Names and pronunciation
(mer-oh-pen′em) Merrem
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Individual generic drug information
Extracted information for meropenem only.
(mer-oh-pen′em) Merrem
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Func. class.: Antiinfective— miscellaneous
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Chem. class.: Carbapenem
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ACTION: Bactericidal; interferes with cell-wall replication of susceptible organisms
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USES: Acinetobacter sp., Aeromonas hydrophila, Bacteroides distasonis, Bacteroides fragilis, Bacteroides ova- tus, Bacteroides thetaiotaomicron, Bacteroides uniformis, Bacteroides ureolyticus, Bacteroides vulgatus, Campylobacter jejuni, Citrobacter diversus, Citrobacter freundii, Clos- tridium difficile, Clostridium perfrin- gens, Enterobacter cloacae, Enterococ- cus faecalis, Escherichia coli, Eubacterium lentum, Fusobacterium sp., Haemophilus influenzae (beta-lac- tamase negative), Haemophilus influen- zae (beta-lactamase positive), Hafnia alvei, Klebsiella oxytoca, Klebsiella pneumoniae, Moraxella catarrhalis, Morganella morganii, Neisseria men- ingitidis, Pasteurella multocida, Pepto- streptococcus sp., Porphyromonas asaccharolytica, Prevotella bivia, Pre- votella intermedia, Prevotella mela- ninogenica, Propionibacterium acnes, Proteus mirabilis, Proteus vulgaris, Pseudomonas aeruginosa, Salmonella sp., Serratia marcescens, Shigella sp., Staphylococcus aureus (MSSA), Staph- ylococcus epidermidis, Streptococcus agalactiae (group B streptococci), Streptococcus pneumoniae, Strepto- coccus pyogenes (group A beta-hemo- lytic streptococci), viridans streptococci, Yersinia enterocolitica; appendicitis, bacteremia, intraabdominal infections, meningitis, peritonitis, skin/skin struc- ture infections
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Extracted information for meropenem only.
CONTRAINDICATIONS: Hyper- sensitivity to this product, carbapenems, hypersensitivity to cephalosporins, penicillins Precautions: Pregnancy, breastfeeding, geriatric patients, renal disease, seizure disorder, gram-negative infection, hyper- sensitivity to pneumonia
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SIDE EFFECTS CNS: Seizures, dizziness, headache CV: Hypotension, tachycardia ENDO: Hypoglycemia GI: Diarrhea, nausea, vomiting, CDAD; hepatitis, glossitis, thrush (child), jaundice INTEG: Rash, urticaria, pruritus, pain at inj site, phlebitis, erythema at inj site, DRESS RESP: Apnea, pneumonia SYST: Anaphylaxis, Stevens-Johnson syndrome, angioedema
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INTERACTIONS Increase: meropenem plasma levels— probenecid; avoid concurrent use Decrease: effect of valproic acid; moni- tor for seizures Drug/Lab Test Increase: AST, ALT, LDH, BUN, alk phos, bilirubin, creatinine M Increase or decrease: INR, platelets, PT, PTT False positive: direct Coombs’ test, urine glucose
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Extracted information for meropenem only.
DOSAGE AND ROUTES Intraabdominal infections (complicated appendicitis, peritonitis) • Adult IV 1-2 g q8h × 3-7 days • Infant child/adolescent: IV 20 mg/kg q8hr × 3-7 days Complicated skin and skin structure infections • Adult/adolescents/child >50 kg: IV 500 mg q8hr over 15-30 min, 1 g q8hr for Pseudomonas aeruginosa • Infants ≥3 mo/children/adolescents ≤50 kg: IV 10 mg/kg q8hr over 15-30 min; 20 mg/kg q8hr for Pseudomonas aeruginosa, max 1 g q8hr for Pseudo- monas aeruginosa Meningitis • Adult/child/adolescent >50 g: IV 2 g q8hr • Infant/child/adolescent ≤50 kg: IV 40 mg/kg q8hr, max 2 g q8hr Renal disease • Adult: IV CCr 26-50 mL/min, give dose q12hr; CCr 10-25 mL/min, give ½ dose q12hr; CCr <10 mL/min, give ½ dose q24hr
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Available forms: Powder for inj 500 mg, 1 g
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Administer: • After C&S is taken • If dose is missed, give as soon as re- membered, readjust subsequent doses • Monitor injection site periodically for redness, inflammation, phlebitis Direct IV route (bolus) • Reconstitute 500-mg or 1-g vials with 10, 20 mL of sterile water for inj, respec- tively; shake to dissolve; let stand until clear (average concentration 50 mg/ mL); reconstituted sol may be stored for 3 hr at room temperature or for 13 hr refrigerated; inject up to 1 g in 5-20 mL over 3-5 min Intermittent IV INFUSION route • Vials may be directly reconstituted and diluted with compatible infusion fluid (NS, D5W) to 2.5-50 mg/mL; vials with NS can be stored 2 hr at room tem- perature or for ≤18 hr refrigerated, D5W solutions may be stored for up to 1 hr at room temperature or ≤15 hr refriger- ated; infuse over 15-30 min
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Extracted information for meropenem only.
Assess: • C&S before starting treatment, may give before results are received • Sensitivity to carbapenem antibiotics, penicillins, cephalosporins before start- ing this product • Renal disease: lower dose may be re- quired; monitor serum creatinine/BUN before, during therapy; monitor weight, fluid balance • CDAD: bowel pattern daily; if severe diarrhea, fever, abdominal pain, fatigue occurs, product should be discontinued • Infection: temperature, sputum, characteristics of wound, WBC, stool; vital signs before, during, and after treatment • Allergic reactions, anaphylaxis: rash, laryngeal edema, wheezing, urti- caria, pruritus; may occur immediately or several days after therapy begins; iden- tify if there has been hypersensitivity to penicillins, cephalosporins, beta-lactams; cross-sensitivity may occur; have emer- gency equipment nearby • DRESS: Rash, fever, swelling of face, lymphadenopathy, may lead to other or- gan systems • Seizures: may occur in those with brain lesions, seizure disorder, bacterial meningitis, or renal disease; stop product, notify prescriber if seizures occur, seizure threshold is lowered • Overgrowth of infection: perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea; change in cough, sputum • Pregnancy/breastfeeding: use only if clearly needed; no well-controlled stud- ies; use cautiously in breastfeeding, ex- creted in breast milk
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Evaluate: • Therapeutic response: negative C&S; ab- sence of symptoms and signs of infection
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • CDAD: to report severe diarrhea • To avoid driving or other hazardous activities until response is known, dizzi- ness may occur • To discuss all OTC, Rx, herbals, sup- plements with prescriber • To report sore throat, bruising, bleed- ing, joint pain; may indicate blood dys- crasias (rare) • To report overgrowth of infection: black, furry tongue; vaginal itching; foul- smelling stools; seizures • To avoid breastfeeding; product is ex- creted in breast milk TREATMENT OF ANAPHY- LAXIS: EPINEPHrine, antihistamines; resuscitate if necessary
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Extracted information for meropenem only.
PHARMACOKINETICS IV: Onset immediate, peak dose depen- dent, half-life 1 hr, excreted unchanged in urine (70%), duration 8 hr
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Filter the extracted dose blocks for this individual drug.
Intraabdominal infections (complicated appendicitis, peritonitis)
• Infant child/adolescent: IV 20 mg/kg q8hr × 3-7 days Complicated skin and skin structure infections
Candidate age grouping · source pages 846, 847
Intraabdominal infections (complicated appendicitis, peritonitis)
• Adult/adolescents/child >50 kg: IV 500 mg q8hr over 15-30 min, 1 g q8hr for Pseudomonas aeruginosa
Candidate age grouping · source pages 846, 847
Intraabdominal infections (complicated appendicitis, peritonitis)
• Infants ≥3 mo/children/adolescents ≤50 kg: IV 10 mg/kg q8hr over 15-30 min; 20 mg/kg q8hr for Pseudomonas aeruginosa, max 1 g q8hr for Pseudo- monas aeruginosa Meningitis
Candidate age grouping · source pages 846, 847
Intraabdominal infections (complicated appendicitis, peritonitis)
• Adult/child/adolescent >50 g: IV 2 g q8hr
Candidate age grouping · source pages 846, 847
Intraabdominal infections (complicated appendicitis, peritonitis)
• Infant/child/adolescent ≤50 kg: IV 40 mg/kg q8hr, max 2 g q8hr Renal disease
Candidate age grouping · source pages 846, 847