Dosing and uses of Merrem IV (meropenem)
Adult dosage forms and strengths
powder for injectable solution
- 500mg/vial
- 1g/vial
Complicated Skin/Skin Structure Infections
Indicated as a single agent therapy for the treatment of complicated skin and skin structure infections due to Staphylococcus aureus (methicillin-susceptible isolates only), Streptococcus pyogenes, Streptococcus agalactiae, viridans group streptococci, Enterococcus faecalis (vancomycin-susceptible isolates only), Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis, Bacteroides fragilis, and Peptostreptococcus species
500 mg IV q8hr; not to exceed 2 g IV q8hr
Complicated Intra-abdominal Infections
Indicated as a single agent therapy for the treatment of complicated appendicitis and peritonitis caused by viridans group streptococci, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bacteroides fragilis, B. thetaiotaomicron, and Peptostreptococcus species
1 g IV q8hr; not to exceed 2 g IV q8hr
Community-Acquired Pneumonia (Off-label)
500 mg IV q8hr for ≤5 days in combination with fluoroquinolone
Febrile Neutropenia (Off-label)
1 g IV q8hr
Dosage modifications
Renal impairment
- CrCl >50 mL/min: 0.5-1 g IV q8hr
- CrCl 26-50 mL/min: 0.5-1 g IV q12hr
- CrCl 10-25 mL/min: 0.25-0.5 g IV q12hr
- CrCl <10 mL/min: 0.25-0.5 g IV q24hr
Pediatric dosage forms and strengths
powder for injectable solution
- 500mg/vial
- 1g/vial
Bacterial Meningitis
Indicated as a single agent therapy for the treatment of bacterial meningitis caused by Streptococcus pneumoniae (penicillin susceptible isolates), Haemophilus influenzae, and Neisseria meningitidis
≥3 months: 40 mg/kg IV q8hr; not to exceed 2 g IV q8hr
Complicated Intra-abdominal Infections
Indicated as a single agent therapy for the treatment of complicated appendicitis and peritonitis caused by viridans group streptococci, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bacteroides fragilis, B. thetaiotaomicron, and Peptostreptococcus species
≥3 months: 20 mg/kg IV q8hr; not to exceed 1 g q8hr
<3 months
- Infants <32 weeks GA and PNA <2 weeks: 20 mg/kg IV q12hr
- Infants <32 weeks GA and PNA ≥2 weeks: 20 mg/kg IV q8hr
- Infants ≥32 weeks GA and PNA <2 weeks: 20 mg/kg IV q8hr
- Infants ≥32 weeks GA and PNA ≥2 weeks: 30 mg/kg IV q8hr
- Infuse IV over 30 min
Complicated Skin/Skin Structure Infections
Indicated as a single agent therapy for the treatment of complicated skin and skin structure infections due to Staphylococcus aureus (methicillin-susceptible isolates only), Streptococcus pyogenes, Streptococcus agalactiae, viridans group streptococci, Enterococcus faecalis (vancomycin-susceptible isolates only), Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis, Bacteroides fragilis, and Peptostreptococcus species
≥3 months: 10 mg/kg IV q8hr; not to exceed 500 mg IV q8hr
Merrem IV (meropenem) adverse (side) effects
1-10%
Constipation (1-7%)
Diarrhea (4-5%)
Nausea or vomiting (1-4%)
Rash (2-3%; includes diaper-area moniliasis in pediatric patients)
Headache (2%)
Inflammation at injection site (2%)
Sepsis (2%)
Oral moniliasis (≤2% in pediatric patients)
Bleeding (1.2%)
Apnea (1%)
Constipation (1%)
Glossitis (1%)
Injection-site reaction (1%)
Phlebitis or thrombophlebitis (1%)
Pruritus (1%)
Septic shock (1%)
<1%
Agranulocytosis
Angioedema
Erythema multiforme
Hypersensitivity reaction
Hypokalemia
Leukopenia
Neutropenia
Pleural effusion
Stevens-Johnson syndrome
Toxic epidermal necrolysis
Postmarketing Reports
Eosinophilia and Systemic Symptoms (DRESS syndrome)
Warnings
Contraindications
Hypersensitivity to IV components, beta-lactams, or other drugs in this class
Cautions
Hypersensitivity reactions have been reported, including fatalities; these reactions are more likely to occur in individuals with history of sensitivity to multiple allergens
Seizures have been reported, most commonly in patients with CNS disorders (eg, brain lesions, history of seizures) or with bacterial meningitis or compromised renal function
Seizures, headaches, or paresthesias may occur, potentially interfering with mental alertness or causing motor impairment
Clostridium difficile-associated diarrhea has been reported
To avoid development of drug resistance, drug should be used only in proven or strongly suspected bacterial infections
Prolonged use may result in overgrowth of nonsusceptible organisms
Thrombocytopenia has been reported in patients with renal impairment
Co-administration of meropenem IV with valproic acid or divalproex sodium reduces serum concentrations of valproic acid potentially increasing risk of breakthrough seizures
Pregnancy and lactation
Pregnancy category: B
Lactation: Unknown whether drug is excreted in breast milk; use with caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Merrem IV (meropenem)
Mechanism of action
Inhibits cell-wall synthesis by binding to penicillin-binding proteins; resistant to most beta-lactamases
Absorption
Peak tissue time: 1 hr after infusion
Distribution
Penetrates well into most body fluids and tissues; CSF concentrations approximate those in plasma
Protein bound: 2%
Vd: Adults, 15-20 L; children, 0.3-0.4 L/kg
Metabolism
Metabolized in liver to open beta-lactam form (inactive)
Elimination
Half-life: Normal renal function, 1-1.5 hr; CrCl >30-80 mL/min, 1.9-3.3 hr; CrCl >2-30 mL/min, 3.82-5.7 hr
Excretion: Urine (~25% as inactive metabolites)
Administration
IV Incompatibilities
Additive: Amphotericin B, metronidazole, multivitamins
Y-site: Amphotericin B, diazepam, metronidazole
IV Administration
Administer IV infusion over 15-30 minutes; administer IV bolus over 3-5 minutes
Storage
Store powder at controlled room temperature
