Meropenem injection is indicated for adults and children in the treatment of infections caused by single or multiple Meropenem-sensitive bacteria, including:

• Pneumonia and hospital-acquired pneumonia
• Urinary tract infections
• Intra-abdominal infections
• Gynecological infections such as endometritis and pelvic inflammatory disease
• Skin and skin structure infections
• Meningitis
• Septicemia
• Pulmonary infections in cystic fibrosis
• Empiric treatment of suspected infections in patients with febrile neutropenia

Meropenem is a carbapenem antibiotic for parenteral use. It works by inhibiting bacterial cell wall synthesis, leading to bacterial cell death. It can penetrate bacterial cell walls and is highly stable against all serine beta-lactamases. It binds strongly to Penicillin Binding Proteins (PBPs). It has broad-spectrum bactericidal activity against Gram-positive, Gram-negative, aerobic, and anaerobic bacteria.

The dosage and duration of therapy shall be established depending on type, severity of infection and the condition of the patient. The recommended daily dosage is as follows:

Adults:

• The usual dose is 500 mg to 1 gm by intravenous administration every 8 hours.
• Pneumonia, urinary tract infections, gynecological infections such as endometritis, pelvic inflammatory disease, skin and skin structure infections: 500 mg IV every 8 hours.
• Nosocomial pneumonias, peritonitis, presumed infections in neutropenic patients and septicemia: 1 g IV every 8 hours.
• Intra-abdominal infections: 500 mg to 1 gm every 8 hours.
• Cystic fibrosis: Up to 2 gm every 8 hours.
• Meningitis: 2 gm IV every 8 hours.

Children:

• 3 months to 12 years: 10 to 40 mg/kg intravenously every 8 hours depending on type and severity of infection, susceptibility of the pathogens 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.
• Febrile neutropenia: 20 mg/kg every 8 hours.
• Children over 50 kg weight: use adult dosage.
• There is no experience in children with hepatic or renal impairment.

Meropenem should be administered by intravenous Infusion over approximately 15-30 minutes or as intravenous bolus (5 to 20 ml) over approximately 3-5 minutes

Probenecid competes with Meropenem for active tubular secretion and inhibits renal excretion, thereby increasing the elimination half-life and plasma concentration of Meropenem. Meropenem may reduce serum valproic acid levels, and sub-therapeutic levels may occur in some patients.

Meropenem is contraindicated in patients who have demonstrated hypersensitivity to this product.

Meropenem is generally well tolerated. Side effects may include inflammation, thrombophlebitis, pain at the injection site, skin reactions such as rash, pruritus, urticaria, abdominal pain, nausea, vomiting, diarrhea, and headache.

Pregnancy Category B. There are no adequate and well-controlled studies in pregnant women. Therefore, this drug should be used during pregnancy only if clearly needed. Since many drugs are excreted in human milk, caution should be exercised when Meropenem is administered to a nursing woman.

If an allergic reaction occurs, Meropenem should be discontinued and appropriate measures taken. Use in patients with hepatic disease should be carefully monitored with transaminase and bilirubin levels.

Renal impairment: Dosage should be reduced in patients with creatinine clearance less than 51 ml/min.
Hepatic impairment: No dosage adjustment is required.
Hemodialysis patients should receive Meropenem after dialysis is completed.
Elderly: No dosage adjustment is required unless creatinine clearance is <51 ml/min.
Children: Safety and efficacy in infants under 3 months have not been established.

Accidental overdose may occur, especially in patients with renal impairment. Treatment is symptomatic. In normal individuals, rapid renal elimination occurs. In patients with renal impairment, hemodialysis can remove Meropenem and its metabolite.

Other beta-lactam Antibiotics

Vial should be stored in a cool, dry place (below 30°C), away from light and moisture. Keep out of the reach of children.