Meropenem (Meronem)

Meropenem - is similar to imipenem but is stable to the renal enzyme dehydropeptidase–1, which inactivates imipenem. Meropenem is also less likely to induce seizures than imipenem. Meropenem has an extremely wide spectrum of activity, including most aerobic and anaerobic Gram -ve and +ve bacteria (but not MRSA).

Uses
Meningitis
Mixed aerobic/anaerobic infections
Presumptive therapy of a wide range of severe infections prior to availability
of sensitivities
Febrile neutropenia

Contraindications
Hypersensitivity to beta lactams
Infections caused by MRSA

Administration
• IV: 0.5–1 g 8 hourly, given over 5 min
  Reconstitute with 10 ml WFI
• IV infusion: 0.5–1 g 8 hourly, give over 15–30 min
  For meningitis, increase to 2 g 8 hourly
  In renal impairment:

Monitor:

CC (ml/min)	Dose*	Interval (h)
20–50	1 unit dose	12
10–20	0.5 unit dose	12
<10	0.5 unit dose	24

FBC

LFT

*Based on unit doses of 0.5, 1 or 2 g

Adverse effects

Thrombophlebitis

Hypersensitivity reactions

Positive Coombs’ test

Reversible thrombocythaemia, thrombocytopenia, eosinophilia and neutropenia

Abnormal LFT (↑ bilirubin, transaminases and alkaline phosphatase)

Cautions

Hypersensitivity to penicillins and cephalosporins

Hepatic impairment

Renal impairment

Concurrent use of nephrotoxic drugs

Organ failure

Hepatic:worsens

Renal: reduce dose

Renal replacement therapy

CVVH dialysed, 500 mg–1 g every 8 hours or 1 g every 12 hours.

HD/PD dialysed, dose as in CC <10 ml/min i.e. 500 mg–1 g every 24 hours