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Meropenem (Lexi-Drugs Multinational)

Outline Expand All Monograph Images Adult Patient Education Pediatric Patient Education
Antibiotic, Carbapenem
Brand Names:
International
Dosing: Adult
International Note: Infusion method: Dosing is presented based on the traditional infusion method over 30 minutes,
Nonproprietary Names unless otherwise specified.
(INN)
Usual dosage range:
Brazilian Nonproprietary
Traditional intermittent infusion method (over 30 minutes): IV: 500 mg every 6 hours or 1 to 2 g
Names (DCB)
every 8 hours; 500 mg every 6 hours achieves comparable pharmacokinetic and
Japanese Accepted Name pharmacodynamic parameters to 1 g every 8 hours (Kuti 2003; Lodise 2006).
(JAN) Extended infusion method (off-label): IV: 1 to 2 g every 8 hours over 3 hours. May give a loading
Anatomic Therapeutic dose of 1 to 2 g over 30 minutes, especially when rapid attainment of therapeutic drug
Chemical (ATC) concentrations is desired (eg, sepsis) (Crandon 2011; SCCM [Rhodes 2017]).
Classification Continuous infusion method (off-label): IV: 2 g every 8 hours over 8 hours or 3 g every 12 hours
over 12 hours (Venugopalan 2018). May give a loading dose of 1 to 2 g over 30 minutes,
Pharmacologic Category
especially when rapid attainment of therapeutic drug concentrations is desired (eg, sepsis)
Dosages (SCCM [Rhodes 2017]).

Dosing: Adult Note: Extended and continuous infusion methods are based largely on pharmacokinetic and
pharmacodynamic modeling data (Crandon 2011; Dulhunty 2015; Yu 2018). A prolonged
Dosing: Geriatric
infusion strategy has a greater likelihood of attaining pharmacokinetic/pharmacodynamic
Dosing: Renal
targets and may offer clinical benefit in patients with severe infections or less susceptible
Impairment: Adult
pathogens (Yu 2018). Meropenem stability (admixed with NS at a concentration of 20 mg/mL)
Dosing: Hepatic at room temperature for >1 hour or under refrigeration for >15 hours is not supported by the
Impairment: Adult
manufacturer. Data exist supporting stability for extended and continuous infusion when
Dosing: Obesity: Adult admixed with NS at a concentration of 14.3 mg/mL at room temperature for ≤7 hours (Fawaz
Dosing: Pediatric 2019) and at a concentration of 20 mg/mL under refrigeration for ≤24 hours (Patel 1997).
Dosing: Renal Pharmacokinetic data support the use of an admixture of 10 mg/mL in NS as stable at room
Impairment: Pediatric temperature for an infusion duration ≤12 hours (Venugopalan 2018).
Dosing: Hepatic
Impairment: Pediatric Indication-specific dosing:
Calculations Anthrax (off-label use): Note: Consult public health officials for event-specific
Uses recommendations.
Systemic (meningitis excluded), treatment (alternative agent): IV: 2 g every 8 hours as part of
Clinical Practice
an appropriate combination regimen for 2 weeks or until clinically stable, whichever is
Guidelines
longer (CDC [Hendricks 2014]).
Administration and Meningitis, treatment: IV: 2 g every 8 hours as part of an appropriate combination regimen for
Storage Issues 2 to 3 weeks or until clinically stable, whichever is longer (CDC [Hendricks 2014]).
Medication Safety Issues Note: Antitoxin should also be administered. Following the course of IV combination therapy
for systemic anthrax infection (including meningitis), patients exposed to aerosolized
Warnings & Precautions spores require oral monotherapy to complete a total antimicrobial course of 60 days (CDC
[Hendricks 2014]).
Reproduction, Pregnancy,
& Lactation Bloodstream infection (gram-negative bacteremia) (off-label use): For empiric therapy of
known or suspected gram-negative organisms (including Pseudomonas aeruginosa) or
Adverse Reactions
pathogen-directed therapy for organisms resistant to other agents.
Interactions IV: 1 g every 8 hours (IDSA [Mermel 2009]); for empiric therapy in patients with neutropenia,
severe burns, sepsis, or septic shock, give as part of an appropriate combination regimen
Patient & Therapy (Kanj 2019a; Moehring 2019a; SCCM [Rhodes 2017]). Note: For critical illness or infection
Management
with an organism with an elevated minimum inhibitory concentration (MIC), some experts
Preparations prefer the extended or continuous infusion method and/or increasing the dose to 2 g
every 8 hours (Del Bono 2017; Moehring 2019a; SCCM [Rhodes 2017]).
Pharmacology & Duration of therapy: Usual duration is 7 to 14 days depending on the source, pathogen, extent
Pharmacokinetics
of infection, and clinical response; a 7-day duration is recommended for patients with
Dental Information uncomplicated Enterobacteriaceae infection who respond appropriately to antibiotic
therapy (Moehring 2019a; Yahav 2018). Note: If neutropenic, extend treatment until
Pearls & Related afebrile for 2 days and neutrophil recovery (ANC ≥500 cells/mm3 and increasing) (IDSA
Information [Freifeld 2011]). For P. aeruginosa bacteremia in neutropenic patients, some experts treat
for a minimum of 14 days and until recovery of neutrophils (Kanj 2019b).
References
Cystic fibrosis, acute pulmonary exacerbation (off-label use): For empiric or targeted
Brand Names: US therapy for P. aeruginosa or other gram-negative bacilli.

Brand Names: Canada IV: 2 g every 8 hours, most often given as part of an appropriate combination regimen (Chmiel
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Duration of therapy: Duration is usually 10 days to 3 weeks or longer based on clinical response