MEROPENEM
Merrem
|
Reviewed by Dr
Malcolm Battin, Dr Lesley Voss (Paediatric Infectious Diseases), Brenda
Hughes, and Helen Lamb (NSANP)
|
| December 2005
|
Dose and Administration
| Intravenous: |
Weight <2000g
|
20 mg/kg/dose every 12 hours
1
|
|
|
Weight >2000g
|
40 mg/kg/dose every 12 hours for first 7 days, then
every 8 hours
2
|
Indication
- Systemic sepsis,
for use as a second or third line agent. It could be considered
when there is failure of a previous therapy or for those certain
situations where broad cover treatment may be necessary.
Use of meropenem must be discussed with the Infectious Diseases
Team.
Contraindications and Precautions
- Inflammation at injection site.
- Caution in infants with impaired renal or hepatic function.
- Caution in infants with history of seizures. 3
Clinical Pharmacology
Meropenem, a potent carbapenem
antibacterial agent with enhanced beta-lactamase stability, has
antimicrobial activity against Gram-negative, Gram-positive and anaerobic
micro-organisms. The bacterial concentrations are usually within one
doubling dilution of the MICs.4
Meropenem is not licensed for children under 3 months of age, but its
efficacy, safety and tolerability have been studied in this age group.
5,6,7 The serum half
life is approximately 3 hours in preterm infants and 2 hours in term
infants.5 The
pharmacokinetics of meropenem, for infants and children, are similar to
those for adults. It penetrates most body fluids and tissues including the
CSF. Protein binding is minimal, and elimination is predominantly renal as
unchanged drug. The only metabolite, produced by non-specific hydrolysis in
plasma of the beta-lactam ring, is inactive.
5
Possible Adverse Effects
- Leukopenia, neutropenia,
thrombocytopenia and anaemia. 3
- Inflammation at injection site. 3
- Vomiting, diarrhoea, and constipation (1%). 3
- Rash (2%) 3
- Nephrotoxicity, hepatotoxicity 3
Interactions
- There are currently no known relevant drug interactions
Special Considerations
- Monitor:
- FBC – monitor for thrombocytosis and eosinophilia with prolonged use.
- Renal function - increase dose interval in renal failure. 8
- Hepatic function – at the beginning of treatment, and weekly thereafter.
- Vomiting and pseudomembranous colitis – consider alternate antibiotic.
- Use under close clinical supervision usually after discussion with ID service.
- Meropenem is not licensed for children <3 months of age.
- The intramuscular route is not recommended. 2
