Adult: 2 g 8 hourly via infusion over 15-30 minutes. Treatment duration depends on the patient condition and type of pathogen. Child: ≥3 months weighing ≤50 kg: 40 mg/kg 8 hourly via infusion over 15-30 minutes; >50 kg: Same as adult dose. Treatment duration depends on the patient condition and type of pathogen.
Intravenous Cystic fibrosis
Adult: For bronchopulmonary infections in patients with cystic fibrosis: 2 g 8 hourly via infusion over 15-30 minutes. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines). Child: ≥3 months weighing ≤50 kg: 40 mg/kg 8 hourly via infusion over 15-30 minutes; >50 kg: Same as adult dose. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Adult: 0.5-1 g 8 hourly via infusion over 15-30 minutes or via bolus inj over 3-5 minutes. Dosage and treatment duration depend on the type and severity of infection, patient condition, and susceptibility of the pathogen. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines). Child: ≥3 months weighing ≤50 kg: 10-20 mg/kg 8 hourly via infusion over 15-30 minutes or via bolus inj over 3-5 minutes; >50 kg: Same as adult dose. Dosage and treatment duration depend on the type and severity of infection, patient condition, and susceptibility of the pathogen. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Adult: 0.5-1 g 8 hourly via infusion over 15-30 minutes or via bolus inj over 3-5 minutes. Child: 1-<3 months Gestational age <32 weeks 20 mg/kg 8 hourly via infusion over 30 minutes; Gestational age ≥32 weeks 30 mg/kg 8 hourly via infusion over 30 minutes. ≥3 months weighing ≤50 kg: 10-20 mg/kg 8 hourly via infusion over 15-30 minutes or via bolus inj over 3-5 minutes; >50 kg: Same as adult dose.
Intravenous Febrile neutropenia
Adult: As monotherapy or in combination with other anti-infectives: 1 g 8 hourly via infusion over 15-30 minutes or via bolus inj over 3-5 minutes. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines). Child: ≥3 months weighing ≤50 kg: 20 mg/kg 8 hourly via infusion over approx 15-30 minutes or via bolus inj over 3-5 minutes; >50 kg: Same as adult dose. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Renal Impairment
Patients on haemodialysis: Administer the required dose after the completion of dialysis session.
CrCl (mL/min)
Dosage
<10
Half the usual dose 24 hourly.
10-25
Half the usual dose 12 hourly.
26-50
Usual dose 12 hourly.
Reconstitution
Reconstitute vials labelled as 500 mg or 1 g with 10 mL or 20 mL of sterile water for inj, respectively, to provide a final concentration of 50 mg/mL. For IV infusion, may further dilute the reconstituted solution with a compatible infusion fluid (e.g. NaCl 0.9%, dextrose 5% in water) to a final concentration of 1-20 mg/mL. Alternatively, vials for infusion may be directly reconstituted with a compatible infusion fluid.
Contraindications
Hypersensitivity to meropenem or other carbapenems. History of severe hypersensitivity reaction (e.g. anaphylactic reaction) to β-lactam antibiotics (e.g. penicillins, cephalosporins).
Special Precautions
Patient with CNS disorder (e.g. history of seizure, brain lesions) or condition that may lower seizure threshold (e.g. bacterial meningitis). Renal and hepatic impairment. Neonates and children. Pregnancy and lactation.
Adverse Reactions
Significant: CNS effects (e.g. seizure, delirium), fungal or bacterial superinfection (prolonged use), severe cutaneous reactions (e.g. acute generalised exanthematous pustulosis [AGEP], erythema multiforme, Stevens-Johnson syndrome [SJS], toxic epidermal necrolysis [TEN], drug reaction with eosinophilia and systemic symptoms [DRESS]). Blood and lymphatic system disorders: Thrombocythaemia. Gastrointestinal disorders: Nausea, diarrhoea, vomiting, abdominal pain. General disorders and administration site conditions: Inj site inflammation, pain, and thrombophlebitis. Investigations: Increased transaminases, blood alkaline phosphatase, and blood LDH. Nervous system disorders: Headache, paraesthesia. Skin and subcutaneous tissue disorders: Rash, urticaria, pruritus. Potentially Fatal: Serious hypersensitivity reactions (e.g. anaphylaxis), Clostridioides difficile-associated diarrhoea and pseudomembranous colitis.
Perform culture and sensitivity tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Monitor LFT, renal function, and CBC periodically during prolonged treatment. Monitor for signs of anaphylaxis during initiation of treatment.
Drug Interactions
May decrease the serum concentrations of valproic acid to subtherapeutic levels, thereby increasing the risk of breakthrough seizures. Increased serum concentration and prolonged elimination half-life with probenecid. May enhance the anticoagulant effects of warfarin.
Lab Interference
May give positive direct or indirect Coombs test.
Action
Description: Mechanism of Action: Meropenem, a synthetic carbapenem β-lactam antibiotic, exhibits bactericidal action against most Gram-positive and Gram-negative bacteria by binding to penicillin-binding proteins (PBPs), which inhibits bacterial cell wall synthesis, thus resulting in cell wall lysis. Pharmacokinetics: Absorption: Time to peak plasma concentration: Approx 1 hour (tissue; except in bile, lung, and muscle); 2-3 hours (CSF; inflamed meninges). Distribution: Extensively distributed into body tissues and fluids including bone, skin, fascia, muscle, peritoneal fluid, urinary tract, gynaecological tissues, lung, bronchial mucosa, bile, heart valves, and CSF. Enters breast milk (small amounts). Volume of distribution: 15-20 L. Plasma protein binding: Approx 2%. Metabolism: Metabolised in the liver via hydrolysis into an inactive form. Excretion: Mainly via urine (approx 70% as unchanged drug; approx 28% as inactive metabolite); faeces (2%). Elimination half-life: Approx 1 hour.
Chemical Structure
Meropenem Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 441130, Meropenem. https://pubchem.ncbi.nlm.nih.gov/compound/Meropenem. Accessed Aug. 22, 2023.
Storage
Store intact vials between 20-25°C. Vials reconstituted with sterile water for inj: Store at up to 5°C for 13 hours or up to 25°C for 3 hours. Solution for infusion reconstituted with NaCl 0.9%: Store at up to 5°C for 15 hours or up to 25°C for 1 hour. Solution for infusion reconstituted with dextrose 5% should be used immediately. Do not freeze.
J01DH02 - meropenem ; Belongs to the class of carbapenems. Used in the systemic treatment of infections.
References
Bradley JS, Peacock G, Krug SE et al. Pediatric Anthrax Clinical Management. Pediatrics. 2014 May;133(5). doi: 10.1542/peds.2014-0563. Accessed 23/05/2023. PMID: 24777226Committee on Infectious Diseases, American Academy of Pediatrics, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH. "Tables of Antibacterial Drug Dosages", Red Book: 2021-2024 Report of the Committee on Infectious Diseases. American Academy of Pediatrics [online]. Accessed 24/03/2023.AFT Pharmaceuticals Ltd. Meropenem-AFT Powder for Injection or Infusion data sheet June 2022. Medsafe. http://www.medsafe.govt.nz. Accessed 11/04/2023.Anon. Meropenem (Pediatric and Neonatal Lexi-Drugs). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 11/04/2023.Anon. Meropenem. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 11/04/2023.Anon. Meropenem. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 11/04/2023.Buckingham R (ed). Meropenem. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 11/04/2023.Joint Formulary Committee. Meropenem. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 11/04/2023.Meronem IV (Sumitomo Pharma Co. Ltd.). MIMS Hong Kong. http://www.mims.com/hongkong. Accessed 23/05/2023.Meropenem 500 mg Powder for Solution for Injection or Infusion (Milpharm Limited). MHRA. https://products.mhra.gov.uk. Accessed 18/05/2023.Meropenem Injection, Powder, for Solution (Daewoong America Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 11/04/2023.Meropenem. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 13/04/2023.Nuronem Injection 500 mg, 1 g (Ranbaxy [Malaysia] Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 11/04/2023.Paediatric Formulary Committee. Meropenem. BNF for Children [online]. London. BMJ Group, Pharmaceutical Press, and RCPCH Publications. https://www.medicinescomplete.com. Accessed 11/04/2023.
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