Meropenem

Oral Antibiotics

Drug class: Carbapenem; beta-lactam antibiotics, a broad-spectrum antibiotic belonging to the carbapenem.

Meropenem (MERONEM)（中文：美羅培南）

Common Strengths

• 500 mg
• 1 g

Drug Trade Names

• Meronem

Drug Usage

It is effective against both Gram-positive and Gram-negative bacteria.

Meropenem is indicated for:

• Complicated skin and skin structure infections
• Complicated intra-abdominal infections
• Bacterial meningitis (in children aged 3 months and older)
• Other serious infections such as pneumonia and sepsis

Mechanism of Action

Meropenem exerts its bactericidal effect by inhibiting bacterial cell wall peptidoglycan synthesis. It binds to penicillin-binding proteins (PBPs), disrupting he formation of the bacterial cell wall, which ultimately leads to cell death. Unlike many other beta-lactam antibiotics, meropenem is resistant to degradation by various beta-lactamases produced by bacteria.

Route of Administration

Meropenem is administered intravenously (IV), either as an infusion or a bolus injection.

Dosages

• Normal Adults:
  • 500 mg every 8 hours for complicated skin infections
  • 1 g every 8 hours for intra-abdominal infections
• Renal Impairment: Dosage adjustments are necessary based on creatinine clearance:
  • For eGFR <51 mL/min, reduce the dose accordingly, typically starting at lower doses and increasing based on clinical response.
• Children:
  • Dosing is weight-based, typically ranging from 10 mg/kg to 40 mg/kg every 8 hours depending on the infection type.

Side Effects

Frequency	Adverse reactions
Common Side Effects	Nausea
	Diarrhea
	Headache
	Rash
	Injection site pain
Serious Side Effects	Seizures
	Clostridium-difficile infectio
	Anaphylaxis (severe allergic reaction)

Patients with a history of allergies to beta-lactam antibiotics (e.g. penicillin) may be at higher risk for allergic reactions.

Meropenem may pose risks for patients with certain conditions, including those with a history of seizures or renal impairment. It can also lead to Clostridium difficile-associated diarrhea, which may occur during or after treatment.

Pharmacokinetics

Meropenem has a rapid onset of action, typically within 15 to 30 minutes after administration.

Its duration of action can vary but generally lasts about 6 to 8 hours, necessitating frequent dosing.

Drug Precautions

Pregnancy

Meropenem appears to be safe during pregnancy; however, it should only be used if clearly needed.

Breastfeeding

Limited data suggest that meropenem may be excreted in breast milk; caution is advised.

Children and Elderly

Safety has been established in children over 3 months. In elderly patients, renal function should be monitored closely due to potential age-related decline.

Monitoring Items

Regular monitoring of renal function and signs of infection or adverse reactions is recommended during treatment.

Drug Interactions

• Valproic Acid [Epilim]: Meropenem significantly reduces the plasma concentrations of valproic acid , which can lead to a relapse of seizures in patients who are on antiepileptic therapy. Studies have shown an average drop of about 66% in valproate levels within 24 hours of co-administration, making this interaction clinically significant and warranting avoidance of concurrent use.
• Probenecid: This medication can increase the levels of meropenem by inhibiting its renal clearance, potentially leading to enhanced side effects such as nausea and headache.
• Meropenem has mild interactions with several vitamins (e.g. biotin, thiamine) and medications like balsalazide and pyridoxine.

FAQ

How Should I Take the Meropenem?

Meropenem is not available in tablet form; it is administered intravenously under medical supervioson.

What Should I Avoid While Taking?

• Avoid using Epilim [Valproic acid] concurrently with meropenem, as meropenem can significantly reduce their plasma concentrations, potentially leading to seizure relapses.
• There is a moderate interaction between alcohol and meropenem. It is generally recommended to avoid alcohol during treatment with antibiotics to prevent any potential complications.
• Seizure Disorders: Patients with a history of seizures should use caution, as meropenem may increase the risk of seizures, particularly in those who are also taking medications like valproate.
• Avoid meropenem if you have a known allergy to it or other similar antibiotics (e.g., ertapenem, penicillin). Serious allergic reactions can occur.