meropenem

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
Meropenemforinjectionisasterile,pyrogen-free,synthetic,carbapenemantibacterialdrugfor
intravenousadministration.ItbelongstoBetalactamantibioticsandexertsitsbactericidalactivitybyinhibiting
bacterialcellwallsynthesisinGram-positiveandGram-negativebacteriathroughbindingtopenicillin-binding
proteins(PBPs).
Peak tissue time : 1 hrafter infusion
Distribution:Meropenemhasbeenshowntopenetratewellintoseveralbodyfluidsandtissues:includinglung,
bronchialsecretions,bile,cerebrospinalfluid,gynecologicaltissues,skin,fascia,muscle,andperitonealexudates.
Elimination : Meropenem is primarily ( 70%) excreted unchanged by the kidneys.
Half-Life : 1 –1.5 hrin normal renal function
1.9 –3.3 hrin Cr.cl. 30-80 ml/min
3.8 –5.7 hrin Cr.Cl2 –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 millerigroup (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
Haemophilusinfluenzae
Klebsiella oxytoca
Klebsiella pneumoniae
Morganellamorganii
Neisseria meningitides
Proteus mirabilis
Proteus vulgaris
Serratia marcescens

7. Gram-positive anaerobes
Clostridium perfringens
Peptoniphilusasaccharolyticus
Peptostreptococcusspecies
Gram-negative anaerobes
Bacteroides caccae
Bacteroides fragilis group
Prevotellabivia
Prevotelladisiens

8. Species for which acquired
resistance may be a problem
Gram-positive aerobes
Enterococcus faecium $†
Gram-negative aerobes
Acinetobacter species
Burkholderiacepacia
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
& dosing03

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 doseq 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.Hypersensitivitytotheactivesubstanceortoanyoftheexcipients
2.Hypersensitivitytoanyothercarbapenemorbetalactamantibacterialagent.
3.Contraindicated where the administration of sodium or chloride could be clinically
detrimental. (Each ml of reconstituted solution contains 50 mg Meropenem. )
Hepaticfunctionmonitoring
1.Hepaticfunctionshouldbecloselymonitoredduringtreatmentwithmeropenem
duetotheriskofhepatictoxicity(hepaticdysfunctionwithcholestasisand
cytolysis)
2.Useinpatientswithliverdisease:patientswithpre-existingliverdisorders
shouldhaveliverfunctionmonitoredduringtreatmentwithmeropenem.There
isnodoseadjustmentnecessary

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 , choeravaccines
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 :
Meropeneminjection,powder,forsolution:
FreshlypreparedsolutionsofMeropenemshouldbeused.However,re-constitutedsolutionsof
Meropenemmaintainsatisfactorypotencyundertheconditionsdescribedbelow.Solutionsof
intravenousMeropenemshouldnotbefrozen.
1.IntravenousBolusAdministration:Meropeneminjectionvialsre-constitutedwithsterile
WaterforInjectionforbolusadministration(upto50mg/mLofMeropenem)maybe
storedforupto3hoursatupto25°C(77°F)orfor13hoursatupto5°C(41°F).
2.IntravenousInfusionAdministration:Solutionspreparedforinfusion(Meropenem
concentrationsrangingfrom1mg/mLto20mg/mL)re-constitutedwithSodiumChloride
Injection0.9%maybestoredfor1houratupto25°C(77°F)or15hoursatupto5°C
(41°F).
3.Solutionspreparedforinfusion(Meropenemconcentrationsrangingfrom1mg/mLto20
mg/mL)re-constitutedwithDextroseInjection5%shouldbeusedimmediately.

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

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