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Drug Reference

meropenem

carbapenem antibiotic· Brands: Meronem, Merrem, Merobact, MeropenIV

Mechanism of action
Meropenem binds to penicillin-binding proteins (PBPs) in bacterial cell walls, inhibiting peptidoglycan cross-linking and thus cell wall synthesis. This results in bactericidal activity against a wide range of Gram-positive, Gram-negative, and anaerobic bacteria. It is stable to most beta-lactamases, including extended-spectrum beta-lactamases and cephalosporinases, but not to metallo-beta-lactamases.
Pharmacokinetics
Meropenem is poorly absorbed orally and is administered intravenously. It is widely distributed into body fluids and tissues, including cerebrospinal fluid when the meninges are inflamed. It is primarily excreted unchanged by the kidneys, with a half-life of approximately 1 hour. Dosage adjustment is required in renal impairment.
Indications & dosing

Complicated intra-abdominal infection

Reduce dose in renal impairment.

  • adult · IV: 1000 mg every 8 hours · Reduce dose in renal impairment.

Bacterial meningitis

Higher dose for CNS penetration.

  • adult · IV: 2000 mg every 8 hours · Higher dose for CNS penetration.

Complicated skin and skin structure infection

Dose based on normal renal function.

  • adult · IV: 1000 mg every 8 hours · Dose based on normal renal function.

Severe pneumonia (hospital-acquired)

Dose based on normal renal function.

  • adult · IV: 1000 mg every 8 hours · Dose based on normal renal function.

Febrile neutropenia

Consider combination therapy in high-risk patients.

  • adult · IV: 1000 mg every 8 hours · Consider combination therapy in high-risk patients.

Bacterial meningitis (paediatric)

Weight-based dosing; maximum 2 g per dose.

  • pediatric · IV: 40 mg/kg every 8 hours · Weight-based dosing; maximum 2 g per dose.

Serious infections (paediatric)

For non-CNS infections; up to 40 mg/kg for severe infections.

  • pediatric · IV: 20 mg/kg every 8 hours · For non-CNS infections; up to 40 mg/kg for severe infections.
Contraindications & precautions
  • Hypersensitivity to meropenem or other carbapenems · Do not use in patients with a history of anaphylactic reaction to any carbapenem.
  • Severe hypersensitivity to other beta-lactam antibiotics · Cross-reactivity may occur; use only if benefit outweighs risk and with close monitoring.
  • Dose should be adjusted in patients with renal impairment as meropenem is eliminated renally.
  • Use with caution in patients with a history of seizures or CNS disorders, especially if renal impairment is present.
  • Cross-reactivity may occur in beta-lactam allergic patients; use caution in patients with a history of severe penicillin or cephalosporin allergy.
  • Monitor for superinfection with prolonged use, especially fungal infections.
  • Consider the risk of Clostridioides difficile-associated diarrhoea; if this occurs, discontinue and treat accordingly.
  • Avoid concurrent use with probenecid; it may increase meropenem concentrations.
Adverse effects
  • Diarrhoea
  • Nausea
  • Headache
  • Rash
  • Elevation of liver transaminases
  • Thrombophlebitis at injection site
  • Seizuresserious
  • Clostridioides difficile-associated diarrhoeaserious
  • Anaphylaxisserious
Interactions
  • valproic acidcontraindicatedAvoid concurrent use of meropenem and valproic acid. Select an alternative antibiotic if possible. If meropenem is unavoidable, consider an alternative anticonvulsant. If no alternative exists, monitor valproic acid concentrations closely and adjust the dose, although this is frequently ineffective. Seek specialist advice and warn patients to report any increase in seizure frequency.
Renal & hepatic adjustment
  • eGFR 50+: No dose adjustment required.
  • eGFR 25–49: Use 1g every 12h (instead of every 8h); consider 500mg every 8h for lower-dose regimens.
  • eGFR 10–24: Use 500mg every 12h (or 250mg every 8h).
  • eGFR 0–9: Use 500mg every 24h. For haemodialysis, administer a supplementary dose after dialysis.
Monitoring, pregnancy & toxicity
  • Renal function (serum creatinine, eGFR) · Before treatment and at least every 2-3 days in renal impairment
  • Full blood count (with differential) · Baseline and periodically during treatment
  • Liver function tests · Baseline and periodically
  • Clinical response and signs of infection · Throughout treatment
  • Signs of adverse effects (e.g., rash, diarrhoea, neurotoxicity) · Daily
  • Pregnancy: Use only if the potential benefit outweighs the potential fetal risk. Animal data do not suggest teratogenic effects; human data are limited.
  • Toxicity: Hypersensitivity reactions (rash, pruritus, urticaria, anaphylaxis) · Stop meropenem, treat anaphylaxis with adrenaline, antihistamines and corticosteroids as needed; use alternative antibiotic.
  • Toxicity: Seizures and other CNS effects, especially in renal impairment or overdose · Discontinue meropenem; consider anticonvulsants; reduce dose or use alternative.
  • Toxicity: Diarrhoea, including Clostridioides difficile-associated colitis · Stop meropenem if possible, provide supportive care, treat C. difficile with oral vancomycin or fidaxomicin.
  • Toxicity: Overdose: may cause neurotoxicity and seizures · No specific antidote; supportive care, monitor renal function; haemodialysis may be beneficial.
Clinical notes
Meropenem is reserved for serious infections such as sepsis, complicated intra-abdominal infections, meningitis, and nosocomial infections caused by multi-resistant organisms. It should be used with caution in patients with a history of seizures or central nervous system disorders. Cross-hypersensitivity with other beta-lactams may occur. Doses are typically 500 mg to 1 g every 8 hours, reduced in renal impairment.

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BNF; local formulary