Meronem

Action

Inhibits bacterial cell-wall synthesis and penetrates gram-negative and gram-positive bacteria

Availability

Powder for injection: 500-mg and 1-g vials

Indications and dosages

➣ Intra-abdominal infections

Adults: 1 g I.V. q 8 hours over 15 to 30 minutes by infusion or over 3 to 5 minutes as a bolus injection

Children weighing 50 kg (110 lb) or more: 1 g I.V. q 8 hours over 15 to 30 minutes by infusion or over 3 to 5 minutes as a bolus injection

Children ages 3 months and older weighing less than 50 kg (110 lb): 20 mg/kg q 8 hours over 15 to 30 minutes by infusion or over 3 to 5 minutes as a bolus injection

➣ Bacterial meningitis

Children weighing 50 kg (110 lb) or more: 2 g I.V. q 8 hours over 15 to 30 minutes by infusion or over 3 to 5 minutes as a bolus injection

Children ages 3 month and older weighing less than 50 kg (110 lb): 40 mg/kg q 8 hours over 15 to 30 minutes by infusion or over 3 to 5 minutes as a bolus injection, to a maximum of 2 g q 8 hours

➣ Complicated skin and skin-structure infections

Adults: 500 mg I.V. q 8 hours

Dosage adjustment

• Renal impairment

Off-label uses

• Acute pulmonary exacerbation caused by respiratory tract infection with susceptible organisms in cystic fibrosis patients

Contraindications

• Hypersensitivity to drug, its components, or other beta-lactams

Precautions

Use cautiously in:

• sulfite sensitivity, renal disease, seizure disorder

• pregnant or breastfeeding patients

• children.

Administration

• For I.V. bolus, add 10 or 20 ml of sterile water to 500-mg or 1-g vial, respectively, to yield a concentration of 50 mg/ml. Shake until clear. Administer single dose over 3 to 5 minutes.

• For intermittent I.V. infusion, piggyback vials can be reconstituted with compatible I.V. solution (0.9% sodium chloride or 5% dextrose) to yield a concentration of 2.5 to 50 mg/ml. Or vials can be reconstituted as for direct I.V. injection and added to compatible I.V. solution for further dilution. To reconstitute and administer ADD-Vantage systems, follow manufacturer's instructions. Infuse drug over 15 to 30 minutes.

• Use diluted solution immediately, if possible.

Adverse reactions

CNS: headache, insomnia, dizziness, drowsiness, weakness, seizures

CV: hypotension, phlebitis, palpitations, heart failure, cardiac arrest, myocardial infarction

GI: nausea, vomiting, diarrhea, constipation, tongue discoloration, oral candidiasis, glossitis, pseudomembranous colitis

GU: vaginal candidiasis

Hematologic: anemia, eosinophilia, leukopenia, bone marrow depression, thrombocytopenia, neutropenia

Musculoskeletal: myoclonus

Respiratory: chest discomfort, dyspnea, hyperventilation

Skin: rash, urticaria, pruritus, erythema at injection site

Other: altered taste, fever, pain, fungal infection, anaphylaxis

Interactions

Drug-drug. Probenecid: increased meropenem blood level

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, amylase, aspartate aminotransferase, bilirubin, blood urea nitrogen, eosinophils, gamma-glutamyl transpeptidase, lactate dehydrogenase, lipase: increased values

Hematocrit, hemoglobin, platelets, neutrophils, white blood cells: decreased values

International Normalized Ratio, partial thromboplastin time, prothrombin time: increased or decreased values

Patient monitoring

• Collect specimens for culture and sensitivity testing as needed. However, be aware that drug therapy may start pending results.

See Monitor patient for hypersensitivity reaction or anaphylaxis. If either occurs, stop infusion immediately and initiate emergency treatment.

• Monitor for CNS irritability and seizures.

• In prolonged therapy, evaluate hematopoietic, renal, and hepatic function and watch for overgrowth of nonsusceptible organisms.

• If diarrhea occurs, check for pseudomembranous colitis and obtain stool cultures.

• Obtain hearing tests in child being treated for bacterial meningitis.

Patient teaching

• Advise patient to report such adverse reactions as CNS irritability, diarrhea, rash, shortness of breath, or pain at infusion site.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.