Scientific Names:

Meropenem
Trade Names:
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• Pharmacologic Category
Cell Wall synthesis inhibitors antibacterial,
is a member of the Carbapenem group.

• Mechanism Of Action
Inhibits bacterial cell wall synthesis by
binding to several of the penicillin-
binding-proteins, which in turn inhibit the
final transpeptidations tep of
peptidoglycan synthesis in bacterial cell
wall, thus inhibiting cell wall biosynthesis;
bacteria eventually lyse due to ongoing
activity of cell wall autolytic enzymes
(autolysins and murein hydrolases) while
cell wall assembly is arrested.

• Antibacterial spectrum
is highly resistant to β-lactamase.
is one of the antibiotics of last resort for
many bacterial infections.
it has a broad-spectrum of antimicrobial
activity against most aerobic and
anaerobic bacteria (Gram-positive and
gram-negative) with the exception of
occasional Pseudomonas strains.
Its strongest affinity is toward PBPs of
Escherichia coli and Pseudomonas
aeruginosa, and PBPs of Staphylococcus
aureus.
Bactericidal concentrations are typically 1
to 2 times the bacteriostatic
concentrations.
• indications
_ Bacterial meningitis
_ complicated skin infections and
subcutaneous tissue infections
_ intra-abdominal infections (complicated
appendicitis and peritonitis )
_ Bacteremia associated with
intravascular line
_ Cystic fibrosis
_ Febrile neutropenia
_ Hospital acquired pneumonia
_ Necrotizing fasciitis
_ Nocardiosis, Solid Organ Transplant
Recipients
_ Osteomyelitis, Native vertebral.

• Dosage Form and Strength

(Concentration)
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• Administration and Dose

A) Route of administration:
Intravenous.
B) Dose:
1_ Adult Dosing:
1 g IV every 8 hours.
2_ Pediatric Dosing:
_ Bacterial meningitis:
(Older than 28 days) 120 mg/kg/day IV
divided every 8 hours; consider adding
aminoglycoside for Pseudomonas
aeruginosa.
(if 3 months or older) 40 mg/kg IV infusion
every 8 hours; MAX 2 g IV every 8 hours .
_ Febrile neutropenia: 20 mg/kg IV every
8 hours for at least 7 days.
_ Complicated skin infections and
subcutaneous tissue infections:
(if 3 months or older) 10 mg/kg IV every 8
hours; increase to 20 mg/kg IV every 8
hours for infections caused by
Pseudomonas aeruginosa; MAX dose 500
mg IV every 8 hours OR 1 g IV every 8
hours for infections caused by
Pseudomonas aeruginosa.
(if 3 months or older, over 50 kg) 500 mg
IV every 8 hours; increase to 1 g IV every 8
hours for infections caused by
Pseudomonas aeruginosa
_ intra-abdominal infections:
(Younger than 3 months, gestational age
less than 32 weeks and postnatal age less
than 2 weeks) 20 mg/kg IV every 12 hours;
infuse over 30 minutes
(Younger than 3 months, gestational age
less than 32 weeks and postnatal age 2
weeks and older, or gestational age 32
weeks or older and postnatal age less
than 2 weeks) 20 mg/kg IV every 8 hours;
infuse over 30 minutes
(Younger than 3 months, gestational age
32 weeks or older and postnatal age 2
weeks or older) 30 mg/kg IV every 8
hours; infuse over 30 minutes.
(if 3 months or older) 20 mg/kg IV every 8
hours; MAX dose 1 g IV every 8 hours;
infuse over 15 to 30 minutes or
administer IV bolus injection (5 to 20 mL)
over 3 to 5 minutes
(if 3 months or older, over 50 kg) 1 g IV
every 8 hours; infuse over 15 to 30
minutes or administer IV bolus injection (5
to 20 mL) over 3 to 5 minutes
_ Necrotizing fasciitis:
(Beyond the neonatal period) Mixed
infection: 20 mg/kg/dose IV every 8 hours;
administer until further debridement is no
longer necessary, the patient has clinically
improved, and has been afebrile for 48 to
72 hours
3_ Dose Adjustments:
_ Renal impairment (CrCl greater than 50
mL/min) in adults:
No dosage adjustment required
_ Renal impairment (CrCl 26 to 50
mL/min) in adults:
Increase dosing interval to every 12 hours
_ Renal impairment (CrCl 10 to 25
mL/min) in adults:
One-half recommended dose depending
on type of infection; increase dosing
interval to every 12 hours
_ Renal impairment (CrCl less than 10
mL/min) in adults:
One-half recommended dose depending
on type of infection; increase dosing
interval to every 24 hours
_ Augmented renal clearance (CrCl 130
mL/min or greater):
8 to 10 g/day either as intermittent
boluses or continuous infusion
_ Hemodialysis:
An additional dose following hemodialysis
session is recommended
_ Conventional intermittent hemodialysis:
0.5 to 1 g every 24 hours (after dialysis on
dialysis day)
_ Prolonged intermittent renal
replacement therapy (PIRRT):
0.5 g every 8 hours
_ Continuous renal replacement therapy:
0.75 g every 8 hours or 1.5 g every 12
hours or continuous infusion
_ Hemofiltration/hemodiafiltration,
critically ill:
1 g IV every 12 hours
_ Continuous renal replacement therapy:
Dose adjustments are dependent on
therapeutic modality and flow rates; see
in-depth content for details.

• Pharmacokinetics
A) Absorption:
Tmax, IV: approximately 1 hour after the
start of the infusion.
Meropenem is known to reach
therapeutic levels in bacterial meningitis
even without inflammation.
B) Distribution:
Vd, adults: 12 to 20 L
Vd, obese adults (mean BMI 65.5
kg/m(2)): 25.1 L
Vd, continuous renal replacement: 28.8 L
Vd, preterm neonates (27 to 32 weeks
gestational age, 21 days mean postnatal
age): 0.74 L/kg
Vd, neurocritical care (adult): 7.11 L
Protein binding: approximately 2%.
C) Metabolism:
Meropenem does not undergo
metabolism by renal dihydropeptidase
enzyme.
Extrarenal: 20% to 25% up to 50% if CrCl
less than 20 mL/min.
D) Excretion:
Renal excretion: 70% unchanged
Fecal excretion: Approximately 2%
Renal clearance: 140 to 230 mL/min
Dialyzable: (hemodialysis) 79 mL/min
Hemofiltration: 47%
Total body clearance: 188 to 300 mL/min
Total body clearance, obese adults (mean
BMI 65.5 kg/m(2)): 8.1 L/hr
Total body clearance, continuous renal
replacement: 3.03 L/hr
Total body clearance, adults patients in
neurocritical care: 14.87 L/hr.
E) Elimination Half Life:
Adults and children 2 years or older: 1
hour
Adults, obese (mean BMI 65.5 kg/m[2]):
2.8 hours
Pediatric patients 3 months to 2 years: 1.5
hours
Preterm neonates (27 to 32 weeks
gestational age, 21 days mean postnatal
age): 3.4 hours
Impaired renal function: 3.4 to 20 hours
or longer.

• Contraindications
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• Precautions
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• Pregnancy:
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• Breast Feeding:
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• Adverse Effects
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• Interactions
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