Indications:
Meropenem IV is indicated for treatment in adults and children for the following
infections caused by single or multiple bacteria sensitive to Meropenem.
– Pneumonia and Nosocomial Pneumonia
– Urinary Tract Infections
– Intra-abdominal Infections
– Gynaecological Infections, such as endometritis and pelvic inflammatory disease
– Skin and Skin Structure Infections
– Meningitis
– Septicaemia
Empiric treatment, for presumed infections in adult patients with febrile neutropenia, used as monotherapy or in combination with anti-viral or anti-fungal agents.
Dosage & Administration:
The dosage and duration of therapy shall be established depending on
type and severity of infection and the condition of the patient. The recommended daily dosage is as
follows:- Adults: The adult dose is 1 gm by intravenous infusion over 15-30 minutes or as
intravenous bolus (5 to 20 mL) over 3-5 minutes every 8 hours. Pneumonia, urinary tract infections,
gynaecological infections such as endometritis, skin and skin structure infections: 500 mg IV every 8
hours. Nosocomial pneumonias, peritonitis, presumed infections in neutropenic patients and
septicaemia: 1g IV every 8 hours. Intra-abdominal infections: 500 mg to 1 gm every 8 hours.
Meningitis: 2 gm IV every 8 hours. Children: Children 3 months -12 years: 20 or 40 mg/kg
intravenously every 8 hours depending on type and severity of infection, susceptibility of the
pathogen(s) and the condition of the patient. Intra-abdominal infections: 20 mg/kg every 8 hours.
Cystic fibrosis (4-18 years): 25-40 mg/kg every 8 hours. Meningitis: 40 mg/kg IV every 8 hours.
Children over 50 kg weight: use adult dosage. There is no experience in children with hepatic or
renal impairment.
Renal impairment: No dosage adjustment is required for the elderly with normal renal function or
creatinine clearance values above 50 ml/min. CrCl 26-50 mL/min, 1 gm every 12 hours; CrCl 10-25
mL/min, 500 mg every 12 hours; and CrCl <10 mL/min, 500 mg every 24 hours. Hepatic impairment:
No dosage adjustments are necessary with impairment of liver function. Hemodialysis patients
should receive meropenem after dialysis has been completed.
Elderly: No dosage adjustments are necessary in elderly patients unless creatinine clearance is <51
mL/min.
Side Effects:
Meropenem is generally well tolerated. Local injection site reactions, rash, pruritus,
urticaria, abdominal pain, nausea, vomiting, diarrhoea, pseudomembranous colitis. Rarely erythema
multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis. Headache, paraesthesia and
infrequently convulsions (although no causal relationship has been established). Oral and vaginal
candidosis. Reversible thrombocythaemia, leucopenia, eosinophilia, thrombocytopenia and
neutropenia (including rare cases of agranulocytosis). Positive Coombs test. Reduction in partial
thromboplastin. Rarely systemic allergic reactions (hypersensitivity), which may include angioedema
and manifestations of anaphylaxis.
Precautions:
If an allergic reaction to Meropenem occurs, the drug should be discontinued and
appropriate measures taken. Use of Meropenem in patients with hepatic disease should be made
with careful monitoring of transaminase and bilirubin levels.
Contraindications: Meropenem is contraindicated in patients who have demonstrated
hypersensitivity to this product.
Use in Pregnancy & Lactation:
Pregnancy: The safety of Meropenem in human pregnancy has not
been evaluated. Meropenem should not be used in pregnancy unless the potential benefit justifies
the potential risk to the foetus. In every case, it should be used under the direct supervision of the
physician. Lactation: Meropenem is detectable at very low concentrations in animal breast milk.
Meropenem should not be used in breast-feeding women unless the potential benefit justifies the
potential risk to the baby.
Drug Interaction:
Probenecid competes with Meropenem for active tubular secretion and thus
inhibits the renal excretion, with the effect of increasing the elimination half-life and plasma
concentration of Meropenem. Meropenem may reduce serum valproic acid levels. Sub therapeutic
levels may be reached in some patients.
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