration: Solutions prepared for infusion (Meropenem
concentrations ranging from 1 mg/mL to 20 mg/mL) re-constituted with Sodium Chloride
Injection 0.9% may be stored for 1 hour at up to 25°C (77°F) or 15 hours at up to 5°C
(41°F).
3. Solutions prepared for infusion (Meropenem concentrations ranging from 1 mg/mL to 20
mg/mL) re-constituted with Dextrose Injection 5% should be used immediately.

15. Adverse events
Headache Nausea & vomiting Constipation OR
Diarrhea
Hypersensitivity Seizures Thrombocytopenia

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