meropenem (Merrem)
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Introduction
Tradename: Merrem.
Indications
- bacterial infections due to susceptible organisms
- respiratory tract infections
- intra-abdominal infections
- urinary tract infections
- bacterial meningitis in pediatric patients > 3 months of age
- skin or soft tissue infections
- sepsis[5]
- anthrax, inhalation anthrax
- empiric treatment of febrile neutropenia
- empiric treatment for fever of unknown origin[5]
Dosage
1-2 g IV every 8 hours
Pediatrics: 20-40 mg/kg every 8 hours.
Infusion: 500 mg (100 mL), 1 g (100 mL)
Dosage adjustment in renal failure
Table
| creatinine clearance | dosage |
|---|---|
| 26-50 mL/min | 1-2 g every 12 hours |
| 10-25 mL/min* | 0.5-1 g every 12 hours |
| < 10 mL/min# | 0.5 g every 24 hours |
* continuous arteriovenous hemofiltration 1 g every 12 hours
# dose after hemodialysis
Pharmacokinetics
- peak tissue concentration 1 hour following infusion
- volume of distribution: 0.3 L/kg (0.4-0.5 L/kg in children)
- penetrates well into most tissues, including CSF
- protein binding 2%
- 25% metabolized in liver to open (inactive) beta-lactam
- NOT metabolized by same enzyme as imipenem which results in toxic metabolite
- elimination 1/2life: 1-1.5 hour (6-8 hours with ESRD)
- elimination: renal, 25% as inactive metabolite
elimination via kidney
elimination via liver
protein binding = 2 %
Antimicrobial activity
- Streptococcus
- Streptococcus pneumonia
- Streptococcus viridans, milleri
- Enterococcus faecalis (+/-)
- Staphylococcus aureus (MSSA)
- Staphylococcus epidermidis
- Listeria monocytogenes
- Neisseria gonorrhoeae
- Neisseria meningitidis
- Moraxella catarrhalis
- Haemophilus influenzae
- Escherichia coli
- Klebsiella species
- Enterobacter species
- Serratia species
- Salmonella species
- Shigella species
- Proteus mirabilis
- Proteus vulgaris
- Providencia species
- Morganella species
- Citrobacter species
- Aeromonas species
- Acinetobacter species
- Pseudomonas aeruginosa
- Pseudomonas cepacia
- Campylobacter fetus[5]
- Bacteroides fragilis
- Bacteroides melaninogenicus
- Clostridium difficile
- Clostridium species
- Peptostreptococcus species
Adverse effects
- less common (1-10%)
- headache, rash, pruritus, diarrhea, nausea/vomiting, constipation, oral moniliasis, glossitis, pain at site of injection, thrombophlebitis, apnea
- uncommon (< 1%)
- hypotension, heart failure, myocardial infarction, arrhythmias, tachycardia, hypertension, edema, seizures, insomnia, agitation, confusion, hallucinations, depression, fever, urticaria, anorexia, flatulence, ileus, dysuria, hematuria, cholestatic jaundice, hepatic failure, increased liver function tests, anemia, leukopenia, leukocytosis, epistaxis, melena, paresthesia, pain (generalized), renal failure
- other
- pseudomembranous colitis
- hypersensitivity reactions
- thrombocytopenia in patients with renal insufficiency
- seizures have occurred in patients with underlying neurologic disorders Drug interactons:
- probenecid competes with meropenem for active tubular secretion, thus prolongs 1/2life up to 40%
More general terms
Component of
References
- ↑ The Pharmacological Basis of Therapeutics, 8th ed. Gilman et al, eds. Permagon Press/McGraw Hill pg 1092
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ Sanford Guide to antimicrobial therapy 1997
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ 5.0 5.1 5.2 5.3 5.4 Deprecated Reference
Database
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=441129
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=64778
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=441130
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=60706
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=5288797
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=4074